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Hospital prices in Parma OH 44129|7007 Powers Boulevard, Ohio

1 hospitals publish price files here.

Hospital Address System Priced procedures
University Hospitals Parma Medical Center 7007 Powers Boulevard University Hospitals 9331

Cash prices in Parma OH 44129|7007 Powers Boulevard

Procedure Lowest cash Median here Highest National median
#_benzodiazconfur $180.00 $180.00 $180.00 $180.00
#_fet/norfentcnfrmur $171.00 $171.00 $171.00 $171.00
#a/b/c/c/h pnl-candida albicans ab $148.50 $148.50 $148.50 $148.50
#acylcarnitineprfl $110.25 $110.25 $110.25 $141.00
#cbg+cort-cbg $156.75 $156.75 $156.75 $156.75
#celiac hla-dq8 $175.50 $175.50 $175.50 $175.50
#cf-97variants $1,191.75 $1,191.75 $1,191.75 $1,377.00
#cms hgb-sulfhemoglobin $132.75 $132.75 $132.75 $132.75
#cmvcul-virus inoculation shell $72.75 $72.75 $72.75 $67.50
#covid19rsv-rsv $75.75 $75.75 $75.75 $75.75
#coxa-coxsackie a serotype a16 $171.75 $171.75 $171.75 $112.80
#creutz-prot.,western blot $939.00 $939.00 $939.00 $676.50
#fecal-sodium $97.50 $97.50 $97.50 $96.00
#mec-opiates $27.75 $27.75 $27.75 $27.75
#pnh-flow cytometry interp $181.50 $181.50 $181.50 $181.50
(both sides) smear without diff wbc count $127.50 $127.50 $127.50 $127.50
11-desoxycortisol - sendout $141.00 $141.00 $141.00 $141.75
17-hydroxypregnenolone $125.25 $125.25 $125.25 $144.75
24 hr ambulatory b/p monitor $359.25 $359.25 $359.25 $195.75
2d tee w or without fol w/con,in $2,282.25 $2,282.25 $2,282.25 $1,892.25
2d tte w or without fol w/con,co $1,278.75 $1,278.75 $1,278.75 $1,278.75
2nd order venous cath $2,337.00 $2,337.00 $2,337.00 $2,354.25
3d ech img cgen car anomal $1,164.00 $1,164.00 $1,164.00 $1,164.00
3d recon without postprocess indpndt $522.75 $522.75 $522.75 $638.25
5' nucleotidase - sendout $252.75 $252.75 $252.75 $252.75
88334 ap bill cytologic exam each additional site $81.00 $81.00 $81.00 $91.20
99381 initial comp preventive med less than 1 year new $135.00 $135.00 $135.00 $135.00
99382 initial comp preventive med 1 to 4 years new $135.00 $135.00 $135.00 $135.00
99383 initial comp preventive med 5 to 11 years new $111.00 $111.00 $111.00 $111.00
99391 periodic comp preventive med less than 1 year est $135.00 $135.00 $135.00 $122.40
99392 periodic comp preventive med 1 to 4 years est $135.00 $135.00 $135.00 $134.40
99393 periodic comp preventive med 5 to 11 years est $111.00 $111.00 $111.00 $111.00
99394 periodic comp preventive med 12 to 17 years est $167.25 $167.25 $167.25 $151.20
99397 periodic comp preventive med 65+ years est $167.25 $167.25 $167.25 $167.25
Abatacept (with maltose) 250 mg intravenous solution $5,313.35 $5,313.35 $5,313.35 $1,429.80
Abd aorta w/runoff s&i $5,568.75 $5,568.75 $5,568.75 $4,845.60
Abd paracentesis/w/o image guide 49082 $1,505.25 $1,505.25 $1,505.25 $1,505.25
Abd/low ext cath 1st $3,237.00 $3,237.00 $3,237.00 $3,237.00
Abd/low ext cath 2nd $3,023.25 $3,023.25 $3,023.25 $3,023.25
Abd/low ext cath 3rd $3,810.00 $3,810.00 $3,810.00 $3,810.00
Abd/low ext cath addl $1,727.25 $1,727.25 $1,727.25 $1,287.00
Abdominal CT scan (with and without contrast) $2,049.00 $2,049.00 $2,049.00 $2,049.00
Abdominal CT scan (with contrast) $1,962.75 $1,962.75 $1,962.75 $1,683.63
Abdominal CT scan (without contrast) $1,722.00 $1,722.00 $1,722.00 $1,358.76
Abdominal MRI (with and without contrast) $2,629.50 $2,629.50 $2,629.50 $3,061.80
Abdominal MRI (with contrast) $2,457.75 $2,457.75 $2,457.75 $2,141.80
Abdominal MRI (without contrast) $2,285.25 $2,285.25 $2,285.25 $1,902.00
Abdominal Ultrasound (complete) $1,119.75 $1,119.75 $1,119.75 $773.80
Abdominal Ultrasound (limited) $753.00 $753.00 $753.00 $629.42
Abdominal paracentesis w/image guidance $1,527.75 $1,527.75 $1,527.75 $1,527.75
Abl1 gene $430.50 $430.50 $430.50 $430.50
Ablate arrhythmia add on $10,523.25 $10,523.25 $10,523.25 $10,523.25
Ablate bone tumor(s) cryo perq 20983 $4,898.25 $4,898.25 $4,898.25 $4,898.25
Ablate bone tumor(s) perq $3,543.75 $3,543.75 $3,543.75 $3,543.75
Ablate heart dysrhythm focus $12,842.25 $12,842.25 $12,842.25 $10,785.75
Ablate inf turbinate superf 30801 $2,706.00 $2,706.00 $2,706.00 $2,706.00
Ablate pulm tumor perq crybl $10,443.00 $10,443.00 $10,443.00 $10,443.00
Ablation cardiac vagal inputs atrium $8,025.00 $8,025.00 $8,025.00 $8,025.00
Ablation cryo abd perit om $8,358.00 $8,358.00 $8,358.00 $6,964.50
Ablation cryo adrenal tumor $6,948.75 $6,948.75 $6,948.75 $6,948.75
Ablation cryo pq chest wall tumor(s) w/guid $280.50 $280.50 $280.50 $280.50
Ablation cryo pq liver tumor(s) $8,080.50 $8,080.50 $8,080.50 $8,080.50
Ablation cryo retro lymph node $503.25 $503.25 $503.25 $503.25
Ablation cryo thigh/knee $274.50 $274.50 $274.50 $274.50
Ablation of upper extremity nerves rf $2,425.50 $2,425.50 $2,425.50 $2,425.50
Abobotulinumtoxina $3,255.66 $3,255.66 $3,255.66 $3,255.66
Abscess drain retroperitoneal surg code $3,121.50 $3,121.50 $3,121.50 $4,627.80
Access & clsr pq fem art endogft dlvry w/img uni $7,299.75 $7,299.75 $7,299.75 $7,299.75
Acetaminophen 10 mg/ml soln 100 ml glass cont $147.54 $147.54 $147.54 $147.54
Acetaminophen level $246.75 $246.75 $246.75 $180.00
Acetazolamide 500 mg solution for injection $137.07 $137.07 $137.07 $137.07
Acetylcholine receptor modulating antibody $489.00 $489.00 $489.00 $388.20
Acetylcysteine 200 mg/ml (20 %) intravenous solution $406.77 $406.77 $406.77 $406.77
Acetylcysteine non-comp unit $87.97 $87.97 $87.97 $87.97
Acne surgery 10040 $295.50 $295.50 $295.50 $295.50
Aco annual medicare visit (awv), initial g0438aco $243.00 $243.00 $243.00 $243.00
Aco annual medicare visit (awv), subsq g0439aco $160.50 $160.50 $160.50 $160.50
Aco med nutria tx/group, ea 30 min 97804aco $67.50 $67.50 $67.50 $59.25
Acoustic immitance testing $141.75 $141.75 $141.75 $141.75
Acoustic refl threshold tst $120.75 $120.75 $120.75 $120.75
Actinotherapy uv light $138.75 $138.75 $138.75 $138.75
Acup 1/> w/estim 1st 15 min $45.75 $45.75 $45.75 $45.75
Acup 1/> wo estim 1st 15 min $45.75 $45.75 $45.75 $45.75
Acute hepatitis panel $480.00 $480.00 $480.00 $480.00
Acute venous thrombus image $873.75 $873.75 $873.75 $873.75
Acyclovir 400 mg tablet $100,424.10 $100,424.10 $100,424.10 $100,424.10
Acyclovir 5 mg/ml in ns IV syringe (neo/ped) - cnr $77.65 $77.65 $77.65 $77.65
Adapter b 8 channel 10cm $29,250.00 $29,250.00 $29,250.00 $29,250.00
Adenosine 3 mg/250 ml bag for osm $528.78 $528.78 $528.78 $528.78
Adenovirus antibody,serum - quest $63.00 $63.00 $63.00 $63.00
Adh-sendout $663.75 $663.75 $663.75 $375.20
Adj gastric band via subq port $4,266.00 $4,266.00 $4,266.00 $4,264.00
Admelog u-100 insulin lispro 100 unit/ml subcutaneous solution $5,046.43 $5,046.43 $5,046.43 $3,000.00
Administration chemotherapy IV infusion each additional hour $472.50 $472.50 $472.50 $420.75
Administration chemotherapy IV infusion each addl sequential infusion diff substance/drug >1 hr $971.25 $971.25 $971.25 $397.80
Administration chemotherapy IV infusion up to 1 hour single/initial substance/drug $857.25 $857.25 $857.25 $808.20
Administration chemotherapy IV push single/initial substance/drug $736.50 $736.50 $736.50 $526.80
Administration chemotherapy subcutaneous/im anti neoplastic hormonal $629.25 $629.25 $629.25 $554.40
Administration chemotherapy subcutaneous/im anti neoplastic non hormonal $645.75 $645.75 $645.75 $388.80
Administration immunization 1 vaccine $33.75 $33.75 $33.75 $33.75
Administration immunization each additional component $63.00 $63.00 $63.00 $63.00
Administration immunization each additional vaccine $33.75 $33.75 $33.75 $16.00
Administration immunization first component each vaccine $63.00 $63.00 $63.00 $67.50
Administration immunization intranasal/oral route 1 vaccine $56.25 $56.25 $56.25 $56.25
Administration immunization intranasal/oral route each additional vaccine $43.50 $43.50 $43.50 $43.50
Administration vaccine hepatitis b $38.25 $38.25 $38.25 $38.25
Administration vaccine influenza virus $38.25 $38.25 $38.25 $16.00
Administration vaccine pneumococcal $38.25 $38.25 $38.25 $35.25
Ado-trastuzumab emtansine 100 mg intravenous solution $23,602.63 $23,602.63 $23,602.63 $23,602.63
Aep hearing status deter i&r $568.50 $568.50 $568.50 $568.50
Aep neurodiagnostic i&r $1,471.50 $1,471.50 $1,471.50 $1,471.50
Aep thrshld est mlt freq i&r $1,308.00 $1,308.00 $1,308.00 $1,308.00
After cataract laser surgery $1,499.25 $1,499.25 $1,499.25 $1,459.50
Agalsidase beta 35 mg intravenous solution $28,942.08 $28,942.08 $28,942.08 $28,942.08
Air conduction bilat $106.50 $106.50 $106.50 $106.50
Airway resistance by impulse oscillometry 94728 $425.25 $425.25 $425.25 $425.25
Albumin (human), 25%, 50ml $295.80 $295.80 $295.80 $304.00
Albumin (human), 5%, 250 ml $295.80 $295.80 $295.80 $466.40
Albumin (microalbumin) 24 hour urine quantitative $85.50 $85.50 $85.50 $76.80
Albumin body fluid quantitative each specimen $43.50 $43.50 $43.50 $43.50
Albumin serum plasma or whole blood $43.50 $43.50 $43.50 $43.50
Albuterol ipratrop non-comp $2.43 $2.43 $2.43 $7.80
Albuterol non-comp con $44.56 $44.56 $44.56 $28.80
Albuterol non-comp unit $2.43 $2.43 $2.43 $6.80
Alcohol (ethanol) any specimen except urine/breath $60.75 $60.75 $60.75 $60.75
Alemtuzumab 12 mg/1.2 ml intravenous solution $112,036.08 $112,036.08 $112,036.08 $112,036.08
Alkaline phosphatase $51.75 $51.75 $51.75 $51.75
All tstg perq&iq drugs/biol $70.50 $70.50 $70.50 $70.50
Allergen alpha lactalbumin ige $110.25 $110.25 $110.25 $71.25
Allergen egg white ige $81.00 $81.00 $81.00 $81.00
Allergen specific ige qual multi scrn ea $39.00 $39.00 $39.00 $39.00
Allergy Skin Testing $97.50 $97.50 $97.50 $47.44
Allergy injection; single 95115 $42.75 $42.75 $42.75 $42.75
Allergy injections; 2 or more 95117 $66.75 $66.75 $66.75 $52.20
Allg patch or app # of tests 95044 $780.00 $780.00 $780.00 $780.00
Allograft allowrap 4x4cm dry 16sqcm $13,768.09 $13,768.09 $13,768.09 $13,768.09
Allograft amnioexcel plus 17mm disk $13,478.20 $13,478.20 $13,478.20 $13,478.20
Allograft amniotic activebarrier 200 2x2cm-q4100-cost per sheet $911.25 $911.25 $911.25 $911.25
Allograft dermis 20x25x1mm decell w/matracell arthroflex $9,702.00 $9,702.00 $9,702.00 $9,702.00
Allograft ecm allopatch hd dehydr thick 0.8-1.7mmx2x5cm-cost per sq cm $30,615.48 $30,615.48 $30,615.48 $30,615.48
Allograft epieffect 2x3cm-q4186-cost per sq cm $10,046.28 $10,046.28 $10,046.28 $10,046.28
Allograft graftjacket 2x12cm-q4107-cost per sq cm $6,367.50 $6,367.50 $6,367.50 $6,367.50
Allograft membrn amnio 1x2cm hu ambriodry $1,887.75 $1,887.75 $1,887.75 $1,887.75
Allograft umbil cord+amniotic membrane-q4148-cost per sq cm $6,075.00 $6,075.00 $6,075.00 $6,075.00
Allograft umbilical epicord 15 sq cm-q4187-cost per sq cm $4,038.75 $4,038.75 $4,038.75 $4,038.75
Alpha-fetoprotein amniotic $61.50 $61.50 $61.50 $65.25
Alpha-fetoprotein tumor marker $168.75 $168.75 $168.75 $162.00
Alprostadil for injection $800.48 $800.48 $800.48 $800.48
Alt/sgpt $63.75 $63.75 $63.75 $63.75
Alteplase 100 mg infusion from pyxis vial $31,563.16 $31,563.16 $31,563.16 $31,563.16
Aluminum - quest $168.00 $168.00 $168.00 $168.00
Alys cplx sp/pn npgt w/prgrm $1,410.00 $1,410.00 $1,410.00 $1,378.20
Amantadine (symmetrel)-sendout $240.00 $240.00 $240.00 $240.00
Ambl bp mntr w/sw a/r $368.25 $368.25 $368.25 $368.25
Amikacin 4 mg/ml intravitreal injection - cnr $79.87 $79.87 $79.87 $44.55
Amino acids quant 2-5 $239.25 $239.25 $239.25 $229.20
Aminocaproic acid 5 g/250 ml 0.9% nacl IV - cnr $35.21 $35.21 $35.21 $10.20
Aminolevulinic acid delta $570.00 $570.00 $570.00 $511.50
Aminophylline 25 mg/ml intravenous solution (wrapper) $65.64 $65.64 $65.64 $65.64
Amiodarone 150 mg/100 ml (1.5 mg/ml) in dextrose, iso-osmotic IV $119.07 $119.07 $119.07 $119.07
Amiodarone 50 mg/ml intravenous solution $50.85 $50.85 $50.85 $50.85
Amitriptyline (elavil) -sendout $260.25 $260.25 $260.25 $260.25
Amivantamab-vmjw 50 mg/ml intravenous solution $14,075.19 $14,075.19 $14,075.19 $14,075.19
Ammonia $151.50 $151.50 $151.50 $151.50
Amniocentesis therapeutic $850.50 $850.50 $850.50 $850.50
Amniocentesisdiagnostic 59000 $1,104.00 $1,104.00 $1,104.00 $1,104.00
Amphetamine confirm urine -sendout $94.50 $94.50 $94.50 $94.50
Amphetamines 5 or more $462.75 $462.75 $462.75 $462.75
Amphotericin b in d5w IV syringe 0.1 mg/ml (neo/ped) - cnr $130.08 $130.08 $130.08 $130.08
Amphotericin b lipid complex $360.00 $360.00 $360.00 $360.00
Amphotericin b liposomal in d5w IV syringe 1 mg/ml (neo/ped) - cnr $434.39 $434.39 $434.39 $434.39
Ampicillin 1 gram solution for injection $114.78 $114.78 $114.78 $114.78
Ampicillin-sulbactam 1.5 gram solution for injection $18.87 $18.87 $18.87 $45.20
Amylase $168.00 $168.00 $168.00 $163.80
An cholangiogram percutaneous compl $2,959.50 $2,959.50 $2,959.50 $2,959.50
An fluoro guide for cvp $888.75 $888.75 $888.75 $888.75
Anal/urinary muscle study $940.50 $940.50 $940.50 $940.50
Anal/urinary muscle study $730.50 $730.50 $730.50 $730.50
Analgesics non-opioid definitive assay 1 or 2 acetaminophen $79.50 $79.50 $79.50 $79.50
Analysis complx cranial nerve pulse gen prgrmg 95977 $1,058.25 $1,058.25 $1,058.25 $1,058.25
Analysis gene f2 20210g>a variant $436.50 $436.50 $436.50 $464.25
Analysis gene f5 leiden variant $577.50 $577.50 $577.50 $613.50
Analysis; simple cranial nerv pulse gen prgrmg 95976 $1,038.00 $1,038.00 $1,038.00 $1,038.00
Analyze neurostimulator simple w/reprogramming 95971 $1,311.00 $1,311.00 $1,311.00 $769.20
Anaplsma phgcytophlm amp prb $105.00 $105.00 $105.00 $105.00
Anca screen with reflex to titer -quest $280.50 $280.50 $280.50 $188.80
Angio balloon ctrl dialysis seg add-on $2,028.00 $2,028.00 $2,028.00 $2,525.40
Angio trnslmnl balloon same artery ea addl $2,886.75 $2,886.75 $2,886.75 $2,886.75
Angio trnslmnl balloon same artery ini $7,883.25 $7,883.25 $7,883.25 $7,883.25
Angio trnslmnl balloon same vein ea addl $4,999.50 $4,999.50 $4,999.50 $4,999.50
Angio trnslmnl balloon same vein ini $7,457.25 $7,457.25 $7,457.25 $7,457.25
Angiotensin ii 0.5 mg/ml soln 1 ml vial $59,352.27 $59,352.27 $59,352.27 $26,215.20
Anidulafungin injection $116.22 $116.22 $116.22 $116.22
Ankle X-ray $396.75 $396.75 $396.75 $325.20
Anl sp inf pmp w/mdreprg&fil $693.75 $693.75 $693.75 $693.75
Annual Physical, Established Patient (age 18-39) $167.25 $167.25 $167.25 $203.45
Annual Physical, Established Patient (age 40-64) $167.25 $167.25 $167.25 $198.00
Annual Physical, New Patient (age 18-39) $167.25 $167.25 $167.25 $218.00
Annual Physical, New Patient (age 40-64) $167.25 $167.25 $167.25 $218.00
Anodyne therapy charges pt $92.25 $92.25 $92.25 $92.25
Anoscopy $1,067.25 $1,067.25 $1,067.25 $1,067.25
Anoscopy ablation lesion 46615 $2,367.00 $2,367.00 $2,367.00 $2,367.00
Anoscopy and biopsy $1,380.00 $1,380.00 $1,380.00 $1,380.00
Anoscopy control bleeding 46614 $3,172.50 $3,172.50 $3,172.50 $3,172.50
Anoscopy remove fb 46608 $2,797.50 $2,797.50 $2,797.50 $2,551.20
Anoscopy remove lesion 46610 $3,723.75 $3,723.75 $3,723.75 $3,723.75
Ans parasymp & symp w/tilt $1,380.75 $1,380.75 $1,380.75 $1,104.75
Anti mog serum - sendout $355.50 $355.50 $355.50 $342.00
Anti-inhibitor $18,764.82 $18,764.82 $18,764.82 $18,764.82
Anti-thymocyte glob (equine)(1:1000) intradermal test dose $17,349.88 $17,349.88 $17,349.88 $17,349.88
Antibody bacterium, not elsewhere specified $164.25 $164.25 $164.25 $119.40
Antibody elution rbc reference $175.50 $175.50 $175.50 $170.25
Antibody htlv-i $210.75 $210.75 $210.75 $96.00
Antibody htlv-ii $210.75 $210.75 $210.75 $210.75
Antibody htlv/hiv confirm test $325.50 $325.50 $325.50 $289.50
Antibody id rbc panel $291.75 $291.75 $291.75 $276.75
Antibody identification platelet antibodies heparin-pf4 igg $1,320.00 $1,320.00 $1,320.00 $694.50
Antibody lymphocytic choriomeningitis $222.00 $222.00 $222.00 $146.40
Antibody screen rbc $136.50 $136.50 $136.50 $113.40
Antidepressant not specified $276.75 $276.75 $276.75 $276.75
Antigen therapy services $60.75 $60.75 $60.75 $60.75
Antihemophilic factor-vwf 250 unit-600 unit intravenous solution $5,102.55 $5,102.55 $5,102.55 $15.20
Antineutrophil cytoplasmic antibody screen each antibody $147.75 $147.75 $147.75 $147.75
Antinuclear antibodies $98.25 $98.25 $98.25 $98.25
Antinuclear antibodies titer $80.25 $80.25 $80.25 $84.75
Antiphosphatidylserine antibody $90.00 $90.00 $90.00 $90.00
Antistreptolysin o titer $83.25 $83.25 $83.25 $83.25
Antithrombin iii activity $216.00 $216.00 $216.00 $175.20
Antithrombin iii injection $6,858.87 $6,858.87 $6,858.87 $6,858.87
Antithymocyte globuln rabbit $4,139.25 $4,139.25 $4,139.25 $4,139.25
Apheresis immunoads slctv $7,110.75 $7,110.75 $7,110.75 $7,110.75
Apl(pml-rara) quant - sendout $1,187.25 $1,187.25 $1,187.25 $1,187.25
App high cost ss f/n/g/h/f <100sq cm addl <25sq cm $552.00 $552.00 $552.00 $552.00
App high cost ss f/n/g/h/f >100sq cm 1st 100sq cm $2,589.00 $2,589.00 $2,589.00 $2,589.00
App high cost ss f/n/g/h/f >100sq cm addl 100sq cm $1,222.50 $1,222.50 $1,222.50 $1,222.50
App high cost ss t/a/l <100sq cm addl <25sq cm $693.75 $693.75 $693.75 $545.25
App high cost ss t/a/l >100sq cm 1st 100sq cm $2,978.25 $2,978.25 $2,978.25 $2,978.25
App high cost ss t/a/l >100sq cm addl 100sq cm $2,072.25 $2,072.25 $2,072.25 $2,072.25
App mltpln uni xtrnl fix xch $3,526.50 $3,526.50 $3,526.50 $3,526.50
Appl modality 1/> areas paraffin bath 97018 $102.00 $102.00 $102.00 $84.75
Appl modality 1/> areas vasopneumatic devices 97016 $123.75 $123.75 $123.75 $106.50
Appl multlay comprs arm/hand $409.50 $409.50 $409.50 $409.50
Appl patllr tdn bearing cast $429.00 $429.00 $429.00 $429.00
Application clubfoot cast $254.25 $254.25 $254.25 $254.25
Application finger splntstatic 29130 $208.50 $208.50 $208.50 $208.50
Application long leg splint 29505 $338.25 $338.25 $338.25 $471.00
Application lower leg splint 29515 $471.75 $471.75 $471.75 $471.00
Application multi layer compression below knee (both sides) $393.75 $393.75 $393.75 $377.25
Application of forearm cast 29075 $303.00 $303.00 $303.00 $303.00
Application of long arm cast 29065 $321.00 $321.00 $321.00 $342.00
Application of long leg cast $480.75 $480.75 $480.75 $480.75
Application of long leg cast 29345 $390.75 $390.75 $390.75 $390.75
Application of paste boot 29580 $390.75 $390.75 $390.75 $390.75
Application short leg cast 29405 $265.50 $265.50 $265.50 $332.25
Application skin substitute graft face/scalp/neck/genit/hnd/ft <100 sq cm 1st 25 sq cm $2,109.00 $2,109.00 $2,109.00 $2,109.00
Application skin substitute graft trunk/arms/legs <100 sq cm 1st 25 sq cm $2,109.00 $2,109.00 $2,109.00 $2,109.00
Applicator tag rfid localizer 12gx7cm $470.25 $470.25 $470.25 $470.25
Apply forearm splintdynamic 29126 $333.00 $333.00 $333.00 $333.00
Apply hand/wrist cast 29085 $249.00 $249.00 $249.00 $249.00
Apply rem fixation device $5,230.50 $5,230.50 $5,230.50 $5,230.50
Apply rigid leg cast 29445 $555.00 $555.00 $555.00 $555.00
Apply short leg castambul type 29425 $333.00 $333.00 $333.00 $333.00
Aqaprn-4 antb flo cytmtry ea $564.75 $564.75 $564.75 $405.75
Aqua therapy w/exercise/ea 15 min 97113 $140.25 $140.25 $140.25 $137.40
Aquatic exercise - group charge $111.00 $111.00 $111.00 $96.00
Argatroban nonesrd (auromed) $668.52 $668.52 $668.52 $668.52
Argatroban nonesrd use 1mg $881.10 $881.10 $881.10 $881.10
Aripiprazole 441 mg/1.6 ml inj $11,842.72 $11,842.72 $11,842.72 $11,842.72
Arsenic trioxide 2 mg/ml intravenous solution $4,375.05 $4,375.05 $4,375.05 $2,751.00
Arterial blood draw/perc 36620 $978.00 $978.00 $978.00 $728.25
Artery x-rays adrenal gland $4,035.00 $4,035.00 $4,035.00 $4,035.00
Artery x-rays adrenals $5,043.00 $5,043.00 $5,043.00 $5,043.00
Artery x-rays arm/leg 75710-26 $3,650.25 $3,650.25 $3,650.25 $3,324.00
Artery x-rays arms/legs 75716-26 $4,206.00 $4,206.00 $4,206.00 $4,122.75
Artery x-rays chest $4,255.50 $4,255.50 $4,255.50 $4,255.50
Artery x-rays lung $3,405.00 $3,405.00 $3,405.00 $3,405.00
Artery x-rays lung $4,931.25 $4,931.25 $4,931.25 $4,931.25
Artery x-rays lungs $5,836.50 $5,836.50 $5,836.50 $5,836.50
Artery x-rays spine $4,294.50 $4,294.50 $4,294.50 $4,294.50
Artery xray each vessel 7577426 $3,282.75 $3,282.75 $3,282.75 $3,035.25
Artery xray of abdomen 75726-26 $4,294.50 $4,294.50 $4,294.50 $4,294.50
Artery xrays of pelvis 75736 26 $4,725.75 $4,725.75 $4,725.75 $4,725.75
Artery-vein nonautograft $6,325.50 $6,325.50 $6,325.50 $6,325.50
Arthrocentesis aspir+/injection small jt/bursa with Ultrasound 20604 $514.50 $514.50 $514.50 $514.50
Arthrocentesis/aspiration/inj major joint/bursa without Ultrasound guidance (both sides) $696.00 $696.00 $696.00 $696.00
Arthrocentesis/aspiration/injection intermediate joint/bursa w/ultrasound guidance (both sides) $619.50 $619.50 $619.50 $619.50
Arthrocentesis/aspiration/injection intermediate joint/bursa without ultrasound guidance right $609.00 $609.00 $609.00 $609.00
Arthrocentesis/aspiration/injection major joint/bursa w/ultrasound guidance (both sides) $803.25 $803.25 $803.25 $803.25
Arthrocentesis/aspiration/injection small joint/bursa without ultrasound guidance $493.50 $493.50 $493.50 $493.50
Arthrodesis/sng lev/ea add ver seg 22614 $3,509.25 $3,509.25 $3,509.25 $3,509.25
Arthrp ntrcrp/crp/mtcr ntrps $3,767.25 $3,767.25 $3,767.25 $3,767.25
Artiss fibrin sealant $3,217.53 $3,217.53 $3,217.53 $3,217.53
Ascenda two piece catheter $32,280.75 $32,280.75 $32,280.75 $32,280.75
Asp & inj bone cyst $756.75 $756.75 $756.75 $756.75
Asp & inj w/heparin pleurx cath $1,135.50 $1,135.50 $1,135.50 $1,135.50
Asp core fat pad $1,123.50 $1,123.50 $1,123.50 $485.40
Aspir/inj thyroid cyst 60300 $815.25 $815.25 $815.25 $815.25
Aspirate bladder/sprapubic cath 51102 $3,146.25 $3,146.25 $3,146.25 $3,146.25
Aspirate pleura without imaging 32554 $991.50 $991.50 $991.50 $1,076.40
Aspirate/inj ganglion cyst 20612 $552.00 $552.00 $552.00 $552.00
Aspiration fine needle (fna) biopsy w/ultrasound guidance 1st lesion $1,219.50 $1,219.50 $1,219.50 $1,085.40
Aspiration peritonsillar abscess $283.50 $283.50 $283.50 $283.50
Assay acid phosphatase $81.00 $81.00 $81.00 $81.00
Assay alkaline phosphatase $87.00 $87.00 $87.00 $87.00
Assay dir meas fr estradiol $391.50 $391.50 $391.50 $124.80
Assay duodenal fluid trypsin $271.50 $271.50 $271.50 $271.50
Assay of adp & amp $293.25 $293.25 $293.25 $292.80
Assay of breath ethanol $64.50 $64.50 $64.50 $64.50
Assay of digoxin free $27.00 $27.00 $27.00 $27.00
Assay of fluoride $270.00 $270.00 $270.00 $241.50
Assay of galactose $426.75 $426.75 $426.75 $426.75
Assay of glucosidase $1,008.00 $1,008.00 $1,008.00 $1,008.00
Assay of glutathione $252.75 $252.75 $252.75 $93.60
Assay of interleukin-6 (il-6) $45.00 $45.00 $45.00 $45.00
Assay of leflunomide $153.00 $153.00 $153.00 $153.00
Assay of lrh hormone $669.75 $669.75 $669.75 $669.75
Assay of osteocalcin $144.75 $144.75 $144.75 $144.75
Assay of procainamide w/metab $70.50 $70.50 $70.50 $70.50
Assay of prostaglandin $93.75 $93.75 $93.75 $93.75
Assay of salicylate $164.25 $164.25 $164.25 $164.25
Assay of sialic acid $342.00 $342.00 $342.00 $229.20
Assay of somatostatin $501.00 $501.00 $501.00 $450.00
Assay of thiocyanate $333.00 $333.00 $333.00 $273.60
Assay of urine sulfate $59.25 $59.25 $59.25 $59.25
Assay phosphohexose enzymes $252.75 $252.75 $252.75 $252.75
Assay toxin or antitoxin $72.75 $72.75 $72.75 $72.75
Assess aphasia/interp/rpt/per hr 96105 $466.50 $466.50 $466.50 $466.50
Assess cyst contrast inject $425.25 $425.25 $425.25 $425.25
Ast/sgot $57.00 $57.00 $57.00 $47.80
Atezolizumab 60 mg/ml intravenous solution (wrapper) $42,851.67 $42,851.67 $42,851.67 $42,851.67
Atropine 0.1 mg/ml injection syringe $39.35 $39.35 $39.35 $39.35
Attn at delivery+ 1 stabilization of newborn 99464 $259.50 $259.50 $259.50 $259.50
Aud brainstem implt programg $372.00 $372.00 $372.00 $372.00
Audiometry air + bone $202.50 $202.50 $202.50 $202.50
Auditory function 60 min $762.75 $762.75 $762.75 $762.75
Augment injectable kit 3.0cc $8,645.34 $8,645.34 $8,645.34 $8,645.34
Augumentation percutaneous vertebral inc cavity creation ea addl thoracic/lumbar vertebral body $9,145.50 $9,145.50 $9,145.50 $9,145.50
Augumentation percutaneous vertebral including cavity creation 1 vertebral body thoracic $9,145.50 $9,145.50 $9,145.50 $9,145.50
Autoimmune rheumatoid arthr anl 12 mrk ia $802.50 $802.50 $802.50 $802.50
Autonomic nrv syst funj test $1,026.75 $1,026.75 $1,026.75 $880.50
Avelumab 20 mg/ml intravenous solution $7,742.64 $7,742.64 $7,742.64 $2,189.40
Avul nail plate addl $318.75 $318.75 $318.75 $318.75
Avulsion nail plate partial/complete simple single nail plate $318.75 $318.75 $318.75 $366.60
Axicabtagene ciloleucel car+ $1,861,987.05 $1,861,987.05 $1,861,987.05 $1,861,987.05
Azacitidine injection $2,163.93 $2,163.93 $2,163.93 $2,163.93
Azathioprine 50 mg tablet $7,093.66 $7,093.66 $7,093.66 $14.40
Azathioprine parenteral $771.30 $771.30 $771.30 $771.30
Azithromycin 500 mg intravenous solution $22.93 $22.93 $22.93 $22.93
Aztreonam 1 gram solution for injection $203.80 $203.80 $203.80 $34.20
B cells total count $84.75 $84.75 $84.75 $84.75
B-hexosaminidase ea assay $104.25 $104.25 $104.25 $104.25
Baclofen eval charges $138.75 $138.75 $138.75 $124.20
Bacterial meningitis antigen $60.75 $60.75 $60.75 $78.75
Bacterial vaginosis pcr $1,973.25 $1,973.25 $1,973.25 $406.40
Balloon dilate urtrl strix $2,118.00 $2,118.00 $2,118.00 $2,345.25
Bartonella dna pcr-sendout $1,113.00 $1,113.00 $1,113.00 $812.00
Basic vestibular evaluation $998.25 $998.25 $998.25 $998.25
Basiliximab $15,941.19 $15,941.19 $15,941.19 $15,941.19
Bausch health Ultrasound surg $2,238.75 $2,238.75 $2,238.75 $2,238.75
Bcg live 50 mg intravesical suspension $605.43 $605.43 $605.43 $605.43
Belatacept 250 mg intravenous solution $3,406.85 $3,406.85 $3,406.85 $3,406.85
Belimumab 120 mg intravenous solution $7,979.25 $7,979.25 $7,979.25 $7,979.25
Bendamustine 25 mg/ml intravenous solution (bendeka) $6,784.08 $6,784.08 $6,784.08 $87.00
Benign lesion paring 2-4 $300.75 $300.75 $300.75 $300.75
Benign lesion paring 4+ $276.75 $276.75 $276.75 $276.75
Benztropine 1 mg/ml injection solution $102.90 $102.90 $102.90 $102.90
Beta 2 glycoprotein 1 antibody iga $129.00 $129.00 $129.00 $129.00
Beta-2 microglobulin $84.00 $84.00 $84.00 $84.00
Beta-amyloid 1-42 $504.00 $504.00 $504.00 $504.00
Betamethasone acetate and sodium phos 6 mg/ml suspension for injection $149.68 $149.68 $149.68 $149.68
Bevacizumab 25 mg/ml intravenous solution $2,946.69 $2,946.69 $2,946.69 $2,946.69
Bevacizumab-awwb 25 mg/ml intravenous solution $10,009.76 $10,009.76 $10,009.76 $6,409.80
Bilateral n blobk inj pudendal 64430 $1,727.25 $1,727.25 $1,727.25 $1,727.25
Bilateral n block inj occipital 64405 $1,218.00 $1,218.00 $1,218.00 $1,141.20
Bilateral n block inj trigeminal 64400 $885.75 $885.75 $885.75 $885.75
Biliary endo perq dx w/speci $7,300.50 $7,300.50 $7,300.50 $7,300.50
Biliary endoscopy thru skin $4,690.50 $4,690.50 $4,690.50 $4,690.50
Biliary endoscopy thru skin $10,884.75 $10,884.75 $10,884.75 $10,884.75
Biliary endoscopy thru skin $2,959.50 $2,959.50 $2,959.50 $2,959.50
Biliary endoscopy thru skin $7,300.50 $7,300.50 $7,300.50 $7,300.50
Bilicheck $39.00 $39.00 $39.00 $39.00
Bilirubin direct $55.50 $55.50 $55.50 $55.50
Bilirubin total $48.00 $48.00 $48.00 $48.00
Biofeedback, pt $189.00 $189.00 $189.00 $189.00
Biopsy abdominal mass $1,897.50 $1,897.50 $1,897.50 $1,897.50
Biopsy bone trocar/needle superficial $1,534.50 $1,534.50 $1,534.50 $1,534.50
Biopsy cervixsingle/multiple 57500 $1,827.75 $1,827.75 $1,827.75 $1,827.75
Biopsy eyelid & lid margin $576.00 $576.00 $576.00 $576.00
Biopsy muscle percutaneous needle $1,282.50 $1,282.50 $1,282.50 $1,536.75
Biopsy needle liver percutaneous $2,136.75 $2,136.75 $2,136.75 $2,056.80
Biopsy needle lymph node superficial $1,722.00 $1,722.00 $1,722.00 $1,710.00
Biopsy of heart lining $7,637.25 $7,637.25 $7,637.25 $7,637.25
Biopsy of ovary(s) 58900 $2,203.50 $2,203.50 $2,203.50 $2,203.50
Biopsy of salivary gland 42400 $1,724.25 $1,724.25 $1,724.25 $1,428.00
Biopsy of salivary glnd;incisional 42405 $1,768.50 $1,768.50 $1,768.50 $1,768.50
Biopsy of upper nose/throat $3,795.00 $3,795.00 $3,795.00 $3,795.00
Biopsy renal percutaneous trocar/needle (both sides) $2,086.50 $2,086.50 $2,086.50 $2,056.80
Biopsy roof of mouth $1,404.00 $1,404.00 $1,404.00 $1,404.00
Biopsy skin incisional single lesion $485.25 $485.25 $485.25 $529.80
Biopsy tongue anterior two-thirds $1,865.25 $1,865.25 $1,865.25 $1,865.25
Biopsy vestibule of mouth 40808 $1,356.75 $1,356.75 $1,356.75 $1,356.75
Biopsy(ies) & aspiration(s) bone marrow diagnostic (both sides) $2,404.50 $2,404.50 $2,404.50 $1,900.50
Biopsy/removal lymph nodes $3,913.50 $3,913.50 $3,913.50 $3,913.50
Biotinidase - quest $331.50 $331.50 $331.50 $298.50
Bis xtracell fluid analysis $147.75 $147.75 $147.75 $147.75
Bivalirudin $18,344.51 $18,344.51 $18,344.51 $5,267.40
Bladder irrigate/lavage/instill 51700 $408.00 $408.00 $408.00 $495.00
Bld prd mix $140.25 $140.25 $140.25 $140.25
Bleomycin 15 unit solution for injection $172.13 $172.13 $172.13 $172.13
Blinatumomab 35 mcg intravenous solution $20,544.09 $20,544.09 $20,544.09 $20,544.09
Blink reflex test $441.75 $441.75 $441.75 $441.75
Bln 1.2 mono emrg 15x1.2 $10,575.00 $10,575.00 $10,575.00 $9,111.60
Bln 30frx10mmx12cm renal nephromax $10,800.00 $10,800.00 $10,800.00 $5,793.60
Bln dil 900ml preperitnl $1,241.51 $1,241.51 $1,241.51 $1,241.51
Bln inpact admiral 4x150x130cm $38,250.00 $38,250.00 $38,250.00 $7,575.60
Bln press regulation 71-80cm $17,775.00 $17,775.00 $17,775.00 $17,775.00
Bln stent lg 19mm diam 10-12mm palmaz gen trnshpat unmtd $5,175.00 $5,175.00 $5,175.00 $5,175.00
Block femoral nerve cont infusion cath w/img $774.75 $774.75 $774.75 $774.75
Block paracervical nrv $1,471.50 $1,471.50 $1,471.50 $1,471.50
Block plantar digital nerve $572.25 $572.25 $572.25 $572.25
Block tap inj(s) w/wo img bi $680.25 $680.25 $680.25 $680.25
Block tap inj(s) w/wo img uni $1,095.00 $1,095.00 $1,095.00 $1,095.00
Blood Clotting (PT/INR) Test $69.00 $69.00 $69.00 $45.00
Blood Clotting (PTT) Test $78.00 $78.00 $78.00 $65.00
Blood Count (CBC) Test $104.25 $104.25 $104.25 $67.20
Blood Count (CBC) Test (without differential) $90.75 $90.75 $90.75 $63.45
Blood Culture Test $150.75 $150.75 $150.75 $112.80
Blood draw capillary 36416 $18.00 $18.00 $18.00 $18.00
Blood gases o2 saturation direct measurement $226.50 $226.50 $226.50 $226.50
Blood occult fecal hemoglobin immunoassay qualitative 1-3 simultaneous determinations diagnostic $60.00 $60.00 $60.00 $46.50
Blood occult feces colorectal neoplasm screening qualitative $34.50 $34.50 $34.50 $25.80
Blood occult peroxidase activity qualitative gastric $27.75 $27.75 $27.75 $27.75
Blood smear interpretation $252.75 $252.75 $252.75 $252.75
Blood smear microscopic w manual differential wbc count $129.75 $129.75 $129.75 $91.80
Blood split unit $130.50 $130.50 $130.50 $247.80
Blood typing abo $186.75 $186.75 $186.75 $72.00
Blood typing ag donor ea ag $270.75 $270.75 $270.75 $123.00
Blood typing rbc ag non abo/rh ea $270.75 $270.75 $270.75 $102.00
Blood typing rh (d) $126.00 $126.00 $126.00 $70.80
Blood typing rh phenotype complete reference $53.25 $53.25 $53.25 $53.25
Bone Density Scan (DEXA) $483.00 $483.00 $483.00 $398.56
Bone acellular derm matrix 2x4cm 0.4-1.0mm allomend-cost per sq cm-8sq cm $19,830.72 $19,830.72 $19,830.72 $19,830.72
Bone filler cerament 10cc $5,163.75 $5,163.75 $5,163.75 $5,163.75
Bone marrow biopsyneedle/trocar 38221 $1,253.25 $1,253.25 $1,253.25 $1,253.25
Bone marrow;aspiration only 38220 $1,253.25 $1,253.25 $1,253.25 $1,253.25
Bone survey-lead poisoning $619.50 $619.50 $619.50 $619.50
Bone tendon board add on $9,547.14 $9,547.14 $9,547.14 $9,547.14
Boot mlti podous univ xlg $318.36 $318.36 $318.36 $318.36
Boot softgait shrt m $113.72 $113.72 $113.72 $113.72
Boot walker genesis full shell 3-strap s $179.82 $179.82 $179.82 $179.82
Boot walker genesis mid-calf full shell s $308.33 $308.33 $308.33 $308.33
Borrelia burgdorferi (lyme disease) antibody nonspecific $101.25 $101.25 $101.25 $101.25
Bowel imaging $1,699.50 $1,699.50 $1,699.50 $1,447.80
Br punct aspir ea add, l $507.75 $507.75 $507.75 $507.75
Brace afo lg left 6607 $70.65 $70.65 $70.65 $70.65
Brace ank air stirrup univ $55.92 $55.92 $55.92 $249.60
Brace ankle stablizing lg $35.15 $35.15 $35.15 $60.60
Brace back epic lso 637 $608.40 $608.40 $608.40 $608.40
Brace cust back lso $417.67 $417.67 $417.67 $417.67
Brace knee extender plus 22-30in $257.51 $257.51 $257.51 $316.20
Brace knee hing pat open med $433.29 $433.29 $433.29 $433.29
Brace knee playmaker ii x-rom hook and loop xl $188.51 $188.51 $188.51 $188.51
Brace m arm board $110.54 $110.54 $110.54 $110.54
Brace oths wrist hnd fngr without $82.50 $82.50 $82.50 $82.50
Brace wrist classic lft sm $99.75 $99.75 $99.75 $129.75
Brach/thor cath 1st $4,128.75 $4,128.75 $4,128.75 $4,128.75
Brach/thor cath 2nd $2,546.25 $2,546.25 $2,546.25 $2,546.25
Brach/thor cath 3rd $3,175.50 $3,175.50 $3,175.50 $3,175.50
Brach/thor cath addl $1,933.50 $1,933.50 $1,933.50 $1,933.50
Braf gene $214.50 $214.50 $214.50 $214.50
Brain MRA (blood vessel MRI, with and without contrast) $2,229.00 $2,229.00 $2,229.00 $2,575.50
Brain MRA (blood vessel MRI, with contrast) $1,998.00 $1,998.00 $1,998.00 $1,998.00
Brain MRA (blood vessel MRI, without contrast) $1,779.75 $1,779.75 $1,779.75 $1,779.75
Brain MRI (with and without contrast) $2,345.25 $2,345.25 $2,345.25 $2,854.80
Brain MRI (with contrast) $2,212.50 $2,212.50 $2,212.50 $2,224.96
Brain MRI (without contrast) $2,081.25 $2,081.25 $2,081.25 $1,830.00
Brain flow imaging only $456.75 $456.75 $456.75 $456.75
Breast Biopsy (ultrasound-guided, percutaneous) $4,049.25 $4,049.25 $4,049.25 $3,092.06
Breast punct aspir cyst, bil $542.25 $542.25 $542.25 $777.00
Breath hydrogen test 91065 $577.50 $577.50 $577.50 $552.00
Brentuximab vedotin 50 mg intravenous solution $46,868.78 $46,868.78 $46,868.78 $46,868.78
Brexucabtagene car pos t $1,475,302.50 $1,475,302.50 $1,475,302.50 $1,475,302.50
Bronch ebus ivntj perph les 31654 $2,765.25 $2,765.25 $2,765.25 $2,765.25
Bronch ebus samplng 1/2 node $5,532.00 $5,532.00 $5,532.00 $4,429.20
Bronch ebus samplng 3/> node $5,532.00 $5,532.00 $5,532.00 $4,740.00
Bronch thermoplsty 1 lobe $7,346.25 $7,346.25 $7,346.25 $7,346.25
Bronch thermoplsty 2/> lobes $7,765.50 $7,765.50 $7,765.50 $7,765.50
Bronch w/balloon occlusion $7,870.50 $7,870.50 $7,870.50 $7,870.50
Bronchial allergy tests $573.00 $573.00 $573.00 $573.00
Bronchial challenge $1,462.50 $1,462.50 $1,462.50 $784.20
Bronchial valve remov addl $1,968.00 $1,968.00 $1,968.00 $1,968.00
Bronchial valve remov init $4,341.75 $4,341.75 $4,341.75 $4,341.75
Bronchoscopy clear airways 31645 $3,143.25 $3,143.25 $3,143.25 $3,022.50
Bronchoscopy dilate w/stent $6,768.75 $6,768.75 $6,768.75 $6,768.75
Bronchoscopy w/biopsy(s) 31625 $2,256.75 $2,256.75 $2,256.75 $2,256.75
Bronchoscopy w/fb removal 31635 $2,919.75 $2,919.75 $2,919.75 $2,919.75
Bronchoscopy w/markers $11,335.50 $11,335.50 $11,335.50 $11,334.75
Bronchoscopy w/tumor excise $3,691.50 $3,691.50 $3,691.50 $3,691.50
Bronchoscopy/lung bx addl 31632 $1,872.75 $1,872.75 $1,872.75 $1,872.75
Bronchoscopy/lung bx each 31628 $2,785.50 $2,785.50 $2,785.50 $2,785.50
Bronchoscopy/needle bx addl 31633 $1,872.75 $1,872.75 $1,872.75 $1,872.75
Bronchoscopy/needle bx each 31629 $2,834.25 $2,834.25 $2,834.25 $3,484.80
Budesonide non-comp unit $32.78 $32.78 $32.78 $463.20
Bundle his recording $5,625.00 $5,625.00 $5,625.00 $5,625.00
Bundled special stain group 1 microorganisms $167.25 $167.25 $167.25 $161.40
Bundled special stain group 2 $134.25 $134.25 $134.25 $134.25
Bupivacaine 0.1 % epidural pca - 1 hour dose limit $44.19 $44.19 $44.19 $1.40
Buprenorph X-ray 100 mg or less $7,360.99 $7,360.99 $7,360.99 $7,360.99
Buprenorphine 2 mg-naloxone 0.5 mg sublingual tablet $545.43 $545.43 $545.43 $27.00
Buprenorphine 8 mg-naloxone 2 mg sublingual tablet $621.18 $621.18 $621.18 $64.40
Buprenorphine X-ray over 100 mg $7,360.99 $7,360.99 $7,360.99 $7,360.99
Buprenorphine and metabolite - sendout $151.50 $151.50 $151.50 $151.50
Buprenorphine hydrochloride $52.01 $52.01 $52.01 $29.85
Buprenorphine oral 1mg $715.66 $715.66 $715.66 $715.66
Bur rotalink 2.15mm $11,463.75 $11,463.75 $11,463.75 $11,463.75
Busulfan injection $783.10 $783.10 $783.10 $783.10
Butorphanol tartrate 1 mg $63.62 $63.62 $63.62 $63.62
Bx bone trocar/ndl deep $2,610.75 $2,610.75 $2,610.75 $2,553.60
Bx breast 1st lesion mr imag $3,197.25 $3,197.25 $3,197.25 $3,197.25
Bx breast 1st lesion strtctc $4,984.50 $4,984.50 $4,984.50 $3,700.20
Bx breast add lesion Ultrasound imag $2,906.25 $2,906.25 $2,906.25 $2,792.40
Bx breast add lesion mr imag $3,008.25 $3,008.25 $3,008.25 $3,008.25
Bx breast add lesion strtctc $4,428.00 $4,428.00 $4,428.00 $3,056.25
Bx breast perq without image 19100 $1,748.25 $1,748.25 $1,748.25 $1,748.25
Bx liver with other $2,265.00 $2,265.00 $2,265.00 $2,265.00
Bx of cervix w/scope leep 57460 $3,876.00 $3,876.00 $3,876.00 $3,876.00
Bx pancreas pq ndl $1,917.75 $1,917.75 $1,917.75 $1,917.75
Bx perianal mass $1,059.00 $1,059.00 $1,059.00 $1,059.00
Bx pleura pq ndl $1,788.75 $1,788.75 $1,788.75 $1,717.20
Bx prostate trnsrctl u/s guid $4,050.75 $4,050.75 $4,050.75 $4,050.75
Bx skin incisnl ea sep/add l les $323.25 $323.25 $323.25 $327.00
Bx skin punch ea sep/ addl les $291.75 $291.75 $291.75 $291.75
Bx skin tangential ea sep/ addl les $291.75 $291.75 $291.75 $291.75
Bx soft tiss pelvis/hip deep 27041 $3,084.75 $3,084.75 $3,084.75 $3,084.75
Bx thigh/knee soft tiss supf 27323 $1,879.50 $1,879.50 $1,879.50 $1,879.50
Bx thyroid/percutan core needle 60100 $1,148.25 $1,148.25 $1,148.25 $1,148.25
Bx vag mucos smpl (sep proc) $2,074.50 $2,074.50 $2,074.50 $1,729.50
Bx vulva or perineum/1 lesion 56605 $2,212.50 $2,212.50 $2,212.50 $2,212.50
Bx vulva or perineum/ea add lesion 56606 $1,827.75 $1,827.75 $1,827.75 $1,365.00
Bx/curett of cervix w/scope 57454 $1,140.75 $1,140.75 $1,140.75 $1,015.20
Bypass temp external fem-fem $15,243.75 $15,243.75 $15,243.75 $2,501.40
C motor evoked lwr limbs $413.25 $413.25 $413.25 $413.25
C motor evoked uppr limbs $780.00 $780.00 $780.00 $780.00
C motor evoked upr&lwr limbs $780.00 $780.00 $780.00 $780.00
C-1 esterase, berinert $13,165.77 $13,165.77 $13,165.77 $13,165.77
C-peptide $128.25 $128.25 $128.25 $128.25
C-reactive protein $126.00 $126.00 $126.00 $126.00
C-reactive protein high sensitivity $117.75 $117.75 $117.75 $126.60
C-reactive protein, quantitative $135.75 $135.75 $135.75 $135.75
C1 esterase inhibitor func - sendout $132.75 $132.75 $132.75 $132.75
CT 3d report other modality w/workstation $633.00 $633.00 $633.00 $697.20
CT Angiogram of Abdomen and Pelvis $2,605.50 $2,605.50 $2,605.50 $2,839.85
CT Angiogram of the Chest (for blood clot) $2,150.25 $2,150.25 $2,150.25 $2,094.23
CT Angiogram of the Head $2,237.25 $2,237.25 $2,237.25 $2,094.23
CT Scan of Abdomen and Pelvis (with and without contrast) $2,605.50 $2,605.50 $2,605.50 $3,610.50
CT Scan of Abdomen and Pelvis (with contrast) $2,493.75 $2,493.75 $2,493.75 $2,985.60
CT Scan of Abdomen and Pelvis (without contrast) $2,418.75 $2,418.75 $2,418.75 $2,418.75
CT angio hrt w/3d image $2,243.25 $2,243.25 $2,243.25 $2,243.25
CT angio pelvis $2,418.75 $2,418.75 $2,418.75 $2,418.75
CT cerebral perf w cont & prcssng $633.00 $633.00 $633.00 $633.00
CT colonography dx $2,139.00 $2,139.00 $2,139.00 $2,139.00
CT guid cryo ablat intramuscular $1,056.00 $1,056.00 $1,056.00 $1,056.00
CT guid parench tis ablat $1,282.50 $1,282.50 $1,282.50 $1,282.50
CT guidance for needle placement $1,632.00 $1,632.00 $1,632.00 $1,632.00
CT guidance for percutaneous drain w/catheter placement supervision & interpretation $2,047.50 $2,047.50 $2,047.50 $1,645.50
CT heart w/evaluation of calcium without contrast $2,051.25 $2,051.25 $2,051.25 $120.00
CT hrt c+ strux cgen hrt ds $2,418.75 $2,418.75 $2,418.75 $2,418.75
CT hrt w/3d image $2,883.00 $2,883.00 $2,883.00 $2,883.00
CT limited or localized follow-up study $642.75 $642.75 $642.75 $642.75
CT lower extremity w/contrast (both sides) $1,553.25 $1,553.25 $1,553.25 $1,553.25
CT lower extremity without contrast (both sides) $1,372.50 $1,372.50 $1,372.50 $1,372.50
CT lwr extremity w/o&w/dye $1,618.50 $1,618.50 $1,618.50 $1,618.50
CT neck soft tissue w/contrast $1,730.25 $1,730.25 $1,730.25 $1,730.25
CT neck soft tissue without & w/contrast $1,752.75 $1,752.75 $1,752.75 $1,752.75
CT neck soft tissue without contrast $1,389.75 $1,389.75 $1,389.75 $1,389.75
CT orbit/sella/ or posterior outer inner or middle ear w/contrast $1,487.25 $1,487.25 $1,487.25 $1,487.25
CT orbit/sella/ or posterior outer inner or middle ear without contrast $1,400.25 $1,400.25 $1,400.25 $1,400.25
CT orbit/sella/fossa w/wo contrast $1,661.25 $1,661.25 $1,661.25 $1,661.25
CT t-spine w /wo contrast $1,817.25 $1,817.25 $1,817.25 $2,005.50
CT thoracic spine w/contrast $1,732.50 $1,732.50 $1,732.50 $1,732.50
CT thoracic spine without contrast $1,464.00 $1,464.00 $1,464.00 $1,464.00
CT thorax low dose for lung screening without contrast $187.50 $187.50 $187.50 $187.50
CT upper extremity w/contrast (both sides) $1,614.75 $1,614.75 $1,614.75 $1,614.75
CT upper extremity without contrast (both sides) $1,473.75 $1,473.75 $1,473.75 $1,473.75
CT uppr extremity w/o&w/dye $2,224.50 $2,224.50 $2,224.50 $2,424.75
Ca screen;flexi sigmoidscope $1,296.00 $1,296.00 $1,296.00 $1,296.00
Cabazitaxel 10 mg/ml (first dilution) intravenous solution $53,887.78 $53,887.78 $53,887.78 $495.60
Cabergoline, oral 0.25mg $173.02 $173.02 $173.02 $173.02
Cable cath 22-pin diag $5,737.50 $5,737.50 $5,737.50 $5,737.50
Cable centrimag pressure $371.25 $371.25 $371.25 $371.25
Cacna1a gene full gene seq $635.25 $635.25 $635.25 $635.25
Caffeine citrate 20 mg/ml inj for po $106.71 $106.71 $106.71 $106.71
Calcitonin (salmon) 200 unit/ml injection solution $9,840.35 $9,840.35 $9,840.35 $9,840.35
Calcium 24 hour urine $78.75 $78.75 $78.75 $78.75
Calcium chloride 100 mg/ml (10 %) intravenous syringe $71.82 $71.82 $71.82 $71.82
Calcium gluconate 100 mg/ml (10 %) intravenous solution $62.13 $62.13 $62.13 $0.80
Calcium gluconate 2 gram/100 ml in sodium chloride,iso-osm IV solution $61.76 $61.76 $61.76 $0.80
Calcium ionized $101.25 $101.25 $101.25 $101.25
Calcium total $52.50 $52.50 $52.50 $44.25
Caloric vstblr test w/rec $465.75 $465.75 $465.75 $465.75
Calprotectin fecal $351.00 $351.00 $351.00 $261.00
Canakinumab injection $79,068.64 $79,068.64 $79,068.64 $79,068.64
Cannula ercp contour 5-4-3 tip $235,532.25 $235,532.25 $235,532.25 $7,828.80
Canthotomy 67715 $2,709.00 $2,709.00 $2,709.00 $2,709.00
Cap nerve 2x15mm $28,177.88 $28,177.88 $28,177.88 $8,136.00
Cap trach decann 15mm $5,400.00 $5,400.00 $5,400.00 $1,842.60
Capecitabine, oral, 50 mg $20,888.96 $20,888.96 $20,888.96 $20,888.96
Carbamazepine free $131.25 $131.25 $131.25 $131.25
Carbamazepine free -sendout $168.75 $168.75 $168.75 $168.75
Carbamazepine total therapeutic drug level $113.25 $113.25 $113.25 $113.25
Carbohydrate deficient transf - sendout $162.00 $162.00 $162.00 $162.00
Carbohydrate urine - sendout $936.00 $936.00 $936.00 $202.80
Carbon dioxide $155.25 $155.25 $155.25 $104.25
Carboplatin 10 mg/ml desensitization $45.78 $45.78 $45.78 $420.80
Carboprost tromethamine 250 mcg/ml intramuscular solution $334.92 $334.92 $334.92 $334.92
Carboxyhemoglobin quantitative $102.00 $102.00 $102.00 $102.00
Carcinoembryonic ag (cea) $162.75 $162.75 $162.75 $162.75
Card MRI veloc flow mapping $1,470.75 $1,470.75 $1,470.75 $1,470.75
Cardiac MRI w/stress img $4,247.25 $4,247.25 $4,247.25 $4,247.25
Cardiac perf planar mult/ef/wm $5,794.50 $5,794.50 $5,794.50 $3,152.00
Cardiac perf planar sgl/ef/wm $3,952.50 $3,952.50 $3,952.50 $3,868.00
Cardiac perf spect sgl/ef/wm rst/strs $4,367.25 $4,367.25 $4,367.25 $3,886.20
Cardiac rehabilitation op phase 2 w/continous ecg monitoring $268.50 $268.50 $268.50 $229.20
Cardiac rehabilitation op phase 2 without continous ecg monitoring $216.00 $216.00 $216.00 $176.40
Cardiolipin antibody iga $213.75 $213.75 $213.75 $211.50
Cardioversion elective electrical conversion arrhythmia external $2,301.75 $2,301.75 $2,301.75 $1,797.75
Cardioversion/elective/internal 92961 $1,707.00 $1,707.00 $1,707.00 $1,707.00
Carfilzomib 10 mg intravenous solution $13,992.87 $13,992.87 $13,992.87 $13,992.87
Carmustine 100 mg intravenous powder for solution $9,719.27 $9,719.27 $9,719.27 $9,719.27
Carotene $75.00 $75.00 $75.00 $75.00
Carotid Artery Ultrasound (Duplex) $1,306.50 $1,306.50 $1,306.50 $1,059.82
Caspofungin acetate $1,158.18 $1,158.18 $1,158.18 $1,158.18
Cath 2lum 14.5frx43cm maxid kt mahurkar $1,115.83 $1,115.83 $1,115.83 $1,115.83
Cath ablat bi-d d-d 8fr 115cm $27,000.00 $27,000.00 $27,000.00 $27,000.00
Cath ablt clsfast 7fx100cmx $1,687.50 $1,687.50 $1,687.50 $1,687.50
Cath ablt rx lasr 2.0mm turbo $7,380.00 $7,380.00 $7,380.00 $7,380.00
Cath access del ds spyscop 2.0 $4,500.00 $4,500.00 $4,500.00 $4,500.00
Cath acuity innr ic130 6f 63cm $64,496.25 $64,496.25 $64,496.25 $28,045.20
Cath acunav ge 10frx90cm $7,951.50 $7,951.50 $7,951.50 $7,951.50
Cath adherent clot 10mm 6f 10 $27,000.00 $27,000.00 $27,000.00 $27,000.00
Cath baloon occl urnry 34f 7x2x65 $7,256.82 $7,256.82 $7,256.82 $7,256.82
Cath bi-dir df smarttouch $8,813.25 $8,813.25 $8,813.25 $8,813.25
Cath blazer dx/20 2-10-2 space $5,062.50 $5,062.50 $5,062.50 $5,062.50
Cath combo lt&rt heart w/inj/s $13,146.00 $13,146.00 $13,146.00 $10,029.00
Cath cv dl inj 7fx16cm $6,738.75 $6,738.75 $6,738.75 $2,865.60
Cath del ampltz 12f 45d 80cm $2,463.75 $2,463.75 $2,463.75 $2,463.75
Cath epdrl brevi-stf 12in .043 $2,295.00 $2,295.00 $2,295.00 $2,295.00
Cath groshong MRI 8fr plstc port $5,309.87 $5,309.87 $5,309.87 $4,219.80
Cath hawkone s directional $7,076.25 $7,076.25 $7,076.25 $7,076.25
Cath imag ivus pv 8.5fx90 .035 $6,378.75 $6,378.75 $6,378.75 $6,378.75
Cath intrdsc spnecth 8 pin $2,463.75 $2,463.75 $2,463.75 $2,463.75
Cath left heart transseptal punc $12,254.25 $12,254.25 $12,254.25 $11,498.40
Cath left heart/lv gram $12,170.25 $12,170.25 $12,170.25 $11,458.20
Cath lt/rt pulm art $3,098.25 $3,098.25 $3,098.25 $3,098.25
Cath malecot 28fr 4-wing ltx $6,845.92 $6,845.92 $6,845.92 $4,114.20
Cath occl flo-rester 2.25x12mm cor internal vessel occluder $38,250.00 $38,250.00 $38,250.00 $38,250.00
Cath place 1st order venous 36011 $2,613.00 $2,613.00 $2,613.00 $2,613.00
Cath place cardio brachytx $15,709.50 $15,709.50 $15,709.50 $15,709.50
Cath plc art ang/grft lt/rt hr $19,300.50 $19,300.50 $19,300.50 $14,482.80
Cath plc art/angio/rt hrt cath $18,666.75 $18,666.75 $18,666.75 $15,848.40
Cath plc art/grft/angio right hrt $20,196.00 $20,196.00 $20,196.00 $17,167.80
Cath ptca pcltxl agent 3x20mm $12,732.75 $12,732.75 $12,732.75 $12,732.75
Cath right heart w/o2 sat & card $8,787.00 $8,787.00 $8,787.00 $6,459.60
Cath right hrt mnpul art $2,094.75 $2,094.75 $2,094.75 $2,094.75
Cath segmntl pulm art $2,868.00 $2,868.00 $2,868.00 $2,868.00
Cath steerable flex adv 12f $2,925.00 $2,925.00 $2,925.00 $2,925.00
Cath stripping venous s&i $2,241.75 $2,241.75 $2,241.75 $1,578.00
Cath symplicity spyral $36,000.00 $36,000.00 $36,000.00 $36,000.00
Cath temp pace flo bipol 5fr electrd $1,408.39 $1,408.39 $1,408.39 $1,408.39
Cath uret open tp 6fx70cm $32,626.80 $32,626.80 $32,626.80 $671.40
Cath/saline/contrast/sis/hysteosal 58340 $521.25 $521.25 $521.25 $460.00
Catheter declot mechanical $2,209.50 $2,209.50 $2,209.50 $2,209.50
Catheter stripping venous $2,902.50 $2,902.50 $2,902.50 $2,902.50
Catheterization collection of specimen single patient all places of service $58.50 $58.50 $58.50 $58.50
Cauterization chemical granulation tissue $543.75 $543.75 $543.75 $421.50
Cdna analysis for variants $1,540.50 $1,540.50 $1,540.50 $1,540.50
Cebpa gene full sequence $387.00 $387.00 $387.00 $421.50
Cefazolin 10 mg/10 ml (dilution #2) IV desensitization - cnr $7.78 $7.78 $7.78 $10.80
Cefepime 1 gram solution for injection $39.95 $39.95 $39.95 $39.95
Cefotaxime sodium injection $43.10 $43.10 $43.10 $43.10
Cefoxitin 1 gram intravenous solution $94.59 $94.59 $94.59 $94.59
Ceftaroline fosamil 600 mg intravenous solution $738.72 $738.72 $738.72 $738.72
Ceftazidime 4.5 mg/0.2 ml intraocular injection - cnr $107.85 $107.85 $107.85 $107.85
Ceftazidime and avibactam $1,418.10 $1,418.10 $1,418.10 $1,418.10
Ceftriaxone 1 gram solution for injection $123.72 $123.72 $123.72 $123.72
Cefuroxime in ns IV syringe 30 mg/ml (neo/ped) - cnr $18.04 $18.04 $18.04 $18.04
Cell count body fluid $76.50 $76.50 $76.50 $76.50
Cell count w differential body fluid $145.50 $145.50 $145.50 $145.50
Cell function assay w/stim $949.50 $949.50 $949.50 $913.20
Cell marker study $1,170.00 $1,170.00 $1,170.00 $243.60
Cemiplimab-rwlc 50 mg/ml intravenous solution $40,395.06 $40,395.06 $40,395.06 $40,395.06
Cerclage of uterine cervix nonob 57700 $7,213.50 $7,213.50 $7,213.50 $7,213.50
Cerebrospinal fld flw imag $1,215.75 $1,215.75 $1,215.75 $1,215.75
Certolizumab pegol 400 mg (200 mg x 2 vials) subcutaneous kit $22,182.90 $22,182.90 $22,182.90 $22,182.90
Cervical or vaginal cancer screening g0101 $156.75 $156.75 $156.75 $156.75
Cesarean section delivery only 59514 $4,472.25 $4,472.25 $4,472.25 $4,472.25
Cetuximab 100 mg/50 ml intravenous solution $5,734.83 $5,734.83 $5,734.83 $5,734.83
Cftr gene dup/delet variants $918.00 $918.00 $918.00 $918.00
Cftr gene intron poly t $285.75 $285.75 $285.75 $285.75
Change cystostomy tube simple $621.75 $621.75 $621.75 $563.25
Change cystostomy tube; complex 51710 $780.75 $780.75 $780.75 $780.75
Change g-tube to g-j perc $1,530.00 $1,530.00 $1,530.00 $1,896.99
Change nephroureteral cath $2,969.25 $2,969.25 $2,969.25 $2,969.25
Change of ureter tube/stent $2,397.00 $2,397.00 $2,397.00 $2,397.00
Change of windpipe airway 31502 $609.00 $609.00 $609.00 $480.00
Change ureter stent percut $4,099.50 $4,099.50 $4,099.50 $4,099.50
Chemo adm cns w/lmbr punct $1,323.75 $1,323.75 $1,323.75 $1,323.75
Chemo intralesional over 7 $246.75 $246.75 $246.75 $246.75
Chemo intralesional up to 7 96405 $83.25 $83.25 $83.25 $83.25
Chemodener muscle larynx emg $801.75 $801.75 $801.75 $801.75
Chemodenerv 1 extrem 1-4 ea 64643 $293.25 $293.25 $293.25 $293.25
Chemodenerv 1 extrem 5/> ea 64645 $281.25 $281.25 $281.25 $281.25
Chemodenerv 1 extrem 5/> mus 64644 $539.25 $539.25 $539.25 $539.25
Chemodenerv 1 extremity 1-4 64642 $988.50 $988.50 $988.50 $988.50
Chemodenerv musc migraine 64615 $512.25 $512.25 $512.25 $512.25
Chemodenerv musc neck dyston 64616 $819.00 $819.00 $819.00 $819.00
Chemodenerv saliv glands bilat 64611 $387.75 $387.75 $387.75 $387.75
Chemodenerv trunk musc 1-5 64646 $822.75 $822.75 $822.75 $787.50
Chemodenerv trunk musc 6/] 64647 $801.75 $801.75 $801.75 $801.75
Chemodenervation/face muscl/unilat 64612 $891.75 $891.75 $891.75 $891.75
Chemotx admn pertl cav impl $852.00 $852.00 $852.00 $852.00
Chest 2 vws w oblique $507.00 $507.00 $507.00 $450.75
Chest CT scan (with and without contrast) $1,829.25 $1,829.25 $1,829.25 $2,105.40
Chest CT scan (with contrast) $1,747.50 $1,747.50 $1,747.50 $1,701.60
Chest CT scan (without contrast) $1,519.50 $1,519.50 $1,519.50 $1,350.03
Chest X-ray $366.00 $366.00 $366.00 $303.53
Chest X-ray (single view) $292.50 $292.50 $292.50 $246.00
Chest apical lordotic proj $500.25 $500.25 $500.25 $419.40
Chg pr pul rehab for copd patients $134.25 $134.25 $134.25 $134.25
Chg radiologic exam esophagus double contrast $759.00 $759.00 $759.00 $759.00
Chimerism anal no cell selec $1,689.75 $1,689.75 $1,689.75 $1,689.75
Chimerism anal w/cell select $822.00 $822.00 $822.00 $822.00
Chlamydia culture $105.00 $105.00 $105.00 $105.00
Chlnggrphy intraop addl s&i $519.00 $519.00 $519.00 $402.75
Chloramphenicol sodium injec $143.40 $143.40 $143.40 $143.40
Chloride $42.75 $42.75 $42.75 $42.75
Chloride 24 hour urine $60.75 $60.75 $60.75 $60.75
Chloroprocaine hcl injection $69.08 $69.08 $69.08 $22.80
Chlorothiazide sodium 500 mg intravenous solution $221.85 $221.85 $221.85 $221.85
Chlorpromazine 0.125 mg/ml IV syringe - cnr $91.92 $91.92 $91.92 $91.92
Cholangiogram percutaneous compl $2,959.50 $2,959.50 $2,959.50 $3,342.00
Cholangiography and/or pancreatography intraoperative supervision & interpretation $694.50 $694.50 $694.50 $694.50
Cholecystostomy complete w/supervision & interpretation $3,449.25 $3,449.25 $3,449.25 $3,449.25
Cholesterol $63.75 $63.75 $63.75 $47.80
Cholesterol (Lipid) Test $143.25 $143.25 $143.25 $102.00
Cholinesterase $105.00 $105.00 $105.00 $105.00
Chorionic gonadotropin/1000u $788.58 $788.58 $788.58 $788.58
Chrom analysis $459.75 $459.75 $459.75 $330.75
Chromatography $252.75 $252.75 $252.75 $222.60
Chromo high res and frag x - sendout $293.25 $293.25 $293.25 $441.00
Chromogenic substrate assay $382.50 $382.50 $382.50 $382.50
Chromosome analys placenta $892.50 $892.50 $892.50 $892.50
Chromosome analysis 100 $519.00 $519.00 $519.00 $519.00
Chromosome analysis 15-20 cell count $1,069.50 $1,069.50 $1,069.50 $1,017.00
Chromosome analysis 45 $1,692.75 $1,692.75 $1,692.75 $1,692.75
Chromosome analysis 5 $1,206.00 $1,206.00 $1,206.00 $1,206.00
Chromosome analysis 50-100 $519.00 $519.00 $519.00 $519.00
Chromosome count additional $147.75 $147.75 $147.75 $147.75
Chromosome karyotype study $337.50 $337.50 $337.50 $266.40
Chromosome study additional $136.50 $136.50 $136.50 $140.25
Chylomicron screen, bf - sendout $336.75 $336.75 $336.75 $336.75
Cidofovir injection $1,615.67 $1,615.67 $1,615.67 $1,615.67
Cilastatin sodium injection $36.62 $36.62 $36.62 $36.62
Cinacalcet 30 mg tablet $5,641.98 $5,641.98 $5,641.98 $5,641.98
Ciprofloxacin 400 mg/200 ml in 5 % dextrose intravenous piggyback $23.67 $23.67 $23.67 $23.67
Circumcision (newborn) $1,549.50 $1,549.50 $1,549.50 $1,549.50
Cladribine 10 mg/10 ml intravenous solution $355.41 $355.41 $355.41 $355.41
Clamp isol transpolr 5mmx6.5cm transpolar $19,012.50 $19,012.50 $19,012.50 $19,012.50
Clean out mastoid cavity $579.00 $579.00 $579.00 $579.00
Clearance of airways $166.50 $166.50 $166.50 $166.50
Clindamycin 600 mg/50 ml in 5 % dextrose intravenous piggyback $49.74 $49.74 $49.74 $49.74
Clip ligating vesolock lg $38,250.00 $38,250.00 $38,250.00 $925.20
Cllr miami j sm $112.39 $112.39 $112.39 $112.39
Clofarabine 1 mg/ml intravenous solution $11,963.49 $11,963.49 $11,963.49 $11,963.49
Clonidine (pf) 1,000 mcg/10 ml (100 mcg/ml) epidural solution $361.14 $361.14 $361.14 $361.14
Clos txnose fx without stablz 21315 $2,896.50 $2,896.50 $2,896.50 $2,896.50
Close lac/mouth vest/2.5 cm or < 40830 $262.50 $262.50 $262.50 $388.80
Closed carpo/metacarpal disl thumb w/manip $273.00 $273.00 $273.00 $273.00
Closed carpo/metacarpal fx disl thumb w/manip $1,815.75 $1,815.75 $1,815.75 $1,815.75
Closed tx humerus fx w/manip 24505 $1,198.50 $1,198.50 $1,198.50 $1,198.50
Closed tx humerus fx with manip 23605 $2,460.00 $2,460.00 $2,460.00 $2,460.00
Closed tx humerus fx without manip 23600 $402.75 $402.75 $402.75 $402.75
Closed tx metatarsophalangeal jnt disl without anes $261.75 $261.75 $261.75 $349.50
Closed tx post hip arthroplasty disloc w/anes 27266 $2,134.50 $2,134.50 $2,134.50 $2,134.50
Closed tx sesamoid fx 28530 $525.75 $525.75 $525.75 $525.75
Closed tx/acetabululm without manip 27220 $261.75 $261.75 $261.75 $261.75
Closed tx/talus fracture without manip 28430 $306.75 $306.75 $306.75 $306.75
Closure laceration vestibule mouth > 2.5 cm cmplx $637.50 $637.50 $637.50 $637.50
Closure paravalvlr leak pq $31,283.25 $31,283.25 $31,283.25 $31,283.25
Clot factor fletcher fact $466.50 $466.50 $466.50 $431.25
Clot factor wght kininogen $393.00 $393.00 $393.00 $393.00
Clot factor xii hageman $246.75 $246.75 $246.75 $220.50
Clot factor xiii fibrin scrn $47.25 $47.25 $47.25 $47.25
Clot factor xiii fibrin stab $292.50 $292.50 $292.50 $292.50
Clozapine, 25 mg $242.19 $242.19 $242.19 $8.40
Clsd tx bimalleol ank fx without manip 27808 $358.50 $358.50 $358.50 $358.50
Clsd tx carpo/metacarpl disl thmb manip ea without anes $543.00 $543.00 $543.00 $539.25
Clsd tx clav dislc without manip 23520 $3,290.25 $3,290.25 $3,290.25 $3,290.25
Clsd tx clavicle dislocation without manip 23540 $581.25 $581.25 $581.25 $581.25
Clsd tx clavicle fracture w/manip 23505 $2,396.25 $2,396.25 $2,396.25 $2,396.25
Clsd tx dist fib fx w/manip 27788 $451.50 $451.50 $451.50 $718.20
Clsd tx elbow dislocation child 24640 $525.75 $525.75 $525.75 $525.75
Clsd tx finger tendon w/wo perq pin 26432 $1,863.75 $1,863.75 $1,863.75 $1,863.75
Clsd tx fracture of radius 25500 $442.50 $442.50 $442.50 $442.50
Clsd tx fx radius/ulna dist w/manip 25605 $1,198.50 $1,198.50 $1,198.50 $1,198.50
Clsd tx fx radius/ulna dist without manip 25600 $409.50 $409.50 $409.50 $409.50
Clsd tx fx radius/ulna w/manip 25565 $1,198.50 $1,198.50 $1,198.50 $1,198.50
Clsd tx fx radius/ulna without manip 25560 $448.50 $448.50 $448.50 $448.50
Clsd tx hip disloc without anes 27265 $261.75 $261.75 $261.75 $718.20
Clsd tx humeral fract without manip 24530 $374.25 $374.25 $374.25 $374.25
Clsd tx humerus fract without manip 24500 $402.75 $402.75 $402.75 $402.75
Clsd tx metacarp fx w/manip&ext fix ea bone 26607 $3,332.25 $3,332.25 $3,332.25 $3,332.25
Clsd tx of ankle fracture w/manip 28435 $1,815.75 $1,815.75 $1,815.75 $1,815.75
Clsd tx patella disloc without anes 27560 $261.75 $261.75 $261.75 $825.60
Clsd tx prox fib/shaft fx w/manip 27781 $1,863.75 $1,863.75 $1,863.75 $1,863.75
Clsd tx radius fracture w/manip 24655 $1,815.75 $1,815.75 $1,815.75 $2,236.20
Clsd tx shoulder dislc/fx 23665 $1,815.75 $1,815.75 $1,815.75 $2,186.40
Clsd tx shoulder disloc w/anatom neck fx w/manip 23675 $1,863.75 $1,863.75 $1,863.75 $1,863.75
Clsd tx temporomandibular dislocat 21480 $261.75 $261.75 $261.75 $825.60
Clsd tx toe dislocation without anes28660 $261.75 $261.75 $261.75 $400.20
Clsd tx trimall ankle fx w/manip 27818 $1,362.75 $1,362.75 $1,362.75 $1,362.75
Clsd tx trimall ankle fx without manip 27816 $378.75 $378.75 $378.75 $378.75
Clsd tx vert body fx without manip req &w/csting/bracing $756.75 $756.75 $756.75 $756.75
Clsd tx wrist carpal fx without manip 25630 $338.25 $338.25 $338.25 $338.25
Clsd tx wrist scaphoid fx without manip 25622 $411.75 $411.75 $411.75 $411.75
Clsd tx wrist ulnar styloid fx 25650 $342.75 $342.75 $342.75 $342.75
Clsd tx/clavicular fx without manip 23500 $425.25 $425.25 $425.25 $425.25
Clsd tx/dis phalan fx without manip/ea 26750 $353.25 $353.25 $353.25 $353.25
Clsd tx/dis tib/wt bear no manip 27824 $581.25 $581.25 $581.25 $581.25
Clsd tx/fem shaft fx/manipulation 27502 $1,815.75 $1,815.75 $1,815.75 $1,815.75
Clsd tx/fx grt toe/phalanx/phalang 28490 $322.50 $322.50 $322.50 $322.50
Clsd tx/fx/phalanx/phalang/manip 28515 $378.75 $378.75 $378.75 $378.75
Clsd tx/grt hum tube fx without manip 23620 $372.00 $372.00 $372.00 $372.00
Clsd tx/metacar/interphal artic fx 26740 $529.50 $529.50 $529.50 $529.50
Clsd tx/metacarpal fx/sg without manip 26600 $377.25 $377.25 $377.25 $377.25
Clsd tx/metacarpal fx/sng/w manip 26605 $427.50 $427.50 $427.50 $808.20
Clsd tx/metatarsal fx without manip 28470 $363.75 $363.75 $363.75 $363.75
Clsd tx/nasal bone fx/stabilize 21320 $3,600.75 $3,600.75 $3,600.75 $3,600.75
Clsd tx/patellar fx without manip 27520 $373.50 $373.50 $373.50 $373.50
Clsd tx/prox/mid phalnx fx/no manp 26720 $327.75 $327.75 $327.75 $327.75
Clsd tx/radial head/neck fx/no manip 24650 $434.25 $434.25 $434.25 $434.25
Clsd tx/scapular fx without manip 23570 $454.50 $454.50 $454.50 $454.50
Clsd tx/shoulder dislo/manip/anest 23655 $1,815.75 $1,815.75 $1,815.75 $1,980.60
Clsd tx/ulnar shaft fx without manip 25530 $344.25 $344.25 $344.25 $344.25
Clsd/shoulder dislo/manip/no anest 23650 $600.00 $600.00 $600.00 $825.60
Clsd/ulnar fx/prox end without manip 24670 $372.00 $372.00 $372.00 $372.00
Cltx hum epcndylr fx wo mnpj $525.75 $525.75 $525.75 $525.75
Cltx humrl cndylr fx w/mnpj $1,815.75 $1,815.75 $1,815.75 $1,815.75
Cltx humrl cndylr fx wo mnpj $546.75 $546.75 $546.75 $546.75
Cltx mndblr fx ntrdntl fixj $6,789.75 $6,789.75 $6,789.75 $6,789.75
Cltx mndblr fx w/mnpj $1,756.50 $1,756.50 $1,756.50 $1,756.50
Cltx mndblr/max alv ridge fx $3,600.75 $3,600.75 $3,600.75 $3,600.75
Cltx palatal/max fx wire fix $3,794.25 $3,794.25 $3,794.25 $3,794.25
Cltx post ankle fx $333.75 $333.75 $333.75 $333.75
Cltx post ankle fx w/mnpj $1,198.50 $1,198.50 $1,198.50 $1,198.50
Cltx scap fx w/mnpj +-tractj $1,815.75 $1,815.75 $1,815.75 $2,421.00
Cltx strnclav dislc w/mnpj $3,526.50 $3,526.50 $3,526.50 $3,526.50
Cmptr ophth img optic nerve $130.50 $130.50 $130.50 $130.50
Cmv pcr-sendout $501.75 $501.75 $501.75 $501.75
Co-treatment - group 15 mins, st $108.00 $108.00 $108.00 $108.00
Co2 monitor per day $337.50 $337.50 $337.50 $337.50
Coagulation factor viia 1,000 mcg/ml inj 1 ml $16,994.46 $16,994.46 $16,994.46 $16,994.46
Coagulation time activated teg $114.75 $114.75 $114.75 $40.80
Cochlear implt f/up exam 7/> $857.25 $857.25 $857.25 $857.25
Cochlear implt f/up exam <7 $857.25 $857.25 $857.25 $857.25
Cold agglutinin titer $114.75 $114.75 $114.75 $100.20
Colistimethate sodium inj $39.42 $39.42 $39.42 $39.42
Collagenase, clost hist inj $26,281.91 $26,281.91 $26,281.91 $26,281.91
Collar cerv adlt perfit ace extric $29.25 $29.25 $29.25 $29.25
Collar cerv ascend 172 reg $318.51 $318.51 $318.51 $318.51
Collection blood specimen from completely implantable venous access device $97.50 $97.50 $97.50 $128.90
Collection blood specimen using established central/peripheral catheter venous nos $208.50 $208.50 $208.50 $208.50
Collection of venous blood by venipuncture $22.50 $22.50 $22.50 $22.50
Colonoscopy (diagnostic) $2,602.50 $2,602.50 $2,602.50 $1,500.00
Colonoscopy (with biopsy) $2,538.00 $2,538.00 $2,538.00 $1,929.60
Colonoscopy (with polyp removal) $2,472.75 $2,472.75 $2,472.75 $1,958.40
Colonoscopy flex w/rem of tumor(s)/polyp(s)/lesion(s) by hot biopsy(s) forceps (rest meth ii cah) $3,043.50 $3,043.50 $3,043.50 $3,043.50
Colonoscopy flex with decompression 45393 $2,495.25 $2,495.25 $2,495.25 $2,495.25
Colonoscopy for foreign body $3,104.25 $3,104.25 $3,104.25 $3,104.25
Colonoscopy stoma w/endo mucosal rescj 44403 $1,368.00 $1,368.00 $1,368.00 $1,368.00
Colonoscopy stoma w/snare 44394 $1,368.00 $1,368.00 $1,368.00 $1,368.00
Colonoscopy submucous njx $2,063.25 $2,063.25 $2,063.25 $2,063.25
Colonoscopy thru stoma spx $1,059.00 $1,059.00 $1,059.00 $1,059.00
Colonoscopy w/ablation $2,571.00 $2,571.00 $2,571.00 $2,571.00
Colonoscopy w/balloon dilat $1,413.00 $1,413.00 $1,413.00 $1,413.00
Colonoscopy w/band ligation $2,495.25 $2,495.25 $2,495.25 $2,495.25
Colonoscopy w/control bleed $2,352.75 $2,352.75 $2,352.75 $2,352.75
Colonoscopy w/dilation $2,495.25 $2,495.25 $2,495.25 $2,495.25
Colonoscopy w/endoscope Ultrasound $3,201.00 $3,201.00 $3,201.00 $3,201.00
Colonoscopy w/endoscopic fnb $3,201.00 $3,201.00 $3,201.00 $3,201.00
Colonoscopy w/fb removal $3,039.00 $3,039.00 $3,039.00 $3,039.00
Colonoscopy w/injection $2,495.25 $2,495.25 $2,495.25 $2,495.25
Colonoscopy w/ndl aspir/bx $2,495.25 $2,495.25 $2,495.25 $2,495.25
Colonoscopy w/resection $3,254.25 $3,254.25 $3,254.25 $3,252.60
Colonoscopy w/stent plcmt $4,379.25 $4,379.25 $4,379.25 $4,379.25
Colonoscopy w/ultrasound $2,495.25 $2,495.25 $2,495.25 $2,495.25
Colonoscopy with ablation $2,495.25 $2,495.25 $2,495.25 $2,495.25
Colonoscopy with biopsy $1,368.00 $1,368.00 $1,368.00 $1,372.20
Colonoscopy/w endoscopic stent 45389 $4,379.25 $4,379.25 $4,379.25 $4,379.25
Colposcopy vulva 56820 $344.25 $344.25 $344.25 $378.00
Colposcopy w/biopsy of cervix 57455 $1,155.75 $1,155.75 $1,155.75 $1,155.75
Colposcopy/cervix/ conization 57461 $4,866.75 $4,866.75 $4,866.75 $4,866.75
Colposcopy/cervix/bx vagina/cervix 57421 $1,651.50 $1,651.50 $1,651.50 $1,452.00
Colposcopy/cervix/inc up/adjacent vag 57452 $853.50 $853.50 $853.50 $851.25
Comp cystometrogram/void presssure 51728 $933.75 $933.75 $933.75 $933.75
Comp cystometrogram/void/uret pres 51729 $976.50 $976.50 $976.50 $976.50
Compatibility test each unit antiglobulin technique $165.00 $165.00 $165.00 $171.36
Compatibility test each unit electronic $131.25 $131.25 $131.25 $131.25
Compatibility test each unit immediate spin technique $131.25 $131.25 $131.25 $131.25
Complement antigen each component c3 $489.00 $489.00 $489.00 $332.00
Complex cystometrogram 51726 $287.25 $287.25 $287.25 $287.25
Complex repair trunk 1.1-2.5cm 13120 $771.75 $771.75 $771.75 $825.60
Complex repair trunk 2.6-7.5cm 13101 $2,143.50 $2,143.50 $2,143.50 $2,143.50
Complex uroflowmetry (electronic) 51741 $607.50 $607.50 $607.50 $607.50
Complx repair enel 1.1-2.5 cm 13151 $3,168.00 $3,168.00 $3,168.00 $3,168.00
Complx repair enel 2.6-7.5 cm 13152 $3,255.75 $3,255.75 $3,255.75 $3,255.75
Complx repair enel addl 5cm/< 13153 $424.50 $424.50 $424.50 $424.50
Complx repair fccmnaxghf 13131 $942.00 $942.00 $942.00 $942.00
Complx repair fccmnaxghf 13132 $1,270.50 $1,270.50 $1,270.50 $1,270.50
Complx repair fccmnaxghf 13133 $942.00 $942.00 $942.00 $942.00
Complx repair sal addl 5 cm/> 13122 $2,126.25 $2,126.25 $2,126.25 $1,128.00
Complx repair trunk addl 5cm/< 13102 $2,185.50 $2,185.50 $2,185.50 $1,095.60
Compre oph exam est pt 1/> $214.50 $214.50 $214.50 $214.50
Compre oph exam new pt 1/> $186.00 $186.00 $186.00 $186.00
Comprehensive hearing test $190.50 $190.50 $190.50 $190.50
Computed tomographic angiography head and neck with contrast $2,237.25 $2,237.25 $2,237.25 $2,237.25
Concentration infection agents any type $41.25 $41.25 $41.25 $41.25
Conditioning play audiometry 92582 $147.75 $147.75 $147.75 $147.75
Condylomata destruction 56420 $786.75 $786.75 $786.75 $786.75
Conization of cervix $3,577.50 $3,577.50 $3,577.50 $3,577.50
Conization/cerv/loop electrode exc 57522 $4,198.50 $4,198.50 $4,198.50 $4,198.50
Conjugated estrogens 25 mg solution for injection $1,291.95 $1,291.95 $1,291.95 $1,291.95
Connect omega .5mm $1,185.42 $1,185.42 $1,185.42 $1,185.42
Connector tis 2x10mm $7,960.44 $7,960.44 $7,960.44 $7,960.44
Consult comp w/report rfrd material $777.75 $777.75 $777.75 $324.60
Consultation pathology during surgery $141.75 $141.75 $141.75 $141.75
Consultation pathology during surgery cytological exam initial site $648.75 $648.75 $648.75 $426.00
Consultation pathology during surgery frozen section each additional block $129.00 $129.00 $129.00 $129.00
Consultation pathology during surgery frozen section first tissue block $131.25 $131.25 $131.25 $175.50
Consultation/report referred material w/preparation of slides $231.75 $231.75 $231.75 $231.75
Cont intraop neuro monitor $335.25 $335.25 $335.25 $335.25
Contrast baths charges $93.00 $93.00 $93.00 $93.00
Contrast exam abdominl aorta 75625-26 $4,711.50 $4,711.50 $4,711.50 $4,711.50
Contrast exam thoracic aorta 75605-26 $5,378.25 $5,378.25 $5,378.25 $5,378.25
Contrast x-ray of hip $1,455.00 $1,455.00 $1,455.00 $1,150.50
Contrast x-ray of knee joint $1,143.75 $1,143.75 $1,143.75 $919.50
Contrast x-ray of wrist $417.75 $417.75 $417.75 $417.75
Control nosebleed pack+caut 30905 $147.00 $147.00 $147.00 $473.25
Control of nosebleed ant comp 30903 $388.50 $388.50 $388.50 $471.00
Control of nosebleedantersmpl 30901 $332.25 $332.25 $332.25 $388.80
Control oropharyngeal hemorr/simp 42960 $638.25 $638.25 $638.25 $1,349.40
Controler lvad heartmate 3 includes ebb $13,218.75 $13,218.75 $13,218.75 $13,218.75
Controller infinity pt dbs $10,901.25 $10,901.25 $10,901.25 $10,901.25
Conv gtube to jtube $3,489.75 $3,489.75 $3,489.75 $3,489.75
Conversion ext bil drg cath $2,959.50 $2,959.50 $2,959.50 $2,959.50
Convert nephrostomy catheter $1,549.50 $1,549.50 $1,549.50 $2,048.51
Coombs direct $117.00 $117.00 $117.00 $81.75
Coombs indirect qualitative each reagent red cell reference $215.25 $215.25 $215.25 $215.25
Coombs indirect titer reference $186.75 $186.75 $186.75 $186.75
Copper intrauterine device $4,211.46 $4,211.46 $4,211.46 $3,515.20
Core ndl bx lng/med perq $1,428.00 $1,428.00 $1,428.00 $2,911.80
Cornea pre-cut midwest eye cornea pre-cut midwest eye $9,900.00 $9,900.00 $9,900.00 $9,900.00
Corneal smear $315.75 $315.75 $315.75 $315.75
Coronary angio/cath placement bypass graft/lv gram/lt heart $18,352.50 $18,352.50 $18,352.50 $13,261.20
Coronary angio/lv gram/lt heart $16,669.50 $16,669.50 $16,669.50 $11,361.60
Coronary angio/lv gram/rt&lt heart $18,093.75 $18,093.75 $18,093.75 $12,658.20
Coronary art/grft angio s&i $13,454.25 $13,454.25 $13,454.25 $9,162.00
Coronary catheterization w/angiography supervision & interpretation $11,955.75 $11,955.75 $11,955.75 $8,608.80
Correct skin color 6.0 cm/< $1,137.75 $1,137.75 $1,137.75 $1,137.75
Cortisol acth stimulation test - sendout $66.00 $66.00 $66.00 $66.00
Cortisol total am $197.25 $197.25 $197.25 $182.25
Cosyntropin 0.25 mg solution for injection $296.55 $296.55 $296.55 $296.55
Counseling smoke cess interm >10mins $167.25 $167.25 $167.25 $50.40
Coveredge 32 lead kit 40cm 48 $8,100.00 $8,100.00 $8,100.00 $8,100.00
Covid-19 administration immunization im inj 1st/only component $101.25 $101.25 $101.25 $25.20
Cptr ophth dx img post segmt $105.00 $105.00 $105.00 $105.00
Crbrospnl fld flw imag cistern $2,313.75 $2,313.75 $2,313.75 $2,313.75
Creatine - sendout $81.00 $81.00 $81.00 $52.50
Creatine kinase $90.00 $90.00 $90.00 $90.00
Creatine kinase isoenzymes $70.50 $70.50 $70.50 $70.50
Creatine kinase mb $114.75 $114.75 $114.75 $114.75
Creatinine $56.25 $56.25 $56.25 $45.00
Creatinine 24 hour urine $73.50 $73.50 $73.50 $73.50
Creatinine clearance urine $178.50 $178.50 $178.50 $155.40
Crisis psychotherapy 90839 $567.00 $567.00 $567.00 $567.00
Crisis psychotherapy additional 30 mins 90840 $219.00 $219.00 $219.00 $219.00
Critical care 30-74 minutes $2,937.75 $2,937.75 $2,937.75 $2,304.00
Critical care each additional 30 minutes $663.00 $663.00 $663.00 $627.60
Crizanlizumab-tmca 10 mg/ml intravenous solution $9,069.75 $9,069.75 $9,069.75 $9,069.75
Cromolyn sodium noncomp unit $48.14 $48.14 $48.14 $48.14
Crtj pericardial window/prtl resecj w/drg/bx $5,697.75 $5,697.75 $5,697.75 $5,697.75
Cryofibrinogen qualitative - sendout $69.00 $69.00 $69.00 $69.00
Cryoprecipitate each unit $219.00 $219.00 $219.00 $235.20
Cryosurgery penis lesion(s) 54056 $231.00 $231.00 $231.00 $231.00
Cryptococcus abs qn - sendout $206.25 $206.25 $206.25 $206.25
Crystal identification light microscopy $65.25 $65.25 $65.25 $65.25
Csf leakage imaging $1,645.50 $1,645.50 $1,645.50 $1,645.50
Cta abdomen without & /or w/contrast $2,422.50 $2,422.50 $2,422.50 $2,422.50
Cta abdominal aorta & (both sides) ileofemoral lower extremity w runoff without & w/contrast $2,718.75 $2,718.75 $2,718.75 $2,718.75
Cta lower extremity without & w/contrast (both sides) $1,807.50 $1,807.50 $1,807.50 $1,807.50
Cta neck without &/or w/contrast $1,987.50 $1,987.50 $1,987.50 $1,987.50
Cta upper extremity w &/or without contrast left $1,652.25 $1,652.25 $1,652.25 $1,652.25
Ctrl nosebld postir subsq 30906 $271.50 $271.50 $271.50 $271.50
Culture aerobic additional method definitive id each $78.75 $78.75 $78.75 $77.25
Culture afb any source $132.75 $132.75 $132.75 $114.60
Culture anaerobic except blood $127.50 $127.50 $127.50 $127.50
Culture body fluid $130.50 $130.50 $130.50 $130.50
Culture fungi definitive id mold $63.75 $63.75 $63.75 $70.80
Culture fungi definitive id yeast $66.00 $66.00 $66.00 $67.20
Culture fungi other (except blood) $126.00 $126.00 $126.00 $126.00
Culture fungi skin/hair/nail $126.00 $126.00 $126.00 $85.60
Culture mycobacteria definitive id each isolate $96.00 $96.00 $96.00 $96.75
Culture mycoplasma any source $145.50 $145.50 $145.50 $145.50
Culture quantitative aerobic other source $99.75 $99.75 $99.75 $99.75
Culture screening strep group a $115.50 $115.50 $115.50 $115.50
Culture typing nucleic acid probe amplified per culture/isolate 6 or more targets $408.75 $408.75 $408.75 $408.75
Curette/treat cornea $1,133.25 $1,133.25 $1,133.25 $1,133.25
Cutter lead $22,020.89 $22,020.89 $22,020.89 $9,055.20
Cv line/pic reposition $2,100.75 $2,100.75 $2,100.75 $2,100.75
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution $25.86 $25.86 $25.86 $25.86
Cyanocobalamin unsat binding capacity $76.50 $76.50 $76.50 $84.75
Cyclic citrullinated peptide antibody $249.75 $249.75 $249.75 $249.75
Cyclophosphamide 1 gram intravenous powder for solution $4,143.90 $4,143.90 $4,143.90 $3.75
Cyclophosphamide 25 mg capsule $2,769.06 $2,769.06 $2,769.06 $43.20
Cyclosporine 2 hour $115.50 $115.50 $115.50 $115.50
Cyclosporine 250 mg/5 ml intravenous solution $243.99 $243.99 $243.99 $243.99
Cyclosporine modified 25 mg capsule $470.55 $470.55 $470.55 $51.45
Cyclosporine oral 100 mg $2,865.39 $2,865.39 $2,865.39 $2,865.39
Cylinder pump set 20cm titan zero angl $42,849.57 $42,849.57 $42,849.57 $42,849.57
Cyp2c19 gene com variants $613.50 $613.50 $613.50 $613.50
Cyp2c9 gene com variants $368.25 $368.25 $368.25 $368.25
Cyp2d6 gene com variants $949.50 $949.50 $949.50 $450.91
Cyp3a4 gene common variants $328.50 $328.50 $328.50 $328.50
Cyp3a5 gene common variants $328.50 $328.50 $328.50 $328.50
Cystatin c $78.75 $78.75 $78.75 $94.20
Cystic fibrosis cftr $6,969.00 $6,969.00 $6,969.00 $6,271.50
Cystine urine quantitative $239.25 $239.25 $239.25 $167.25
Cystogram >= 3 views supervision & interpretation $919.50 $919.50 $919.50 $919.50
Cystoscopy & ureter catheter $2,397.00 $2,397.00 $2,397.00 $2,397.00
Cystoscopy (Bladder Scope) $2,580.00 $2,580.00 $2,580.00 $1,636.00
Cystoscopy and treatment $5,949.75 $5,949.75 $5,949.75 $5,949.75
Cystoscopy and treatment $4,587.75 $4,587.75 $4,587.75 $4,170.00
Cystoscopy and treatment $4,056.00 $4,056.00 $4,056.00 $4,056.00
Cystoscopy and treatment $4,056.00 $4,056.00 $4,056.00 $4,056.00
Cystoscopy and treatment $4,056.00 $4,056.00 $4,056.00 $4,056.00
Cystoscopy and treatment $4,056.00 $4,056.00 $4,056.00 $4,056.00
Cystoscopy chemodenervation $975.75 $975.75 $975.75 $975.75
Cystostomy cystotomy w/drainage 51040 $2,396.25 $2,396.25 $2,396.25 $3,276.00
Cystouretero w/lithotripsy $11,789.25 $11,789.25 $11,789.25 $11,789.25
Cystourethroscop/calib/dilat stric 52281 $2,360.25 $2,360.25 $2,360.25 $2,360.25
Cytarabine 20 mg/ml injection solution $64.71 $64.71 $64.71 $64.71
Cytogenetics 25-99 $143.25 $143.25 $143.25 $188.25
Cytomegalovirus (cmv) antibody igg $101.25 $101.25 $101.25 $101.25
Cytomegalovirus (cmv) antibody igm $131.25 $131.25 $131.25 $131.25
Cytomegalovirus imm IV /vial $6,333.64 $6,333.64 $6,333.64 $6,333.64
Cytopath smear other source $94.50 $94.50 $94.50 $82.50
Cytopath tbs c/v manual $168.75 $168.75 $168.75 $156.00
Cytopathology cellular enhancement technique non-gyn $197.25 $197.25 $197.25 $240.00
Cytopathology cervical/vaginal thin layer auto screen/manual rescreen/review $198.75 $198.75 $198.75 $104.00
Cytopathology cervical/vaginal thin layer manual screening $173.25 $173.25 $173.25 $64.80
Cytopathology concentration technique smears & interpretation $225.00 $225.00 $225.00 $113.40
Cytopathology fluids/washings/brushings smears with interpretation $111.00 $111.00 $111.00 $111.00
Cytopathology fna adequacy evaluation first episode each site $131.25 $131.25 $131.25 $131.25
Cytopathology fna adequacy evaluation first episode each site interp/rpt $186.75 $186.75 $186.75 $186.75
Cytotoxic antibody screening $504.75 $504.75 $504.75 $504.75
Cytp urine 3-5 probes cmptr $907.50 $907.50 $907.50 $907.50
D&c after delivery 59160 $3,102.00 $3,102.00 $3,102.00 $3,102.00
D&c/diagnostic/therapeutic/non ob 58120 $2,361.75 $2,361.75 $2,361.75 $2,361.75
Dacarbazine 100 mg intravenous solution $53.55 $53.55 $53.55 $53.55
Dactinomycin 0.5 mg intravenous solution $10,014.84 $10,014.84 $10,014.84 $10,014.84
Dalbavancin 500 mg intravenous solution $6,061.91 $6,061.91 $6,061.91 $6,061.91
Daratumumab 1,800 mg-hyaluronidase-fihj 30,000 unit/15 ml subcut soln $38,894.03 $38,894.03 $38,894.03 $109.20
Darbepoetin alfa 100 mcg/0.5 ml in polysorbate injection syringe $5,546.48 $5,546.48 $5,546.48 $5,546.48
Daunorubicin 44 mg and cytarabine 100 mg in liposome IV solution $38,568.63 $38,568.63 $38,568.63 $38,568.63
Daunorubicin 5 mg/ml intravenous solution $300.73 $300.73 $300.73 $300.73
Dch glucoscan $23.25 $23.25 $23.25 $23.25
Dch pulmonary stress test $1,811.25 $1,811.25 $1,811.25 $1,811.25
Dch validity tests $34.50 $34.50 $34.50 $33.60
Dcm pq ndl dsk sgl/mlt lv lmbr w/guide $2,238.00 $2,238.00 $2,238.00 $2,238.00
Deamidated gliadin antibody iga $42.75 $42.75 $42.75 $42.75
Debr musc/fascia 20sq cm/< 11043 $888.00 $888.00 $888.00 $933.75
Debrid ecz/inf skin up tp 10% body 11000 $3,006.00 $3,006.00 $3,006.00 $1,317.00
Debrid mastoidectomy cavity simple 69220 $292.50 $292.50 $292.50 $292.50
Debride nail1-5 11720 $291.75 $291.75 $291.75 $282.60
Debride nail6 or more 11721 $300.75 $300.75 $300.75 $300.75
Debride/subq tissue/ea add 20sq cm 11045 $940.50 $940.50 $940.50 $817.20
Debridement (>20 cm) charge pt $363.75 $363.75 $363.75 $341.40
Debridement bone <= 20 sq cm $4,119.00 $4,119.00 $4,119.00 $2,649.75
Debridement subcutaneous tissue <= 20 sq cm $1,148.25 $1,148.25 $1,148.25 $1,148.25
Debridement/bone/20 sq cm or less 11046 $654.75 $654.75 $654.75 $765.60
Debridement/bone/ea add 20 sq cm 11047 $2,045.25 $2,045.25 $2,045.25 $2,045.25
Decalcification $50.25 $50.25 $50.25 $121.20
Decitabine 50 mg intravenous solution $634.17 $634.17 $634.17 $634.17
Declotting thrombolytic agent implanted vas access device 36 $610.50 $610.50 $610.50 $610.50
Deferoxamine 500 mg solution for injection $102.84 $102.84 $102.84 $102.84
Degarelix 120 mg subcutaneous solution $3,396.16 $3,396.16 $3,396.16 $3,396.16
Delivery of placenta 59414 $2,570.25 $2,570.25 $2,570.25 $2,570.25
Delivery transcath fxtn dvc to endogrft w/s&i $10,770.75 $10,770.75 $10,770.75 $10,770.75
Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device $196.50 $196.50 $196.50 $196.50
Denosumab 120 mg/1.7 ml (70 mg/ml) subcutaneous solution $12,371.55 $12,371.55 $12,371.55 $10,269.00
Dentoalveolar/drain abs/cyst/hema 41800 $460.50 $460.50 $460.50 $589.80
Dermagraft $129.00 $129.00 $129.00 $129.00
Des thora aorta rpr without left sub art 33881 $15,243.75 $15,243.75 $15,243.75 $15,243.75
Desmopressin 4 mcg/ml injection solution $172.46 $172.46 $172.46 $172.46
Desoxycorticosterone $364.50 $364.50 $364.50 $364.50
Dest mal lesion tal 1.1-2.0cm 17262 $332.25 $332.25 $332.25 $332.25
Dest mal lesion tal <0.5 17260 $366.75 $366.75 $366.75 $366.75
Destroy cervthor facet jnt 64633 $2,381.25 $2,381.25 $2,381.25 $2,381.25
Destroy cth facet jnt addl 64634 $1,879.50 $1,879.50 $1,879.50 $1,893.75
Destroy premlg lesns;1st lesn 17000 $199.50 $199.50 $199.50 $199.50
Destroy vulva lesion simple 56501 $3,691.50 $3,691.50 $3,691.50 $3,691.50
Destruct ben lesion 15/> 17111 $332.25 $332.25 $332.25 $307.50
Destruct cut vasl lesions <10cm 17106 $666.75 $666.75 $666.75 $666.75
Destruct cut vasl lesions >50cm 17108 $1,442.25 $1,442.25 $1,442.25 $1,442.25
Destruction 2-14 lesions 17003 $83.25 $83.25 $83.25 $83.25
Destruction anal lesion(s) $3,711.00 $3,711.00 $3,711.00 $3,711.00
Destruction anal lesion(s) smpl chem 46900 $638.25 $638.25 $638.25 $468.00
Destruction benign lesions < 14 lesions $268.50 $268.50 $268.50 $268.50
Destruction by injection tx of nerve 64630 $915.75 $915.75 $915.75 $915.75
Destruction by neurolytic agent w/imaging guidance lumbar/sacral (both sides) $2,325.75 $2,325.75 $2,325.75 $2,343.75
Destruction by neurolytic agent w/imaging guidance lumbar/sacral additional (both sides) $1,879.50 $1,879.50 $1,879.50 $1,879.50
Destruction mal lsn t/a/l >4cm $954.75 $954.75 $954.75 $954.75
Destruction premal lesions 15/> 17004 $521.25 $521.25 $521.25 $521.25
Detect agnt mult dna direc $147.75 $147.75 $147.75 $147.75
Dev tst admin phys/qhp ea addl 30 min $183.00 $183.00 $183.00 $183.00
Devel tst phys/qhp 1st hr $398.25 $398.25 $398.25 $398.25
Developmental screen/score/document 96110 $573.75 $573.75 $573.75 $573.75
Device ablt adv novasure $11,239.88 $11,239.88 $11,239.88 $11,239.88
Device hemospray 7frx220cm endo hemostat min access $5,175.00 $5,175.00 $5,175.00 $5,175.00
Device intraute mirena $4,491.10 $4,491.10 $4,491.10 $4,133.60
Device sut capio slim opn $1,454.07 $1,454.07 $1,454.07 $1,454.07
Device tiss remov myosure reach $1,070.85 $1,070.85 $1,070.85 $1,070.85
Dexa bone density study >=1 sites appendicular skeleton (peripheral) $417.00 $417.00 $417.00 $161.60
Dexamethasone 4 mg tablet $554.26 $554.26 $554.26 $256.80
Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr $16.28 $16.28 $16.28 $11.40
Dexrazoxane hcl 250 mg intravenous solution $465.34 $465.34 $465.34 $465.34
Dextran 40 infusion $225.55 $225.55 $225.55 $225.55
Dextrose 5 % IV bolus $22.19 $22.19 $22.19 $26.80
Dextrose 5 % and 0.9 % sodium chloride intravenous solution $22.19 $22.19 $22.19 $32.40
Dextrose 5 % and lactated ringers intravenous solution $22.19 $22.19 $22.19 $29.00
Dextrose 5 % in water (d5w) intravenous solution (non-pvc) $36.98 $36.98 $36.98 $47.40
Dhea-s (dehydroepiand sulfate) $249.75 $249.75 $249.75 $222.00
Diab manage trn ind/group $57.75 $57.75 $57.75 $57.75
Diabetes (HbA1c) Test $114.75 $114.75 $114.75 $70.00
Diag bronchoscope/catheter $4,125.75 $4,125.75 $4,125.75 $4,125.75
Diagnostic Mammogram (both breasts) $655.50 $655.50 $655.50 $432.90
Diagnostic Mammogram (one breast) $502.50 $502.50 $502.50 $297.05
Diagnostic anoscopy spx 46600 $181.50 $181.50 $181.50 $181.50
Diagnostic digital breast tomosynthesis bil $70.50 $70.50 $70.50 $70.50
Diagnostic digital breast tomosynthesis unil $57.00 $57.00 $57.00 $57.00
Diagnostic laryngoscopy 31505 $592.50 $592.50 $592.50 $592.50
Diagnostic laryngoscopy 31575 $381.00 $381.00 $381.00 $381.00
Diagnostic radio unlisted proc $564.75 $564.75 $564.75 $564.75
Dialysis circuit perm vascular embolization 36909 $10,461.00 $10,461.00 $10,461.00 $10,461.00
Diatrizoate meglumine 18 % urethral solution $58.24 $58.24 $58.24 $58.24
Diazepam 5 mg/ml injection solution (wrapper) $143.84 $143.84 $143.84 $127.20
Dicyclomine injection $310.41 $310.41 $310.41 $310.41
Diffusing capacity $504.00 $504.00 $504.00 $504.00
Digoxin 250 mcg/ml (0.25 mg/ml) injection solution $472.14 $472.14 $472.14 $34.00
Digoxin immune fab 40 mg intravenous solution $17,050.66 $17,050.66 $17,050.66 $16,441.80
Digoxin total therapeutic drug level $138.75 $138.75 $138.75 $135.00
Dihydroergotamine 0.05 mg/ml IV syringe - cnr $297.86 $297.86 $297.86 $297.86
Dilate esophagus 1/mult pass $1,548.00 $1,548.00 $1,548.00 $1,548.00
Dilate urethra stricture $513.00 $513.00 $513.00 $513.00
Dilation of rectal stricture 45910 $1,375.50 $1,375.50 $1,375.50 $1,375.50
Dilation/female urethra/initial 53660 $387.75 $387.75 $387.75 $387.75
Dilator fascial 10fx20cm $291.87 $291.87 $291.87 $291.87
Diltiazem 5 mg/ml intravenous solution $107.23 $107.23 $107.23 $107.23
Dimenhydrinate injection $17.32 $17.32 $17.32 $17.32
Dimethyl sulfoxide 50% 50 ml $2,501.55 $2,501.55 $2,501.55 $2,501.55
Diphenhydramine 12.5 mg/5 ml oral elixir $36.98 $36.98 $36.98 $36.98
Diphenhydramine 50 mg/ml injection (wrapper) $5.92 $5.92 $5.92 $5.92
Disability dlco $340.50 $340.50 $340.50 $264.60
Disaccharidases $1,265.25 $1,265.25 $1,265.25 $186.00
Discography cerv/thor spine $2,691.00 $2,691.00 $2,691.00 $2,691.00
Dlyd plmt xtn prosth ea addl $6,681.75 $6,681.75 $6,681.75 $6,681.75
Dmd dup/delet analysis $2,106.00 $2,106.00 $2,106.00 $2,106.00
Dmpk gene detc abnor allele $613.50 $613.50 $613.50 $613.50
Dna antibody native/double stranded $131.25 $131.25 $131.25 $131.25
Dobutamine 250 mg/20 ml (12.5 mg/ml) intravenous solution $130.35 $130.35 $130.35 $130.35
Docetaxel 20 mg/ml intravenous solution (wrapper) $1,164.72 $1,164.72 $1,164.72 $1,164.72
Dopamine 40 mg/ml intravenous solution (wrapper) $98.91 $98.91 $98.91 $89.40
Doppler echo complete $498.00 $498.00 $498.00 $608.25
Doppler intravascular pressure flow initial vessel $3,066.75 $3,066.75 $3,066.75 $3,066.75
Doppler upper/lower extremity arteries complete bilateral $946.50 $946.50 $946.50 $946.50
Doppler upper/lower extremity arteries limited bilateral $885.00 $885.00 $885.00 $717.60
Dornase alfa non-comp unit $479.80 $479.80 $479.80 $479.80
Dornhoffer fixed part w/window $77,636.25 $77,636.25 $77,636.25 $77,636.25
Doxorubicin 2 mg/ml intravenous solution (wrapper) $901.65 $901.65 $901.65 $631.20
Doxycycline hyclate 100 mg intravenous powder for solution $89.34 $89.34 $89.34 $1.20
Dpyd gene common variants $354.00 $354.00 $354.00 $354.00
Drain blood from under nail 11740 $257.25 $257.25 $257.25 $257.25
Drain cath image guided peri/retroperitoneal transvag/transrectal $2,976.00 $2,976.00 $2,976.00 $2,976.00
Drain cath image guided visceral pq $3,255.75 $3,255.75 $3,255.75 $3,637.20
Drain cerebro spinal fluid 62272 $1,416.75 $1,416.75 $1,416.75 $1,416.75
Drain finger abscess;simple 26010 $228.75 $228.75 $228.75 $265.20
Drain lower leg lesion 27603 $3,269.25 $3,269.25 $3,269.25 $3,269.25
Drain neck/chest lesion 21501 $3,293.25 $3,293.25 $3,293.25 $3,293.25
Drain ovarn cyst abd $4,305.75 $4,305.75 $4,305.75 $4,305.75
Drainage absc/cyst/hmtma/vestibule mouth smpl $820.50 $820.50 $820.50 $820.50
Drainage ext aud canal abscess 69020 $820.50 $820.50 $820.50 $820.50
Drainage external ear complex 69005 $4,074.75 $4,074.75 $4,074.75 $4,074.75
Drainage external ear simple 69000 $741.00 $741.00 $741.00 $712.80
Drainage mouth roof lesion $282.00 $282.00 $282.00 $282.00
Drainage of arm bursa 23931 $2,638.50 $2,638.50 $2,638.50 $2,638.50
Drainage of eye $2,702.25 $2,702.25 $2,702.25 $2,702.25
Drainage of kidney lesion $1,989.75 $1,989.75 $1,989.75 $1,989.75
Drainage of mouth lesion $3,946.50 $3,946.50 $3,946.50 $3,379.20
Drainage of mouth lesion $3,731.25 $3,731.25 $3,731.25 $3,435.60
Drainage of nose lesion int 30000 $283.50 $283.50 $283.50 $283.50
Drainage of nose lesion sept 30020 $637.50 $637.50 $637.50 $637.50
Dress/debrid prtl-thick burn l 16030 $417.00 $417.00 $417.00 $639.75
Dress/debride pt-tck burn/5-10% bs 16025 $350.25 $350.25 $350.25 $423.75
Dress/debride pt-thick burn/<5% bs 16020 $338.25 $338.25 $338.25 $355.80
Dressing change not for burn w/anes 15852 $716.25 $716.25 $716.25 $716.25
Dressing wound matrix 2x2in 25sqcm-q4108-cost per sq cm $9,875.23 $9,875.23 $9,875.23 $9,875.23
Drng of eyelid abscess 67700 $335.25 $335.25 $335.25 $747.00
Drng of finger abscess comp 26011 $1,253.25 $1,253.25 $1,253.25 $1,620.24
Drng of ovarian cyst(s) 58800 $3,624.75 $3,624.75 $3,624.75 $3,624.75
Drng of scrotum abscess 55100 $1,897.50 $1,897.50 $1,897.50 $2,486.40
Drng salivary gland submax/subling 42310 $596.25 $596.25 $596.25 $596.25
Dronabinol 2.5mg oral $1,907.03 $1,907.03 $1,907.03 $1,907.03
Drsg interceed 3x4in adh wnd barr absorb $1,956.48 $1,956.48 $1,956.48 $1,956.48
Drsg oasis fen mesh thick 3x7cm 21sqcm -cost per sq cm $530.83 $530.83 $530.83 $530.83
Drsg oasis ultr ster 3lyr 7x10 70sqcm -cost per sq cm $983.03 $983.03 $983.03 $983.03
Drsg sht 5.625x4.625in std $639.00 $639.00 $639.00 $639.00
Drsg wnd mesh bovine bilayer 4x10in matrix-q4104-cost per sq cm $26,932.05 $26,932.05 $26,932.05 $26,932.05
Drsg wound matrix sheet 2.5x2.5cm-7 sq cm-cost per sq cm $22,027.50 $22,027.50 $22,027.50 $22,027.50
Drug admin & hemodynmic meas $3,098.25 $3,098.25 $3,098.25 $3,098.25
Drug assay caffeine $59.25 $59.25 $59.25 $59.25
Drug assay posaconazole $186.00 $186.00 $186.00 $186.00
Drug assay rufinamide $135.75 $135.75 $135.75 $135.75
Drug assay vedolizumab $949.50 $949.50 $949.50 $431.40
Drug assay voriconazole $186.00 $186.00 $186.00 $186.00
Drug asy hydroxychloroquine $531.75 $531.75 $531.75 $531.75
Drug of abuse screen urine $63.75 $63.75 $63.75 $54.00
Drug screen quant tiagabine $260.25 $260.25 $260.25 $260.25
Drug test(s) presumptive any class instrument chemistry analyzers $732.00 $732.00 $732.00 $453.00
Drvvt confirm - quest $255.75 $255.75 $255.75 $195.00
Dstrj nulyt agt gnclr nrv $1,746.75 $1,746.75 $1,746.75 $1,746.75
Ductogram sgl duct $515.25 $515.25 $515.25 $515.25
Duodenal motility study $1,729.50 $1,729.50 $1,729.50 $1,729.50
Dup scan/hemodialysis access 93990 $835.50 $835.50 $835.50 $806.25
Dup scan/lwr xtr vasc stdy bilat 93924 $963.75 $963.75 $963.75 $963.75
Dup scan/ue art/graft/bilat/comp 93930 $782.25 $782.25 $782.25 $819.60
Duplex scan bilateral study 93985 $657.75 $657.75 $657.75 $692.40
Duplex scan unilateral study 93986 $124.50 $124.50 $124.50 $375.60
Dura-guard dura repair patch 10x16cm -q4432-cost per sq cm-160sq cm $23,482.80 $23,482.80 $23,482.80 $23,482.80
Dx aly aud oi snd prcsr 1st $183.00 $183.00 $183.00 $183.00
Dx bronchoscope/brush 31623 $2,283.00 $2,283.00 $2,283.00 $2,283.00
Dx bronchoscope/lavage 31624 $2,886.75 $2,886.75 $2,886.75 $2,886.75
Dx bronchoscope/wash 31622 $2,734.50 $2,734.50 $2,734.50 $2,322.60
Dxa bone density axl vrt fx $591.75 $591.75 $591.75 $591.75
E equine encephalitis igg $135.75 $135.75 $135.75 $135.75
ER Visit (level 1, minor) $312.00 $312.00 $312.00 $286.94
ER Visit (level 2) $510.00 $510.00 $510.00 $469.39
ER Visit (level 3) $850.50 $850.50 $850.50 $836.00
ER Visit (level 4) $1,334.25 $1,334.25 $1,334.25 $1,330.12
ER Visit (level 5, high severity) $4,134.00 $4,134.00 $4,134.00 $1,892.80
Ear and throat examination $579.00 $579.00 $579.00 $579.00
Ear canal biopsy 69105 $1,768.50 $1,768.50 $1,768.50 $1,768.50
Ear irrigation 69209 $216.75 $216.75 $216.75 $149.40
Ecg 12 lead tracing only $292.50 $292.50 $292.50 $271.80
Ecg < 30 days transmission & analysis $624.75 $624.75 $624.75 $624.75
Ecg external < 48 hours recording $500.25 $500.25 $500.25 $500.25
Ecg external < 48 hours scanning analysis w/report $567.00 $567.00 $567.00 $567.00
Ecg external > 48 hours up to 7 days recording $238.50 $238.50 $238.50 $75.00
Ecg external >7 days up to 15 days recording $238.50 $238.50 $238.50 $75.00
Echo exam of fetal heart $300.75 $300.75 $300.75 $300.75
Echo exam of fetal heart $644.25 $644.25 $644.25 $644.25
Echo exam of fetal heart $480.75 $480.75 $480.75 $480.75
Echo exam of fetal heart $576.75 $576.75 $576.75 $576.75
Echo exam uterus 76831- $825.75 $825.75 $825.75 $819.60
Echo guide for amniocentesis $680.25 $680.25 $680.25 $680.25
Echo guide for artery repair $1,386.00 $1,386.00 $1,386.00 $1,220.80
Echo guide for transfusion $317.25 $317.25 $317.25 $317.25
Echo guide villus sampling $693.75 $693.75 $693.75 $693.75
Echo stress $1,949.25 $1,949.25 $1,949.25 $1,737.60
Echo tee guidance $2,007.00 $2,007.00 $2,007.00 $2,007.00
Echo tee probe placement image acquisition interpretation & report $2,282.25 $2,282.25 $2,282.25 $2,057.25
Echo transesophageal $1,826.25 $1,826.25 $1,826.25 $1,826.25
Echo transesophageal intraop $1,165.50 $1,165.50 $1,165.50 $1,165.50
Echo transthoracic $1,922.25 $1,922.25 $1,922.25 $1,475.25
Echo transthoracic $1,341.75 $1,341.75 $1,341.75 $693.75
Echo tte 2d comp wo ctrst wo clr/dplr $1,278.75 $1,278.75 $1,278.75 $1,278.75
Echocardiogram (Heart Ultrasound) $2,126.25 $2,126.25 $2,126.25 $2,024.64
Echocardiography doppler color flow mapping $407.25 $407.25 $407.25 $480.00
Echocardiography transthoracic 2d complete w/contrast or without & w/contrast with doppler $2,126.25 $2,126.25 $2,126.25 $2,126.25
Echocardiography transthoracic 2d followup/limited $939.00 $939.00 $939.00 $841.20
Echocardiography transthoracic 2d followup/limited w/contrast or without & w/contrast $939.00 $939.00 $939.00 $900.00
Echocardiograpy doppler follow up/limited study $350.25 $350.25 $350.25 $350.25
Ecmo/ecls daily mgmt artery 33949 $4,409.25 $4,409.25 $4,409.25 $4,409.25
Ecmo/ecls daily mgmt-venous 33948 $4,324.50 $4,324.50 $4,324.50 $4,324.50
Ecmo/ecls initiation artery 33947 $3,066.75 $3,066.75 $3,066.75 $1,826.25
Ecmo/ecls initiation venous 33946 $4,324.50 $4,324.50 $4,324.50 $4,324.50
Ecmo/ecls insj prph cannula 6yrs&older perq 33952 $15,762.00 $15,762.00 $15,762.00 $9,378.75
Eculizumab 300 mg/30 ml intravenous solution $22,430.49 $22,430.49 $22,430.49 $268.80
Edetate calcium disodium inj $20,833.61 $20,833.61 $20,833.61 $20,833.61
Eeg 41-60 minutes 95812-26 $1,081.50 $1,081.50 $1,081.50 $1,081.50
Eeg during surgery $1,512.75 $1,512.75 $1,512.75 $1,512.75
Eeg monitor/record/awake/drowsy 95816 $1,099.50 $1,099.50 $1,099.50 $1,099.50
Eeg monitoring/function test $2,747.25 $2,747.25 $2,747.25 $2,747.25
Eeg over 1 hour 95813 - 26 $1,523.25 $1,523.25 $1,523.25 $1,440.75
Eeg recording awake and asleep $1,173.00 $1,173.00 $1,173.00 $1,173.00
Eeg without vid 2-12 hr unmntr $364.50 $364.50 $364.50 $364.50
Eeg without vid 2-12hr cont mntr $2,025.00 $2,025.00 $2,025.00 $2,025.00
Eeg without vid ea 12-26hr cont $4,050.00 $4,050.00 $4,050.00 $4,050.00
Eeg without vid ea 12-26hr intmt $2,361.75 $2,361.75 $2,361.75 $1,502.40
Eeg wo vid 2-12hr intmt mntr $1,181.25 $1,181.25 $1,181.25 $1,181.25
Eeg wo vid ea 12-26hr unmntr $364.50 $364.50 $364.50 $530.60
Eeg/cerebral death evaluation only 95824 -26 $1,116.75 $1,116.75 $1,116.75 $1,133.40
Eeg/record in coma or sleep only 95822 $1,091.25 $1,091.25 $1,091.25 $1,091.25
Egd Ultrasound exam duodenum/jejunum $3,135.75 $3,135.75 $3,135.75 $3,135.75
Egd Ultrasound fine needle bx/aspir $4,259.25 $4,259.25 $4,259.25 $4,026.00
Egd Ultrasound fine needle bx/aspir $3,514.50 $3,514.50 $3,514.50 $3,514.50
Egd Ultrasound transmural injxn/mark $4,423.50 $4,423.50 $4,423.50 $4,128.80
Egd balloon dil esoph30 mm/> $2,440.50 $2,440.50 $2,440.50 $2,440.50
Egd control bleeding any $2,553.75 $2,553.75 $2,553.75 $2,553.75
Egd dilate stricture $3,148.50 $3,148.50 $3,148.50 $3,148.50
Egd endo mucosal resection $4,083.75 $4,083.75 $4,083.75 $4,041.75
Egd endoscopic stent place $4,379.25 $4,379.25 $4,379.25 $4,379.25
Egd esophagogastrc fndoplsty $11,934.00 $11,934.00 $11,934.00 $11,934.00
Egd flx trnsorl rmvl balo $1,051.50 $1,051.50 $1,051.50 $1,051.50
Egd guide wire insertion $2,765.25 $2,765.25 $2,765.25 $2,765.25
Egd injection varices $2,571.75 $2,571.75 $2,571.75 $2,571.75
Egd lesion ablation $3,672.75 $3,672.75 $3,672.75 $3,634.50
Egd remove foreign body $2,295.00 $2,295.00 $2,295.00 $2,295.00
Egd remove lesion snare $2,597.25 $2,597.25 $2,597.25 $2,597.25
Egd varices ligation $3,264.00 $3,264.00 $3,264.00 $3,264.00
Egd w/thrml txmnt gerd $5,043.00 $5,043.00 $5,043.00 $5,043.00
Egd w/transmural drain cyst $4,379.25 $4,379.25 $4,379.25 $4,379.25
Egd/insert intraluminal tube/cath 43241 $2,502.75 $2,502.75 $2,502.75 $2,502.75
Egd/remov tum/polyp/hot bx forcep 43250 $2,736.75 $2,736.75 $2,736.75 $2,736.75
Ehrlicha chaffeensis amp prb $105.00 $105.00 $105.00 $105.00
Elec analys infus pump w/reprog 62368 $669.75 $669.75 $669.75 $669.75
Elect analysis of infusion pump 62367 $509.25 $509.25 $509.25 $509.25
Electrd sq emblem s-icd $12,127.50 $12,127.50 $12,127.50 $12,127.50
Electrical stimulation/unattended 97014 $125.25 $125.25 $125.25 $125.25
Electroacous eval hear aid/biaural 92595 $97.50 $97.50 $97.50 $97.50
Electrocochleography $1,054.50 $1,054.50 $1,054.50 $1,054.50
Electroconvulsive therapy 90870 $1,353.00 $1,353.00 $1,353.00 $1,353.00
Electrocorticography durng sx $4,220.25 $4,220.25 $4,220.25 $1,450.50
Electrode stimulation brain $1,137.75 $1,137.75 $1,137.75 $1,137.75
Electrolyte panel $120.00 $120.00 $120.00 $120.00
Electron microscopy diagnostic $2,129.25 $2,129.25 $2,129.25 $1,968.75
Electronic analysis with brain program ea add 15 min 95984 $642.00 $642.00 $642.00 $642.00
Electronic analysis with brain program first 15 min 95983 $1,237.50 $1,237.50 $1,237.50 $1,237.50
Electrophys map 3d add-on $8,985.00 $8,985.00 $8,985.00 $8,231.40
Electrophysiologic study $10,470.75 $10,470.75 $10,470.75 $10,470.75
Electrophysiology evaluation $5,625.00 $5,625.00 $5,625.00 $5,625.00
Electrophysiology evaluation $3,121.50 $3,121.50 $3,121.50 $3,064.20
Electrophysiology evaluation $10,838.25 $10,838.25 $10,838.25 $10,838.25
Electrophysiology evaluation $13,146.75 $13,146.75 $13,146.75 $13,146.75
Electrophysiology evaluation $6,516.00 $6,516.00 $6,516.00 $6,516.00
Electrophysiology evaluation $3,130.50 $3,130.50 $3,130.50 $3,130.50
Elotuzumab 300 mg intravenous solution $11,443.25 $11,443.25 $11,443.25 $11,443.25
Emb w/colposcopy 58110 $1,077.00 $1,077.00 $1,077.00 $1,077.00
Emb without cervical dilation 58100 $1,692.75 $1,692.75 $1,692.75 $1,692.75
Embo or occlude vascular arterial s&i $13,812.00 $13,812.00 $13,812.00 $13,812.00
Embo or occlude vascular hemorrhage s&i $11,680.50 $11,680.50 $11,680.50 $11,680.50
Embo or occlude vascular tumor/organ/infarct s&i $11,680.50 $11,680.50 $11,680.50 $11,680.50
Embo or occlude vascular venous s&i $15,038.25 $15,038.25 $15,038.25 $13,903.50
Embolization s&i $6,008.25 $6,008.25 $6,008.25 $6,008.25
Emg 2 ext w-w/o paraspinal area 95861 $725.25 $725.25 $725.25 $687.75
Emg 3 ext w-w/o paraspinal area 95863 $869.25 $869.25 $869.25 $869.25
Emg cranial nerve bilateral $807.00 $807.00 $807.00 $768.00
Emg needle test 1-extremity $398.25 $398.25 $398.25 $398.25
Emg needle test 4-extremities $1,050.00 $1,050.00 $1,050.00 $1,050.00
Emg thor paraspinal without t1/t2 $383.25 $383.25 $383.25 $383.25
Encephalitis, california igg/igm $135.75 $135.75 $135.75 $135.75
Encephalitis, st louis igg/igm $135.75 $135.75 $135.75 $135.75
Encephalitis, western equine igg/igm $135.75 $135.75 $135.75 $135.75
Endo abl/incom vein/ext/laser/#1 36478 $6,948.00 $6,948.00 $6,948.00 $6,948.00
Endo abl/incom vein/ext/rad fre/#1 36475 $6,527.25 $6,527.25 $6,527.25 $6,527.25
Endo cath bile duct s&i $864.00 $864.00 $864.00 $950.40
Endo cath panc duct s&i $771.75 $771.75 $771.75 $810.75
Endo cholangiopancreatograph $3,536.25 $3,536.25 $3,536.25 $3,804.53
Endo cholangiopancreatograph $3,543.00 $3,543.00 $3,543.00 $3,543.00
Endo outlet restrict w/tube $12,180.75 $12,180.75 $12,180.75 $12,180.75
Endo sleeve gastro w/tube $12,180.75 $12,180.75 $12,180.75 $12,180.75
Endocerv curettage w/scope 57456 $592.50 $592.50 $592.50 $592.50
Endocervical curettage 57505 $956.25 $956.25 $956.25 $956.25
Endoluminal bx urtr rnl plvs $1,203.00 $1,203.00 $1,203.00 $1,203.00
Endoluminl ivus oct c 1st $3,315.00 $3,315.00 $3,315.00 $3,315.00
Endoluminl ivus oct c ea $3,258.00 $3,258.00 $3,258.00 $3,258.00
Endoscopic Ultrasound exam esoph $3,226.50 $3,226.50 $3,226.50 $3,226.50
Endoscopic pancreatoscopy $2,117.25 $2,117.25 $2,117.25 $2,117.25
Endoscopy bowel pouch/biop $2,199.75 $2,199.75 $2,199.75 $2,199.75
Endoscopy of bowel pouch 44385 $2,187.00 $2,187.00 $2,187.00 $2,187.00
Endoscopy swallow (fees) vid $551.25 $551.25 $551.25 $551.25
Endoscpy nsl/sns w/cntrl nsl hmrrgh $2,209.50 $2,209.50 $2,209.50 $2,287.20
Endovasc rpr a-biiliac endogft 34705 $10,604.25 $10,604.25 $10,604.25 $10,604.25
Endovasc tempory vessel occl $8,869.50 $8,869.50 $8,869.50 $8,869.50
Endoven ther chem adhes 1st 36482 $3,548.25 $3,548.25 $3,548.25 $3,548.25
Endoven ther chem adhes sbsq 36483 $4,050.75 $4,050.75 $4,050.75 $4,050.75
Endovenous laser vein addon 36479 $2,203.50 $2,203.50 $2,203.50 $2,203.50
Endovenous rf abl vein addl $6,432.75 $6,432.75 $6,432.75 $3,909.00
Enfortumab vedotin-ejfv 20 mg intravenous solution $15,579.42 $15,579.42 $15,579.42 $72.00
Enoxaparin 30 mg/0.3 ml subcutaneous syringe $109.71 $109.71 $109.71 $77.00
Entamoeba histolytica ag eia - sendout $89.25 $89.25 $89.25 $89.25
Enzyme cell activity ra $1,045.50 $1,045.50 $1,045.50 $1,045.50
Enzyme histochemistry $648.75 $648.75 $648.75 $648.75
Ep & ablate supravent arrhyt $23,285.25 $23,285.25 $23,285.25 $24,376.50
Ep & ablate ventric tachy $36,500.25 $36,500.25 $36,500.25 $36,500.25
Ep induct arrhy by elect pacing $3,894.75 $3,894.75 $3,894.75 $3,894.75
Epidural lysis on single day 62264 $2,673.00 $2,673.00 $2,673.00 $2,673.00
Epidural/lumbar/sacral/ea add level64484 $1,182.00 $1,182.00 $1,182.00 $1,461.00
Epinephrine 0.1 mg/ml injection syringe $831.94 $831.94 $831.94 $831.94
Epinephrine 1 mg/ml im kit - adult $424.18 $424.18 $424.18 $424.18
Epinephrine hcl (pf) 1 mg/ml (1 ml) injection solution $46.16 $46.16 $46.16 $46.16
Epirubicin 200 mg/100 ml intravenous solution $161.59 $161.59 $161.59 $161.59
Episiotomy/vag rpr oth/thn attending phys 59300 $2,952.75 $2,952.75 $2,952.75 $2,952.75
Epoetin alfa in ns IV syringe 100 unit/ml (neo/ped) - cnr $379.58 $379.58 $379.58 $379.58
Epoetin alfa-epbx 40,000 unit/ml injection solution $336.66 $336.66 $336.66 $336.66
Epoprostenol (arginine) 1 mg in 50 ml ns inhalation syringe - cnr $208.65 $208.65 $208.65 $208.65
Epstein barr early antigen antibody $136.50 $136.50 $136.50 $136.50
Epstein barr nuclear antigen antibody $120.75 $120.75 $120.75 $120.75
Epstein barr viral capsid antigen antibody igm $120.75 $120.75 $120.75 $120.75
Eptifibatide 0.75 mg/ml intravenous solution $924.38 $924.38 $924.38 $924.38
Eptinezumab-jjmr 100 mg/ml intravenous solution $7,173.42 $7,173.42 $7,173.42 $4,849.80
Ercp bil/panc duct; each stent plcmt 43274 $4,379.25 $4,379.25 $4,379.25 $4,379.25
Ercp biliary & pancreas $943.50 $943.50 $943.50 $975.00
Ercp ea duct/ampulla dilate $4,199.25 $4,199.25 $4,199.25 $4,199.25
Ercp lesion ablate w/dilate 43278 $5,948.25 $5,948.25 $5,948.25 $5,886.75
Ercp lithotripsy calculi $4,379.25 $4,379.25 $4,379.25 $4,379.25
Ercp remove duct calculi 43264 $3,955.50 $3,955.50 $3,955.50 $3,955.50
Ercp remove forgn body duct 43275 $3,726.00 $3,726.00 $3,726.00 $3,726.00
Ercp sphincter pressure meas $3,552.00 $3,552.00 $3,552.00 $3,552.00
Ercp stent exchange w/dilate $4,497.75 $4,497.75 $4,497.75 $4,497.75
Ercp w/specimen collection $4,277.25 $4,277.25 $4,277.25 $4,277.25
Eribulin 1 mg/2 ml (0.5 mg/ml) intravenous solution $5,213.48 $5,213.48 $5,213.48 $1,355.40
Ertapenem 1000 mg/10 ml IV (dilution #1) desensitization - cnr $107.31 $107.31 $107.31 $107.31
Erythromycin in ns IV syringe 5 mg/ml (neo/ped) - cnr $209.75 $209.75 $209.75 $209.75
Esd endoscopy or colonoscopy $4,440.75 $4,440.75 $4,440.75 $4,440.75
Esmolol 2,500 mg/250 ml (10 mg/ml) IV wrapper osm only $240.34 $240.34 $240.34 $11.80
Esoph balloon distension tst $622.50 $622.50 $622.50 $622.50
Esoph egd dilation <30 mm $2,597.25 $2,597.25 $2,597.25 $2,597.25
Esoph endoscopy dilation $2,205.75 $2,205.75 $2,205.75 $2,205.75
Esoph imped funct test > 1hr $1,232.25 $1,232.25 $1,232.25 $1,232.25
Esoph imped function test $1,190.25 $1,190.25 $1,190.25 $1,190.25
Esoph scope w/sclerosis inj $1,968.00 $1,968.00 $1,968.00 $1,968.00
Esoph scope w/submucous inj $3,268.50 $3,268.50 $3,268.50 $3,268.50
Esophageal dilat s&i $787.50 $787.50 $787.50 $787.50
Esophageal recording $5,991.75 $5,991.75 $5,991.75 $5,991.75
Esophagosc dilate balloon 30 $2,101.50 $2,101.50 $2,101.50 $2,101.50
Esophagosc flex trnsn biopsy $2,230.50 $2,230.50 $2,230.50 $2,230.50
Esophagoscop mucosal resect $3,837.00 $3,837.00 $3,837.00 $3,837.00
Esophagoscop stent placement $6,977.25 $6,977.25 $6,977.25 $6,977.25
Esophagoscop ultrasound exam $3,936.00 $3,936.00 $3,936.00 $3,895.50
Esophagoscopy balloon <30mm $3,333.00 $3,333.00 $3,333.00 $3,333.00
Esophagoscopy control bleed $3,333.00 $3,333.00 $3,333.00 $3,333.00
Esophagoscopy flex biopsy $2,676.75 $2,676.75 $2,676.75 $2,676.75
Esophagoscopy flex dx brush $1,930.50 $1,930.50 $1,930.50 $1,930.50
Esophagoscopy flex remove fb $289.50 $289.50 $289.50 $1,788.60
Esophagoscopy lesion ablate $2,951.25 $2,951.25 $2,951.25 $2,951.25
Esophagoscopy lesion removal $3,778.50 $3,778.50 $3,778.50 $3,778.50
Esophagoscopy retro balloon $2,101.50 $2,101.50 $2,101.50 $2,101.50
Esophagoscopy snare les remv $3,438.00 $3,438.00 $3,438.00 $3,438.00
Esophagoscopy w/us needle bx $4,181.25 $4,181.25 $4,181.25 $4,137.60
Esophagoscopy/flex/diagnostic 43200 $2,623.50 $2,623.50 $2,623.50 $2,623.50
Esophagoscopy/rigid/diagnostic 43191 $2,690.25 $2,690.25 $2,690.25 $2,690.25
Esophagus endoscopy/ligation $3,386.25 $3,386.25 $3,386.25 $3,386.25
Esophagus motility study $1,332.75 $1,332.75 $1,332.75 $1,332.75
Esophgl motil w/stim/perfus $1,341.75 $1,341.75 $1,341.75 $1,341.75
Establish access to aorta $1,294.50 $1,294.50 $1,294.50 $1,294.50
Establish access to artery $2,063.25 $2,063.25 $2,063.25 $2,063.25
Established Patient Office Visit (level 1) $109.50 $109.50 $109.50 $109.50
Established Patient Office Visit (level 2) $114.00 $114.00 $114.00 $127.53
Established Patient Office Visit (level 3) $126.00 $126.00 $126.00 $183.00
Established Patient Office Visit (level 4) $147.75 $147.75 $147.75 $216.00
Established Patient Office Visit (level 5) $168.75 $168.75 $168.75 $291.00
Estradiol total $174.00 $174.00 $174.00 $174.00
Estrogens total-sendout $270.00 $270.00 $270.00 $270.00
Etanercept injection $7,314.47 $7,314.47 $7,314.47 $7,314.47
Ethanolamine oleate 100 mg $1,622.73 $1,622.73 $1,622.73 $1,622.73
Ethylene glycol -sendout $79.50 $79.50 $79.50 $95.25
Etonogestrel implant system $4,715.65 $4,715.65 $4,715.65 $4,715.65
Etoposide 20 mg/ml intravenous solution $213.17 $213.17 $213.17 $213.17
Etoposide 50 mg cap $5,934.05 $5,934.05 $5,934.05 $5,934.05
Euflexxa inj per dose $1,186.77 $1,186.77 $1,186.77 $1,186.77
Evacuate mole of uterus $5,835.00 $5,835.00 $5,835.00 $5,835.00
Eval aud rehab status/first hr 92626 $219.00 $219.00 $219.00 $219.00
Eval/fit voice prosthesis iii, st $431.25 $431.25 $431.25 $431.25
Evaluation cervicovaginal fluid for specific amniotic fluid proteins qualitative each specimen $237.00 $237.00 $237.00 $237.00
Evaluation heart device $3,057.00 $3,057.00 $3,057.00 $3,057.00
Evaluation of speech fluency 92521 $393.00 $393.00 $393.00 $393.00
Evaluation psychiatric diagnostic $509.25 $509.25 $509.25 $394.50
Evasc prlng admn rx agnt 1st $2,127.75 $2,127.75 $2,127.75 $2,127.75
Evasc prlng admn rx agnt add $272.25 $272.25 $272.25 $272.25
Evasc repair of iliac artery; endograft 34718 $15,243.75 $15,243.75 $15,243.75 $15,243.75
Evasc rpr a-ao ndgft 34701 $3,078.00 $3,078.00 $3,078.00 $3,078.00
Evasc rpr a-ao ndgft rpt 34702 $2,142.00 $2,142.00 $2,142.00 $2,142.00
Evasc rpr a-biiliac ndgft rptr $15,243.75 $15,243.75 $15,243.75 $12,276.00
Evasc rpr a-iliac ndgft 34717 $15,243.75 $15,243.75 $15,243.75 $15,243.75
Evasc rpr a-unilac ndgft 34703 $3,078.00 $3,078.00 $3,078.00 $3,078.00
Evasc rpr a-unilac ndgft rpt $10,196.25 $10,196.25 $10,196.25 $10,196.25
Evasc rpr ilio-iliac ndgft $1,826.25 $1,826.25 $1,826.25 $1,826.25
Evasc rpr ilio-iliac rpt $1,826.25 $1,826.25 $1,826.25 $1,826.25
Event monitor $330.00 $330.00 $330.00 $330.00
Evok oa screening qual $286.50 $286.50 $286.50 $286.50
Evoked auditory tst complete $628.50 $628.50 $628.50 $628.50
Evoked oa emissions ltd $234.00 $234.00 $234.00 $234.00
Evoked potential visual not glaucoma $1,172.25 $1,172.25 $1,172.25 $1,172.25
Evoked potentials auditory screening automated analysis $632.25 $632.25 $632.25 $632.25
Evoked potentials upper limbs $1,179.00 $1,179.00 $1,179.00 $978.60
Ex palate/uvula lesion without closure 42104 $3,629.25 $3,629.25 $3,629.25 $3,629.25
Ex sq tumor/face or scalp 2 cm/> 21012 $3,845.25 $3,845.25 $3,845.25 $3,845.25
Ex sq tumor/face or scalp < 2 cm 21011 $2,397.75 $2,397.75 $2,397.75 $2,397.75
Exam of vagina w/scope 57420 $1,230.00 $1,230.00 $1,230.00 $1,230.00
Exc arm/elbo les sc <3cm 24075 $1,880.25 $1,880.25 $1,880.25 $1,880.25
Exc back les sbq <3 cm 21930 $2,531.25 $2,531.25 $2,531.25 $2,531.25
Exc ben+marg excep skin tag feenlm 1.1-2cm 11442 $2,448.00 $2,448.00 $2,448.00 $2,448.00
Exc ben+marg excep skin tag feenlm 2.1-3cm 11443 $2,319.75 $2,319.75 $2,319.75 $2,319.75
Exc ben+marg excep skin tag feenlm <0.5cm 11440 $1,447.50 $1,447.50 $1,447.50 $1,447.50
Exc ben+marg excep skin tag snhfg 0.6-1cm 11421 $1,989.75 $1,989.75 $1,989.75 $1,989.75
Exc ben+marg excep skin tag snhfg 2.1-3cm 11423 $1,967.25 $1,967.25 $1,967.25 $1,967.25
Exc ben+marg excep skin tag snhfg >4cm 11426 $3,483.00 $3,483.00 $3,483.00 $3,483.00
Exc ben+marg excep skin tag tal 0.6-1cm 11401 $2,131.50 $2,131.50 $2,131.50 $2,131.50
Exc ben+marg excep skin tag tal 2.1-3/>cm 11403 $1,743.00 $1,743.00 $1,743.00 $1,743.00
Exc benign feenlm 3.1-4.0cm 11444 $3,069.75 $3,069.75 $3,069.75 $2,979.60
Exc benign snhfg 3.1-4.0cm 11424 $2,306.25 $2,306.25 $2,306.25 $2,306.25
Exc benign tal 0.5 < cm 11400 $2,040.00 $2,040.00 $2,040.00 $1,703.40
Exc face tum deep 2cm/> 21014 $6,184.50 $6,184.50 $6,184.50 $6,184.50
Exc feenl mal+mrg 2.1-3 11643 $2,185.50 $2,185.50 $2,185.50 $2,185.50
Exc forearm les sc 3 cm/> $3,778.50 $3,778.50 $3,778.50 $3,778.50
Exc hand les sc < 1.5 cm $1,897.50 $1,897.50 $1,897.50 $1,897.50
Exc hidradenitis peri/umb int 11470 $3,294.00 $3,294.00 $3,294.00 $3,294.00
Exc im tumor/shoulder area 5cm/> 23073 $3,294.00 $3,294.00 $3,294.00 $3,294.00
Exc les/mucos/sub/ves mouth/no rpr 40810 $3,401.25 $3,401.25 $3,401.25 $3,401.25
Exc mal+marg tal 1.1-2 cm 11602 $2,151.75 $2,151.75 $2,151.75 $2,151.75
Exc mal+marg tal 2.1-3 cm 11603 $1,521.75 $1,521.75 $1,521.75 $1,521.75
Exc mal+marg tal 3.1-4 cm 11604 $1,891.50 $1,891.50 $1,891.50 $1,891.50
Exc malig feenl 1.1-2 11642 $2,185.50 $2,185.50 $2,185.50 $2,185.50
Exc malig snhfg 2.1-3 cm 11623 $2,306.25 $2,306.25 $2,306.25 $2,306.25
Exc malig tal 0.6-1.0cm 11601 $1,407.75 $1,407.75 $1,407.75 $1,407.75
Exc malig tal <0.5cm 11600 $1,407.75 $1,407.75 $1,407.75 $1,407.75
Exc neck tum deep 5 cm/> $3,294.00 $3,294.00 $3,294.00 $3,294.00
Exc prtl bn phlnx toe $3,752.25 $3,752.25 $3,752.25 $3,752.25
Exc snhfg mal+mrg 1.1-2 11622 $2,185.50 $2,185.50 $2,185.50 $2,185.50
Exc snhfg mal+mrg 3.1-4 11624 $2,444.25 $2,444.25 $2,444.25 $2,444.25
Exc sq tum/neck or ant thorax <3cm 21555 $4,381.50 $4,381.50 $4,381.50 $4,381.50
Exc sq tum/neck/ant thorax 3cm/> 21552 $5,280.00 $5,280.00 $5,280.00 $5,280.00
Exc sq tum/vasc malform/hand/fngr 26111 $1,897.50 $1,897.50 $1,897.50 $1,897.50
Exc sq tumor/forearm/wrist/<3cm 25075 $1,897.50 $1,897.50 $1,897.50 $1,897.50
Exc sq tumor/leg/ankle 3cm/> 27632 $4,661.25 $4,661.25 $4,661.25 $4,661.25
Exc sq tumor/thigh/knee area 3cm/> 27337 $3,293.25 $3,293.25 $3,293.25 $3,293.25
Exc thigh/knee les sc<3cm 27327 $1,897.50 $1,897.50 $1,897.50 $1,897.50
Exc thrombosed hemorrhoid 46320 $5,596.50 $5,596.50 $5,596.50 $4,867.50
Exc tmr sft tiss shldr subq <3cm $1,880.25 $1,880.25 $1,880.25 $1,880.25
Exc tr-ext mal+marg tal >4 cm 11606 $2,732.25 $2,732.25 $2,732.25 $2,732.25
Exc/pilonidal cyst/sinus/simple 11770 $3,163.50 $3,163.50 $3,163.50 $3,163.50
Exchange biliary drg cath $2,959.50 $2,959.50 $2,959.50 $2,959.50
Exchange drainage catheter $2,774.25 $2,774.25 $2,774.25 $2,774.25
Exchange nephrostomy cath $2,515.50 $2,515.50 $2,515.50 $2,515.50
Excise anal ext tag/papilla $1,380.00 $1,380.00 $1,380.00 $1,380.00
Excise lip or cheek fold $2,247.75 $2,247.75 $2,247.75 $2,247.75
Excise/repair mouth lesion $3,501.00 $3,501.00 $3,501.00 $3,501.00
Excision benign lesion face/ears/eyelids/nose/lips/muc memb 0.6 - 1.0 cm $1,447.50 $1,447.50 $1,447.50 $1,447.50
Excision benign lesion scalp/neck/hands/feet/genitalia 1.1 - 2.0 cm $2,064.75 $2,064.75 $2,064.75 $2,064.75
Excision benign lesion trunk/arms/legs 1.1 - 2.0 cm $1,520.25 $1,520.25 $1,520.25 $1,520.25
Excision benign lesion trunk/arms/legs > 4.0 cm $3,723.75 $3,723.75 $3,723.75 $3,510.75
Excision lesion mouth roof $3,600.75 $3,600.75 $3,600.75 $3,600.75
Excision of anal lesion(s) $3,190.50 $3,190.50 $3,190.50 $3,190.50
Excision of penis lesion(s) 54060 $2,371.50 $2,371.50 $2,371.50 $2,371.50
Excision of tongue lesion $3,732.00 $3,732.00 $3,732.00 $3,732.00
Excision tumor soft tissue back/flank subcutaneous >= 3 cm $3,255.75 $3,255.75 $3,255.75 $3,255.75
Exercise tst brncspsm w/ecg $337.50 $337.50 $337.50 $337.50
Exercise w/hemodynamic meas $3,198.75 $3,198.75 $3,198.75 $3,198.75
Exome sequence analysis $7,002.00 $7,002.00 $7,002.00 $7,002.00
Expander breast 300cc mod hght extra proj smth natrelle $4,848.75 $4,848.75 $4,848.75 $4,151.40
Expander tiss 133s-mv-12-t 300ml natrelle smth $7,852.50 $7,852.50 $7,852.50 $7,852.50
Explore penetrating wnd/extremity 20103 $1,971.00 $1,971.00 $1,971.00 $2,421.60
Explore woundchest 20101 $2,113.50 $2,113.50 $2,113.50 $2,113.50
Explore/treat knee joint $4,723.50 $4,723.50 $4,723.50 $4,723.50
Ext ecg>48hr<7d scan a/r $238.50 $238.50 $238.50 $238.50
Ext ecg>7d<15d scan a/r $238.50 $238.50 $238.50 $238.50
Extended visual field xm $162.75 $162.75 $162.75 $162.75
External chromosome analysis 20-25 cells $457.50 $457.50 $457.50 $462.00
External tissue culture neoplastic disorders bone marrow/blood cells $943.50 $943.50 $943.50 $943.50
Extractable nuclear antigen/antibody any method each antibody centromere $234.00 $234.00 $234.00 $234.00
Eye implant band 40 $356.07 $356.07 $356.07 $356.07
F-18 fdg pet diag $2,773.11 $2,773.11 $2,773.11 $2,773.11
F-18 florbetapir less than or equal to 10 mci $5,679.38 $5,679.38 $5,679.38 $5,679.38
Facial bones <3 $570.00 $570.00 $570.00 $405.00
Factor ix $254.25 $254.25 $254.25 $223.80
Factor ix alprolix recomb $38,712.83 $38,712.83 $38,712.83 $38,712.83
Factor ix complex $4,991.63 $4,991.63 $4,991.63 $4,991.63
Factor ix idelvion inj $36,235.50 $36,235.50 $36,235.50 $36,235.50
Factor ix recombinant nos $7,321.05 $7,321.05 $7,321.05 $7,321.05
Factor viii $274.50 $274.50 $274.50 $239.40
Factor viii fc fusion recomb $17,969.85 $17,969.85 $17,969.85 $17,969.85
Factor viii pegylated recomb $11.10 $11.10 $11.10 $11.10
Factor viii recomb obizur $5,435.33 $5,435.33 $5,435.33 $5,435.33
Factor viii recombinant nos $11.10 $11.10 $11.10 $11.10
Factor xiii recomb a-subunit $68.26 $68.26 $68.26 $68.26
Fallopian tube recnl $3,624.75 $3,624.75 $3,624.75 $3,179.53
Family therapy with patient 50 min 90847 $297.00 $297.00 $297.00 $297.00
Family therapy without pt 50min 90846 $309.75 $309.75 $309.75 $309.75
Famotidine in ns IV syringe 0.4 mg/ml (neo/ped) - cnr $8.88 $8.88 $8.88 $0.40
Fatty acids nonesterified $121.50 $121.50 $121.50 $121.50
Fda ide #g240020 carry bag $956.25 $956.25 $956.25 $956.25
Fecal microbiota prep instil $1,059.00 $1,059.00 $1,059.00 $1,059.00
Felbamate (felbatol(r)) - sendout $97.50 $97.50 $97.50 $97.50
Feno poc $153.75 $153.75 $153.75 $153.75
Fentanyl citrate (pf) 50 mcg/ml injection for compounding (wrapper) $35.94 $35.94 $35.94 $35.94
Ferric carboxymaltose 50 mg iron/ml intravenous solution $3,736.68 $3,736.68 $3,736.68 $3,736.68
Ferritin $242.25 $242.25 $242.25 $242.25
Ferumoxytol 510 mg/17 ml (30 mg/ml) intravenous solution $4,030.11 $4,030.11 $4,030.11 $4,030.11
Fetal biophys profile w/nst 76818 $831.75 $831.75 $831.75 $831.75
Fetal contract stress test 59020 - 26 $267.75 $267.75 $267.75 $267.75
Fetal hemoglobin rosette $204.00 $204.00 $204.00 $128.25
Fetal non stress test $478.50 $478.50 $478.50 $451.20
Fetal shunt placement w/us $355.50 $355.50 $355.50 $355.50
Fibrin degradation d dimer quantitative $162.00 $162.00 $162.00 $93.60
Fibrin degradation products $171.00 $171.00 $171.00 $171.00
Fibrinogen activity $113.25 $113.25 $113.25 $113.25
Fibrinolysins/coagulopathy screen interpretation/report $72.00 $72.00 $72.00 $72.00
Fibrinolytic antiplasmin $103.50 $103.50 $103.50 $84.00
Fibrinolytic plasminogen $650.25 $650.25 $650.25 $650.25
Fibrinolytic plasminogen xcpt antgnc asa $544.50 $544.50 $544.50 $225.00
Filgrastim in d5w IV syringe 20 mcg/ml (neo) - cnr $1,964.97 $1,964.97 $1,964.97 $1,964.97
Filgrastim-aafi 300 mcg/0.5 ml subcutaneous syringe $492.48 $492.48 $492.48 $492.48
Filgrastim-sndz 300 mcg/0.5 ml injection syringe $1,504.82 $1,504.82 $1,504.82 $1,504.82
Filter spider fx 3mmx320cm $8,212.50 $8,212.50 $8,212.50 $8,212.50
Filter vena cava fem denali $4,659.75 $4,659.75 $4,659.75 $4,659.75
Filtered speech hearing test $237.00 $237.00 $237.00 $237.00
Fine needle asp without image guide 10021 $642.75 $642.75 $642.75 $668.25
Fine needle aspiration biopsy w/fluor gdn; ea addtl 10008 $1,165.50 $1,165.50 $1,165.50 $954.00
Fine needle aspiration biopsy w/fluor gdn;1st lesion 10007 $1,219.50 $1,219.50 $1,219.50 $1,085.40
Fine needle aspiration biopsy w/us gdn; ea addtl 10006 $1,165.50 $1,165.50 $1,165.50 $833.25
Fine needle aspiration biopsy without img gdn; ea addtl 10004 $226.50 $226.50 $226.50 $226.50
Fixation of knee joint $1,863.75 $1,863.75 $1,863.75 $1,863.75
Fl exam g/colon tube w contrast $565.50 $565.50 $565.50 $602.40
Flebogamma injection $3,562.92 $3,562.92 $3,562.92 $3,562.92
Flecainide (tambocor)-sendout $96.00 $96.00 $96.00 $96.00
Flexible Sigmoidoscopy $1,763.25 $1,763.25 $1,763.25 $1,278.72
Flow cytometry marker each additional $181.50 $181.50 $181.50 $181.50
Flow cytometry one marker technical component $270.75 $270.75 $270.75 $276.60
Floxuridine injection $14,923.11 $14,923.11 $14,923.11 $14,923.11
Flt3 gene $206.25 $206.25 $206.25 $206.25
Fluconazole 200 mg/100 ml in sod. chloride (iso) intravenous piggyback $24.41 $24.41 $24.41 $24.41
Fludarabine 50 mg intravenous solution $601.96 $601.96 $601.96 $601.96
Fluid pressure muscle 20950 $445.50 $445.50 $445.50 $445.50
Fluidotherapy charges pt $139.50 $139.50 $139.50 $121.50
Fluocinolone acetonide implt $70,344.94 $70,344.94 $70,344.94 $70,344.94
Fluorescent antibody titer dna $429.75 $429.75 $429.75 $202.20
Fluoroguide for spine inject 77003-26 $843.75 $843.75 $843.75 $843.75
Fluoroguide needle placement $599.25 $599.25 $599.25 $599.25
Fluoroscopy up to 1 hour $818.25 $818.25 $818.25 $647.20
Fluorouracil 50 mg/ml intravenous solution (wrapper) $203.74 $203.74 $203.74 $203.74
Fluphenazine decanoate 25 mg/ml injection solution $380.85 $380.85 $380.85 $380.85
Fmri brain by tech $1,157.25 $1,157.25 $1,157.25 $1,157.25
Fna bx w/ct gdn 1st les $900.75 $900.75 $900.75 $900.75
Fna bx w/ct gdn ea addl $847.50 $847.50 $847.50 $847.50
Fna bx w/mr gdn 1st les $900.75 $900.75 $900.75 $900.00
Fna bx w/mr gdn ea addl $847.50 $847.50 $847.50 $847.50
Folic acid $85.50 $85.50 $85.50 $89.40
Folic acid 5 mg/ml injection solution $78.99 $78.99 $78.99 $1.05
Follow-up angiography $2,599.50 $2,599.50 $2,599.50 $2,599.50
Fomepizole 1 gram/ml intravenous solution $1,261.49 $1,261.49 $1,261.49 $1,261.49
Fondaparinux sodium $121.83 $121.83 $121.83 $121.83
Foot X-ray $420.00 $420.00 $420.00 $339.50
Foreskn manip w/lss preputial ads+stretching 54450 $285.00 $285.00 $285.00 $285.00
Fosaprepitant 150 mg intravenous powder for solution $1,233.17 $1,233.17 $1,233.17 $1,233.17
Foscarnet sodium injection $1,101.86 $1,101.86 $1,101.86 $1,101.86
Fosphenytoin 50 mg pe/ml injection (wrapper) $94.85 $94.85 $94.85 $94.85
Fracture assessment via dxa $771.00 $771.00 $771.00 $616.50
Fragmenting of kidney stone $9,827.25 $9,827.25 $9,827.25 $9,827.25
Fresh frozen plasma 8-24 hours collection each unit $168.75 $168.75 $168.75 $243.00
Fresh frozen plasma frozen within 8 hours of collection each unit $223.50 $223.50 $223.50 $229.20
Fresh frozen plasma thawing ea un $131.25 $131.25 $131.25 $131.25
Fructosamine glycated protein $76.50 $76.50 $76.50 $80.25
Full thick gft/scalp/arm/leg/20sqcm or< 15220 $2,910.75 $2,910.75 $2,910.75 $2,910.75
Furosemide 10 mg/ml injection solution $19.53 $19.53 $19.53 $0.60
G-esoph reflx tst w/electrod $1,684.50 $1,684.50 $1,684.50 $1,557.75
G-tube reposition $631.50 $631.50 $631.50 $631.50
Ga-68 gallium 68 dotatate $156.00 $156.00 $156.00 $156.00
Gadobutrol 1 mmol/ml intravenous solution (wrapper) $177.43 $177.43 $177.43 $177.43
Gadoterate meglumine 0.5 mmol/ml (376.9 mg/ml) intravenous solution $119.29 $119.29 $119.29 $119.29
Gadoxetate 0.25 mmol/ml (181.43 mg/ml) intravenous solution $486.60 $486.60 $486.60 $90.60
Galac-1-phosphate uridyltran - sendout $85.50 $85.50 $85.50 $85.50
Galectin-3 $280.50 $280.50 $280.50 $94.40
Gamma glutamyltransferase $77.25 $77.25 $77.25 $77.25
Gammaglobulin iga $183.00 $183.00 $183.00 $183.00
Gammaglobulin ige $148.50 $148.50 $148.50 $148.50
Gamunex-c/gammaked $8,519.04 $8,519.04 $8,519.04 $8,519.04
Ganciclovir in ns IV syringe 10 mg/ml (neo/ped) - cnr $94.28 $94.28 $94.28 $264.80
Gastric motility studies $1,942.50 $1,942.50 $1,942.50 $1,688.25
Gastrin test $138.00 $138.00 $138.00 $138.00
Gastroesophageal reflux study $1,232.25 $1,232.25 $1,232.25 $1,232.25
Gastroesophageal reflux test $1,635.75 $1,635.75 $1,635.75 $1,531.20
Gel-syn injection 0.1 mg $1,330.04 $1,330.04 $1,330.04 $1,330.04
Gemcitabine 1 gram intravenous solution $168.02 $168.02 $168.02 $168.02
Gemtuzumab ozogamicin 4.5 mg (1 mg/ml initial concentration) IV soln $37,698.54 $37,698.54 $37,698.54 $37,698.54
Generator barostim neo2 2014 $83,687.18 $83,687.18 $83,687.18 $69,642.00
Generator emblem MRI sicd subq $61,875.00 $61,875.00 $61,875.00 $61,875.00
Genetic tstg severe inh cond $11,208.75 $11,208.75 $11,208.75 $11,208.75
Genome sequence analysis $8,306.25 $8,306.25 $8,306.25 $7,352.40
Gentamicin 10 mg/ml liquid compound - enteral use only $85.57 $85.57 $85.57 $80.40
Gentamicin peak therapeutic drug level $156.75 $156.75 $156.75 $156.75
Ghs HIV antibody $147.75 $147.75 $147.75 $129.75
Ghs IV inf sq injection, on-body injector $166.50 $166.50 $166.50 $147.00
Ghs IV infusion bamlanivimab/etesevimab $784.50 $784.50 $784.50 $784.50
Ghs IV infusion casirivimab/imdevimab $784.50 $784.50 $784.50 $784.50
Ghs IV infusion sotrovimab $784.50 $784.50 $784.50 $1,020.00
Ghs IV thrombolytics - cerebral $541.50 $541.50 $541.50 $541.50
Ghs abscess perianal iandd $2,153.25 $2,153.25 $2,153.25 $1,991.25
Ghs abscess postoperative iandd complex $4,318.50 $4,318.50 $4,318.50 $4,318.50
Ghs acetylcholinesterase, rbc $133.50 $133.50 $133.50 $133.50
Ghs alcohol, methyl (methanol)-medtox $858.00 $858.00 $858.00 $171.60
Ghs analysis neurostim without reprogramming $829.50 $829.50 $829.50 $714.00
Ghs antibodies (torch) igm $131.25 $131.25 $131.25 $131.25
Ghs bladder cath - complex-foley $277.50 $277.50 $277.50 $471.00
Ghs block ilioinguinal/gentitofemoral $1,471.50 $1,471.50 $1,471.50 $1,470.75
Ghs central line insert < age 5, failed $2,676.75 $2,676.75 $2,676.75 $2,676.75
Ghs change cysto/gastrost $909.00 $909.00 $909.00 $1,143.75
Ghs chemo >8 hrs $862.50 $862.50 $862.50 $862.50
Ghs chemo IV push, ea addtl $736.50 $736.50 $736.50 $446.40
Ghs chlamydia pneumoniae by pcr (arup) (306630) $744.75 $744.75 $744.75 $535.50
Ghs cl tx knee disl; wo anesth $261.75 $261.75 $261.75 $261.75
Ghs cl tx metacarpophal disloc without anes $471.75 $471.75 $471.75 $471.75
Ghs closd tx interphalang jt disloc w/ma $630.00 $630.00 $630.00 $630.00
Ghs closed reduction ankle dislocation $732.75 $732.75 $732.75 $819.60
Ghs closed tx bimalleolar fracture w/manip $1,198.50 $1,198.50 $1,198.50 $1,198.50
Ghs closed tx radiocarpal disloc w manip $273.00 $273.00 $273.00 $273.00
Ghs closed tx tibial fracture w/manip $1,547.25 $1,547.25 $1,547.25 $1,547.25
Ghs closure surg wound/dehiscence-13160 $2,182.50 $2,182.50 $2,182.50 $2,182.50
Ghs clsd red med malleolus fx w manip $2,659.50 $2,659.50 $2,659.50 $2,659.50
Ghs clsd red med malleolus fx without manip $321.00 $321.00 $321.00 $321.00
Ghs clsd tx frac distal tibia w/manipulation $1,815.75 $1,815.75 $1,815.75 $2,186.40
Ghs community re-entry 15 minutes $96.75 $96.75 $96.75 $93.75
Ghs conjunctiva foreign body-embed bil $393.00 $393.00 $393.00 $399.04
Ghs conjunctiva foreign body-superf bil $351.75 $351.75 $351.75 $351.75
Ghs corneal fb with slit lamp bilat $372.00 $372.00 $372.00 $396.00
Ghs corneal fb without slit lamp bilat $422.25 $422.25 $422.25 $422.25
Ghs cricothyroidotomy $271.50 $271.50 $271.50 $271.50
Ghs dislocation elbow closed treatment $525.75 $525.75 $525.75 $825.60
Ghs ed peritoneal lavage w guidance if performed $3,175.50 $3,175.50 $3,175.50 $3,175.50
Ghs ed rmvl or bivalving cast $303.75 $303.75 $303.75 $303.75
Ghs eeg cont rec w/video by tec min 8 chnls $843.75 $843.75 $843.75 $780.00
Ghs elect vertical elct $256.50 $256.50 $256.50 $256.50
Ghs electrostagmgraphy $931.50 $931.50 $931.50 $931.50
Ghs epidermal shaving diameter >2.0 cm $377.25 $377.25 $377.25 $377.25
Ghs excision ingrown nail $311.25 $311.25 $311.25 $399.53
Ghs eye exam $136.50 $136.50 $136.50 $136.50
Ghs eyelid foreign body-embedded - bil $349.50 $349.50 $349.50 $349.50
Ghs fat & muscle $45.75 $45.75 $45.75 $45.75
Ghs fb removal - incisional $1,253.25 $1,253.25 $1,253.25 $1,620.24
Ghs fb removal - non-incisional $1,897.50 $1,897.50 $1,897.50 $1,620.24
Ghs fb removal foot - deep - left $2,538.75 $2,538.75 $2,538.75 $2,538.75
Ghs fb removal from muscle - complicated $5,736.75 $5,736.75 $5,736.75 $5,736.75
Ghs febrile agglutinns(mayo) $76.50 $76.50 $76.50 $76.50
Ghs fish cytogen $1,133.25 $1,133.25 $1,133.25 $354.60
Ghs fish hybrid in situ 100-300 $566.25 $566.25 $566.25 $366.60
Ghs flow volume loop $364.50 $364.50 $364.50 $303.75
Ghs gastric intub aspiration lavage $363.75 $363.75 $363.75 $311.40
Ghs hcv amplificaiton $442.50 $442.50 $442.50 $371.25
Ghs hepatitis c virus (hcv riba) $828.00 $828.00 $828.00 $784.50
Ghs hgb stability-thal $252.75 $252.75 $252.75 $252.75
Ghs histoplasma antigen $492.00 $492.00 $492.00 $492.00
Ghs i and d abscess/hematoma scrotum $4,134.00 $4,134.00 $4,134.00 $4,134.00
Ghs i and d perirectal abscess 46040 $3,297.75 $3,297.75 $3,297.75 $3,048.75
Ghs i and d pilonidal cyst complex $2,460.00 $2,460.00 $2,460.00 $2,337.75
Ghs i and d pilonidal cyst simple $825.00 $825.00 $825.00 $762.75
Ghs immun0electrophoresis $178.50 $178.50 $178.50 $178.50
Ghs incision thrombosed ext hemorrhoid $526.50 $526.50 $526.50 $526.50
Ghs inf midline insertion $2,032.50 $2,032.50 $2,032.50 $2,032.50
Ghs inhibitor screen $662.25 $662.25 $662.25 $372.00
Ghs init tx 1st degree burn $485.25 $485.25 $485.25 $471.00
Ghs inj neurolytic intercostal nerve $3,021.75 $3,021.75 $3,021.75 $3,021.75
Ghs inj neurolytic other perph nerve $2,300.25 $2,300.25 $2,300.25 $1,343.40
Ghs inj tendon origin/insertion $293.25 $293.25 $293.25 $295.19
Ghs inj transforaminal cerv ea add bil $1,320.00 $1,320.00 $1,320.00 $1,320.00
Ghs inj transforaminal cerv single bil $1,727.25 $1,727.25 $1,727.25 $1,727.25
Ghs insertion of needle - bone $366.75 $366.75 $366.75 $471.00
Ghs intermed repair 12.6 - 20.0 cm-12035 $2,315.25 $2,315.25 $2,315.25 $2,183.40
Ghs intermed repair 20.1 - 30.0 cm-12036 $735.00 $735.00 $735.00 $2,075.40
Ghs intermed repair over 30 cm - 12037 $2,912.25 $2,912.25 $2,912.25 $2,912.25
Ghs intro needle/intracath vein - 36000 $240.00 $240.00 $240.00 $240.00
Ghs irrigate corpora cavernosa for priapism $286.50 $286.50 $286.50 $286.50
Ghs lac repair mouth.ant tong 2.5cm/less $478.50 $478.50 $478.50 $478.50
Ghs layer closure 2.5 cm or less - 12031 $396.00 $396.00 $396.00 $399.53
Ghs layer closure 2.5 cm or less - 12041 $1,428.75 $1,428.75 $1,428.75 $852.60
Ghs layer closure 2.5cm or less - 12051 $550.50 $550.50 $550.50 $550.50
Ghs layer closure 2.6 - 5.0 cm - 12052 $1,967.25 $1,967.25 $1,967.25 $951.00
Ghs layer closure 2.6 - 7.5 cm - 12042 $2,092.50 $2,092.50 $2,092.50 $998.40
Ghs layer closure 5.1 - 7.5 cm - 12053 $2,133.00 $2,133.00 $2,133.00 $1,146.00
Ghs layer closure 7.6 - 12.5 cm - 12034 $876.00 $876.00 $876.00 $876.00
Ghs layer closure 7.6 - 12.5 cm - 12044 $735.00 $735.00 $735.00 $998.40
Ghs layer closure 7.6 - 12.5 cm - 12054 $471.75 $471.75 $471.75 $630.00
Ghs layered repair 12.6 - 20.0 cm -12045 $979.50 $979.50 $979.50 $979.50
Ghs layered repair 12.6 - 20.0 cm -12055 $471.75 $471.75 $471.75 $825.60
Ghs layered repair 20.1 - 30.0 cm -12056 $471.75 $471.75 $471.75 $471.75
Ghs layered repair over 3.0 cm -12057 $471.75 $471.75 $471.75 $471.75
Ghs mbp $108.00 $108.00 $108.00 $112.80
Ghs moderate sedation < 5 yr, 30 min $738.00 $738.00 $738.00 $484.80
Ghs moderate sedation < 5 yr, 30 min, other $525.75 $525.75 $525.75 $525.75
Ghs moderate sedation ea addtl 15 min, other $69.75 $69.75 $69.75 $69.75
Ghs moderate sedation, > 5 yr, 30 min, other $667.50 $667.50 $667.50 $640.50
Ghs musc test done w/n test comp $392.25 $392.25 $392.25 $386.40
Ghs musc tst done w/n tst non ext $291.75 $291.75 $291.75 $291.75
Ghs musc tst done w/nerv tst lim $372.75 $372.75 $372.75 $340.50
Ghs myocardial strain img spckl track $138.00 $138.00 $138.00 $306.60
Ghs nailbed repair/nail removal $900.00 $900.00 $900.00 $900.00
Ghs nerve blk intercostal, ea addtl level $1,618.50 $1,618.50 $1,618.50 $1,618.50
Ghs nerve blk intercostal, single level $1,471.50 $1,471.50 $1,471.50 $1,471.50
Ghs nerve block axillary nerve $1,907.25 $1,907.25 $1,907.25 $1,907.25
Ghs nerve block brachial plexus $1,828.50 $1,828.50 $1,828.50 $1,828.50
Ghs nerve block celiac plexus $2,300.25 $2,300.25 $2,300.25 $2,300.25
Ghs nerve block interscaline $1,926.75 $1,926.75 $1,926.75 $1,926.75
Ghs nerve block lumbar or thoracic symp $1,907.25 $1,907.25 $1,907.25 $1,907.25
Ghs nerve block sciatic nerve $1,745.25 $1,745.25 $1,745.25 $1,745.25
Ghs nerve block suprascapular $1,471.50 $1,471.50 $1,471.50 $1,471.50
Ghs ng placement w fluoro guidance $684.75 $684.75 $684.75 $602.40
Ghs o2 saturation $106.50 $106.50 $106.50 $106.50
Ghs o2 uptake rest & indirect $433.50 $433.50 $433.50 $433.50
Ghs opcc repair cvp w subq port $5,914.50 $5,914.50 $5,914.50 $5,034.60
Ghs opcc repair cvp without subq port $2,205.00 $2,205.00 $2,205.00 $2,205.00
Ghs optokenetic $256.50 $256.50 $256.50 $256.50
Ghs oscillating trac $256.50 $256.50 $256.50 $256.50
Ghs osteopathic manipulative tx, 1-2 regions $54.00 $54.00 $54.00 $54.00
Ghs osteopathic manipulative tx, 3-4 regions $88.50 $88.50 $88.50 $88.50
Ghs ot dds rom $196.50 $196.50 $196.50 $196.50
Ghs ot prosthetic training/15 min $138.75 $138.75 $138.75 $124.20
Ghs ot sensory integrative tech/15min $138.75 $138.75 $138.75 $130.20
Ghs pacing - transcutaneous $940.50 $940.50 $940.50 $940.50
Ghs paravert facet/nerve cerv ea add bil $1,236.75 $1,236.75 $1,236.75 $1,320.00
Ghs paravert facet/nerve lumb ea add bil $1,053.00 $1,053.00 $1,053.00 $1,053.00
Ghs peritonsillar abscess i andd $765.75 $765.75 $765.75 $998.40
Ghs phenylketonurid $148.50 $148.50 $148.50 $148.50
Ghs picc line insert < 5 $6,876.75 $6,876.75 $6,876.75 $6,357.75
Ghs plngl fx pm cl $418.50 $418.50 $418.50 $498.00
Ghs pos nystagmus $678.00 $678.00 $678.00 $591.00
Ghs ppd (tb intradermal) $52.50 $52.50 $52.50 $52.50
Ghs pr without cont pulse ox $134.25 $134.25 $134.25 $134.25
Ghs prostatic acid phosphatase (mayo) $87.00 $87.00 $87.00 $87.00
Ghs protoporphyrins fract $60.75 $60.75 $60.75 $72.60
Ghs pseudocholinesterase,dibucain-inhibi $138.75 $138.75 $138.75 $122.25
Ghs refill of implantable pump $870.75 $870.75 $870.75 $774.00
Ghs removal intranasal foreign body $531.75 $531.75 $531.75 $473.25
Ghs removal pharyngeal foreign body $478.50 $478.50 $478.50 $478.50
Ghs sensitivity (per antimicro) $78.75 $78.75 $78.75 $76.20
Ghs simple repair 12.6 - 20.0 cm - 12005 $368.25 $368.25 $368.25 $589.80
Ghs simple repair 12.6 - 20.0 cm - 12016 $368.25 $368.25 $368.25 $589.80
Ghs simple repair 20.1 - 30.0 cm - 12006 $374.25 $374.25 $374.25 $781.80
Ghs simple repair 20.1 - 30.0 cm - 12017 $374.25 $374.25 $374.25 $399.53
Ghs simple repair 5.1 - 7.5 cm - 12014 $364.50 $364.50 $364.50 $510.00
Ghs simple repair 7.6 - 12.5 cm - 12004 $362.25 $362.25 $362.25 $510.00
Ghs simple repair 7.6 - 12.5 cm - 12015 $364.50 $364.50 $364.50 $510.00
Ghs simple repair over 30 cm - 12007 $381.75 $381.75 $381.75 $589.80
Ghs simple repair over 30 cm - 12018 $381.75 $381.75 $381.75 $381.75
Ghs somatosensory testing lower extremit $1,464.00 $1,464.00 $1,464.00 $1,464.00
Ghs somatosensory testing upper & lower limbs $2,091.75 $2,091.75 $2,091.75 $1,077.00
Ghs sp train/fitting sp device - kx $365.25 $365.25 $365.25 $365.25
Ghs speech-gen aug dev eval iii, st $230.25 $230.25 $230.25 $213.00
Ghs sphenopalatine ganglion block $2,005.50 $2,005.50 $2,005.50 $928.80
Ghs spont nystagmus $256.50 $256.50 $256.50 $256.50
Ghs st - eval for alt comm $99.75 $99.75 $99.75 $99.75
Ghs st - re-eval for alt comm $468.00 $468.00 $468.00 $468.00
Ghs strapping shoulder - 29240 $257.25 $257.25 $257.25 $257.25
Ghs subcutaneous infus. for therapy init 1 hr $269.25 $269.25 $269.25 $269.25
Ghs superficial wnd dehis w packing12021 $471.75 $471.75 $471.75 $894.00
Ghs superficial wnd dehiscence simp12020 $728.25 $728.25 $728.25 $759.00
Ghs tx distal phalangeal fx with manipulation $405.75 $405.75 $405.75 $415.80
Ghs urine, porphyrins quant $499.50 $499.50 $499.50 $499.50
Ghs vaginal delivery only $2,361.75 $2,361.75 $2,361.75 $2,361.75
Ghs veeg 12-26 hr intmt mont $2,699.25 $2,699.25 $2,699.25 $2,699.25
Gi inhouse confirmation $79.50 $79.50 $79.50 $79.50
Gi tract capsule endoscopy (pillcam) 91110 $2,745.00 $2,745.00 $2,745.00 $2,521.80
Giardia lamblia antibody $147.00 $147.00 $147.00 $138.00
Glassia injection $2,551.28 $2,551.28 $2,551.28 $2,551.28
Glove finger flexion right lg xl $36.75 $36.75 $36.75 $36.75
Glucagon hcl 1 mg/ml solution for injection $509.06 $509.06 $509.06 $509.06
Glucagon plasma - sendout $63.00 $63.00 $63.00 $78.75
Glucose 1 hr post dose $168.00 $168.00 $168.00 $86.25
Glucose blood by monitoring device cleared by fda for home use $39.00 $39.00 $39.00 $32.40
Glucose blood quantitative $45.00 $45.00 $45.00 $45.00
Glucose body fluid $72.75 $72.75 $72.75 $72.75
Glucose tolerance test (gtt) 3 specimens $201.75 $201.75 $201.75 $199.80
Glucose tolerance test (gtt) >3 specimens each additional $63.00 $63.00 $63.00 $42.60
Glucose-6-phosphate dhydrogenase screen $55.50 $55.50 $55.50 $55.50
Glycopyrrolate 0.2 mg/ml injection solution $102.50 $102.50 $102.50 $35.40
Golimumab 12.5 mg/ml intravenous solution $7,166.65 $7,166.65 $7,166.65 $104.80
Gonadotropin follicle stimulating hormone (fsh) $187.50 $187.50 $187.50 $187.50
Gonadotropin luteinizing hormone (lh) $129.00 $129.00 $129.00 $129.00
Goserelin 10.8 mg subcutaneous implant $11,433.78 $11,433.78 $11,433.78 $2,802.00
Graft apligraf 3in 44sqcm-q4101-cost per sq cm $3,026.25 $3,026.25 $3,026.25 $3,026.25
Graft axiofill 1000mg $675,000.00 $675,000.00 $675,000.00 $3,597.00
Graft fish skin 16mm round marigen 2units-cost per sq cm $17,736.75 $17,736.75 $17,736.75 $17,736.75
Graft impl ult thck 6x12cm -cost per sq cm $31,488.75 $31,488.75 $31,488.75 $31,488.75
Graft nerve adv 3-4x70mm $27,652.41 $27,652.41 $27,652.41 $27,652.41
Graft patch felt ptfe 2x2 $78,750.00 $78,750.00 $78,750.00 $55,935.00
Graft primatrix xcr 6cm x6cm n-q4110-cost per sq cm $29,670.10 $29,670.10 $29,670.10 $29,670.10
Graft puraplyam antimicrob 1.6-q4196-cost per sq cm $6,187.50 $6,187.50 $6,187.50 $6,187.50
Graft sft tiss grafix amnio prime 3x4cm 12sqcm-q4133-cost per sq cm $6,075.00 $6,075.00 $6,075.00 $6,075.00
Graft sft tiss theraskin lg 5.1x7.6cm meshed 39 sq cm-q4121-cost per sq cm $7,746.75 $7,746.75 $7,746.75 $7,746.75
Graft tiss strattice 10x10 frm 10x10cm firm -cost per sq cm $66,548.25 $66,548.25 $66,548.25 $66,548.25
Graft wnd mtrx grfx core 1.5x2cm-q4132-cost per sq cm $2,227.50 $2,227.50 $2,227.50 $2,227.50
Graft xenmtrx sft rect 15x20cm $99,296.10 $99,296.10 $99,296.10 $99,296.10
Graft xenmtrx sft rect 19x28cm $6,187.50 $6,187.50 $6,187.50 $3,260.40
Great toe with reduction 28495 $581.25 $581.25 $581.25 $581.25
Growth stimulation gene 2 $1,637.25 $1,637.25 $1,637.25 $1,637.25
Gu dilat ureter/urethra s&i $1,712.25 $1,712.25 $1,712.25 $1,712.25
Guide endoanchr sg-64 aaa 62cm $2,108.25 $2,108.25 $2,108.25 $2,108.25
Guide wire threaded 1.4x150mm $20,413.63 $20,413.63 $20,413.63 $7,078.80
Guide worley csg 9fx50cm std $3,593.25 $3,593.25 $3,593.25 $3,593.25
Guided cath fluid drainage 10030 $542.25 $542.25 $542.25 $1,252.80
Gw stiffened micro access kit $101,250.00 $101,250.00 $101,250.00 $12,466.20
H pylori (c-13) breath $342.75 $342.75 $342.75 $342.75
Haloperidol decanoate 50 mg/ml intramuscular solution $120.02 $120.02 $120.02 $120.02
Haloperidol lactate 5 mg/ml injection solution $8.58 $8.58 $8.58 $8.58
Hand X-ray $431.25 $431.25 $431.25 $317.78
Haptoglobin quantitative $105.00 $105.00 $105.00 $105.00
Hast w/i&r phys/qhp $351.00 $351.00 $351.00 $351.00
Hast w/oxygen titrate $422.25 $422.25 $422.25 $422.25
Hba1/hba2 full gene sequence $1,051.50 $1,051.50 $1,051.50 $1,051.50
Hba1/hba2 gene dup/del vrnts $743.25 $743.25 $743.25 $743.25
Hbot, full body chamber, 30m $738.75 $738.75 $738.75 $738.75
Hc ea ha check monaural $58.50 $58.50 $58.50 $58.50
Hc hearing aid chck binaurl $23.25 $23.25 $23.25 $23.25
Hc hearing aid chck monarl $24.75 $24.75 $24.75 $24.75
Hc hearing aid exam both ears $161.25 $161.25 $161.25 $161.25
Hc hearing aid exam one ear $129.75 $129.75 $129.75 $129.75
Hc nm fusion spect CT unlisted $680.25 $680.25 $680.25 $680.25
Hc nm kidney imaging with flow $1,419.75 $1,419.75 $1,419.75 $1,419.75
Hc nm myocard infarct avid plnr tomo spect w/wo quant $1,006.50 $1,006.50 $1,006.50 $1,006.50
Hc pet myocardial imaging metabolic eval single study $4,680.75 $4,680.75 $4,680.75 $4,680.75
Hc transcatheter placement and sbsq removal cepd perq $2,175.00 $2,175.00 $2,175.00 $2,175.00
Hcg qualitative $138.00 $138.00 $138.00 $90.60
Hcg quantitative $88.50 $88.50 $88.50 $88.50
Head CT scan (with and without contrast) $1,629.00 $1,629.00 $1,629.00 $1,881.36
Head CT scan (with contrast) $1,496.25 $1,496.25 $1,496.25 $1,587.69
Head CT scan (without contrast) $1,257.00 $1,257.00 $1,257.00 $1,268.90
Heart first pass add-on $1,157.25 $1,157.25 $1,157.25 $1,157.25
Hematocrit $52.50 $52.50 $52.50 $39.75
Hematopoietic nuclear tx $2,648.25 $2,648.25 $2,648.25 $918.60
Hemin 350 mg intravenous powder for solution $41,382.91 $41,382.91 $41,382.91 $41,382.91
Hemoglobin $52.50 $52.50 $52.50 $37.20
Hemoglobin fetal qualitative $57.00 $57.00 $57.00 $57.00
Hemoglobin methemoglobin quantitative $132.75 $132.75 $132.75 $132.75
Hemoglobin plasma $187.50 $187.50 $187.50 $74.00
Hemorrhoidectomy intrnl lig rbbr band ligations $1,314.00 $1,314.00 $1,314.00 $1,314.00
Hepagam b im injection $2,543.59 $2,543.59 $2,543.59 $2,543.59
Heparin assay $194.25 $194.25 $194.25 $194.25
Heparin bolus from bag $57.46 $57.46 $57.46 $46.20
Heparin neutralization $187.50 $187.50 $187.50 $187.50
Heparin, porcine (pf) 10 unit/ml flush (wrapper) $6.20 $6.20 $6.20 $6.20
Hepatitis a antibody igm $84.00 $84.00 $84.00 $84.00
Hepatitis b core antibody igm $127.50 $127.50 $127.50 $127.50
Hepatitis b core antibody total $84.75 $84.75 $84.75 $84.75
Hepatitis b immune globulin greater than 1,560 units/5 ml im solution $1,890.21 $1,890.21 $1,890.21 $1,720.80
Hepatitis b surface antibody $88.50 $88.50 $88.50 $88.50
Hepatitis b vaccine 40 mcg/ml inj-adult $51.75 $51.75 $51.75 $51.75
Hepatitis c antibody $106.50 $106.50 $106.50 $106.50
Hepatitis d quantification $1,161.75 $1,161.75 $1,161.75 $1,161.75
Hepatobiliary system imaging $1,494.00 $1,494.00 $1,494.00 $1,494.00
Herpes simplex type 1 antibody igg $100.50 $100.50 $100.50 $100.50
Herpes simplex type 2 antibody igg $111.00 $111.00 $111.00 $111.00
Herpes simplex virus isolation $54.75 $54.75 $54.75 $97.20
Heterophile antibodies screening $97.50 $97.50 $97.50 $85.20
Hhv-6 dna quant $652.50 $652.50 $652.50 $551.40
Hip X-ray $436.50 $436.50 $436.50 $290.40
Histamine $189.00 $189.00 $189.00 $209.40
Hizentra injection $4,991.26 $4,991.26 $4,991.26 $4,991.26
Hla class i high defin qual $666.75 $666.75 $666.75 $556.80
Hla class i semiquant panel $697.50 $697.50 $697.50 $697.50
Hla class i/ii antibody qual $435.00 $435.00 $435.00 $435.00
Hla class ii high defin qual $568.50 $568.50 $568.50 $507.00
Hla class ii semiquant panel $620.25 $620.25 $620.25 $620.25
Hla i & ii type verify lr $342.00 $342.00 $342.00 $342.00
Hla i low res one antigen equiv ea $197.25 $197.25 $197.25 $197.25
Hla i typing 1 locus hr $177.00 $177.00 $177.00 $177.00
Hla i typing complete hr $381.00 $381.00 $381.00 $381.00
Hla i typing complete lr $488.25 $488.25 $488.25 $488.25
Hla i typing high res 1 allele grp ea $201.75 $201.75 $201.75 $448.20
Hla ii typing 1 loc hr $867.00 $867.00 $867.00 $867.00
Hla ii typing ag equiv lr $193.50 $193.50 $193.50 $210.00
Hla x-match noncytotoxc addl $168.00 $168.00 $168.00 $168.00
Hla x-math non-cytotoxic $429.75 $429.75 $429.75 $429.75
Hlth bhv assmt/reassessment $117.00 $117.00 $117.00 $117.00
Hlth bhv ivntj fam 1st 30 $115.50 $115.50 $115.50 $115.50
Hlth bhv ivntj grp 1st 30 $117.00 $117.00 $117.00 $117.00
Hlth bhv ivntj indiv 1st 30 $115.50 $115.50 $115.50 $115.50
Hocm 250-299mg/ml iodine,1ml $52.51 $52.51 $52.51 $52.51
Homocysteine $90.75 $90.75 $90.75 $91.20
Homovanillic acid (hva) $220.50 $220.50 $220.50 $166.50
Hpa-1 genotyping $165.00 $165.00 $165.00 $165.00
Hpa-15 genotyping $165.00 $165.00 $165.00 $165.00
Hpa-2 genotyping $165.00 $165.00 $165.00 $165.00
Hpa-3 genotyping $165.00 $165.00 $165.00 $165.00
Hpa-4 genotyping $165.00 $165.00 $165.00 $165.00
Hpa-5 genotyping $165.00 $165.00 $165.00 $165.00
Hpa-6 genotyping $165.00 $165.00 $165.00 $165.00
Hpa-9 genotyping $165.00 $165.00 $165.00 $165.00
Htt gene detc abnor alleles $345.75 $345.75 $345.75 $345.75
Hyaluronidase 200 units/ml inj $414.18 $414.18 $414.18 $414.18
Hydralazine 20 mg/ml injection solution $51.42 $51.42 $51.42 $51.42
Hydration IV infusion each additional hour $456.75 $456.75 $456.75 $322.20
Hydration IV infusion initial 31minutes - 1 hour $722.25 $722.25 $722.25 $722.25
Hydrocortisone in ns IV syringe 1 mg/ml (neo/ped) - cnr $569.91 $569.91 $569.91 $256.80
Hydromorphone 0.2 mg/ml in 0.9% nacl IV pca opioid naive - 4 hr dose limit (wrapper) $72.63 $72.63 $72.63 $13.60
Hydromorphone 20-0.9 mg/100ml-% soln 100 ml cartridge $277.32 $277.32 $277.32 $630.40
Hydroxocobalamin im 10mcg $83.64 $83.64 $83.64 $83.64
Hydroxyzine hcl 50 mg/ml intramuscular solution $87.60 $87.60 $87.60 $87.60
Hymovis injection 1 mg $2,459.97 $2,459.97 $2,459.97 $2,459.97
Hyoscyamine sulfate inj $308.52 $308.52 $308.52 $308.52
Hysterosalpingography s&i $1,139.25 $1,139.25 $1,139.25 $1,139.25
Hysteroscopy ablation $5,865.75 $5,865.75 $5,865.75 $5,865.75
Hysteroscopy biopsy $5,110.50 $5,110.50 $5,110.50 $5,110.50
Hysteroscopy dx sep proc $3,568.50 $3,568.50 $3,568.50 $3,568.50
Hysteroscopy lysis $5,766.75 $5,766.75 $5,766.75 $5,766.75
Hysteroscopy remove fb $5,843.25 $5,843.25 $5,843.25 $5,843.25
Hysteroscopy remove myoma $4,302.75 $4,302.75 $4,302.75 $4,302.75
Hzv zoster vacc recombinant adjuvanted im inj $650.11 $650.11 $650.11 $157.80
I&d frarm&/wrst deep absc/hematoma $3,761.25 $3,761.25 $3,761.25 $3,761.25
I&d lacrimal sac $2,729.25 $2,729.25 $2,729.25 $2,729.25
I-123 iobenguane diag $17,222.25 $17,222.25 $17,222.25 $17,222.25
I-123 ioflupane diag $9,058.88 $9,058.88 $9,058.88 $9,058.88
IV infusion therapy/prophylaxis/diagnosis addl sequential infusion new drug/substance > 1 hour $456.75 $456.75 $456.75 $298.20
IV infusion therapy/prophylaxis/diagnosis concurrent infusion $454.50 $454.50 $454.50 $355.50
IV infusion therapy/prophylaxis/diagnosis each additional 1 hour $456.75 $456.75 $456.75 $370.50
IV infusion therapy/prophylaxis/diagnosis initial up to 1 hour $722.25 $722.25 $722.25 $687.00
Ia infect ag ab qual/semiquant sgl step $36.75 $36.75 $36.75 $36.75
Iadna legionella pneumophila amplified probe tq $329.25 $329.25 $329.25 $329.25
Ibandronate 3 mg/3 ml intravenous syringe $839.85 $839.85 $839.85 $839.85
Ibuprofen injection $86.20 $86.20 $86.20 $86.20
Ibutilide fumarate 0.1 mg/ml intravenous solution $1,022.55 $1,022.55 $1,022.55 $1,022.55
Icatibant injection $3,697.02 $3,697.02 $3,697.02 $3,697.02
Icd cobalt xt dr MRI is1 df1 $48,847.50 $48,847.50 $48,847.50 $48,847.50
Icd crtd cobalt hf MRI is1 df1 $44,003.25 $44,003.25 $44,003.25 $44,003.25
Icd crtp serena MRI $15,759.00 $15,759.00 $15,759.00 $15,759.00
Icd reliance df4 ib 64cm $6,463.81 $6,463.81 $6,463.81 $6,463.81
Icut allergy test drug/bug $118.50 $118.50 $118.50 $118.50
Idarubicin hcl injection $249.51 $249.51 $249.51 $249.51
Idursulfase injection $11,942.56 $11,942.56 $11,942.56 $11,942.56
Ifosfamide 1 gram intravenous solution $294.81 $294.81 $294.81 $294.81
Igh gene rearrange amp meth $464.25 $464.25 $464.25 $464.25
Igh@ var region somatic mutation analy $607.50 $607.50 $607.50 $646.50
Ihc/icc per specimen each additional single antibody stain $309.75 $309.75 $309.75 $293.40
Ihc/icc per specimen each multiplex antibody stain $318.75 $318.75 $318.75 $318.75
Ihc/icc per specimen initial single antibody stain $310.50 $310.50 $310.50 $310.50
Iliac/fem angio cath insert $2,980.50 $2,980.50 $2,980.50 $2,980.50
Img rta detc/mntr ds poc aly $71.25 $71.25 $71.25 $71.25
Immobilizer shldr cntor adlt $134.01 $134.01 $134.01 $134.01
Immobilizer shldr dlx str 24-36in med $67.77 $67.77 $67.77 $67.77
Immobilizer shldr sling med $29.14 $29.14 $29.14 $29.14
Immune complex assay $89.25 $89.25 $89.25 $89.25
Immune globulin, gamma (igg) (10 %)-gly-iga over 50 mcg/ml injection solution $2,613.77 $2,613.77 $2,613.77 $629.40
Immune globulin, gamma (igg) (10 %)-malt-iga over 50 mcg/ml intravenous solution $3,486.01 $3,486.01 $3,486.01 $3,486.01
Immune globulin, gamma (igg) 10 gram-gly-gluc-iga 0 to 50 mcg/ml IV solution $2,778.42 $2,778.42 $2,778.42 $2,778.42
Immunoassay tumor antigen quantitative ca 125 $104.25 $104.25 $104.25 $116.40
Immunoassay tumor antigen quantitative ca 19-9 $130.50 $130.50 $130.50 $141.00
Immunodiff gel qual ea antigen/ab $108.00 $108.00 $108.00 $108.00
Immunodiffusion nes $189.75 $189.75 $189.75 $175.80
Immunofixation electrophoresis serum $231.00 $231.00 $231.00 $231.00
Immunofluorescence per specimen each additional single antibody stain $511.50 $511.50 $511.50 $194.40
Immunofluorescence per specimen initial single antibody stain $408.00 $408.00 $408.00 $316.20
Immunoglobulin assay $258.00 $258.00 $258.00 $231.75
Impl neurostim electr perc $5,517.75 $5,517.75 $5,517.75 $5,517.75
Implant 11 volt lithium-ion backup battery for controller pocket $1,518.75 $1,518.75 $1,518.75 $1,518.75
Implant cartilage 10mm synthetic $101,250.00 $101,250.00 $101,250.00 $31,672.20
Implant cochlear osia osi300 $20,655.00 $20,655.00 $20,655.00 $20,655.00
Implant hormone pellet(s) 11980 $315.75 $315.75 $315.75 $315.75
Implant neuroelectrodes $5,517.75 $5,517.75 $5,517.75 $5,517.75
Implant neuroelectrodes $6,447.00 $6,447.00 $6,447.00 $6,447.00
Implant neuroelectrodes $12,807.00 $12,807.00 $12,807.00 $12,807.00
Implant power module patient cable cable 14 volt $2,812.50 $2,812.50 $2,812.50 $2,812.50
Implant pulse generator remede el $57,375.00 $57,375.00 $57,375.00 $57,375.00
Implant ureth bulk agent $2,587.50 $2,587.50 $2,587.50 $2,587.50
Implnt spinl canal catheter 62350 $7,722.75 $7,722.75 $7,722.75 $7,722.75
In situ hybridization per specimen each additional single probe stain $435.00 $435.00 $435.00 $435.00
In situ hybridization per specimen initial single probe stain $384.75 $384.75 $384.75 $337.20
In-111 oxyquinolin per 0.5 mci $2,808.00 $2,808.00 $2,808.00 $2,808.00
In-111 pentetate dtpa / 0.5 mci $2,156.25 $2,156.25 $2,156.25 $2,156.25
In-111 pentetreotide $47,542.46 $47,542.46 $47,542.46 $47,542.46
Incise inner ear $3,648.00 $3,648.00 $3,648.00 $3,648.00
Incise/drain eyelid lining $1,104.00 $1,104.00 $1,104.00 $1,104.00
Incision & drainage hematoma/seroma/fluid collection $3,867.00 $3,867.00 $3,867.00 $3,208.50
Incision of achilles tendon $1,863.75 $1,863.75 $1,863.75 $1,863.75
Incision of breast lesion $1,897.50 $1,897.50 $1,897.50 $1,959.00
Incision of eardrum $1,272.00 $1,272.00 $1,272.00 $1,272.00
Incision of foot fascia $3,752.25 $3,752.25 $3,752.25 $3,752.25
Incision of hip tendons $3,752.25 $3,752.25 $3,752.25 $3,752.25
Incision of tendon & muscle $8,293.50 $8,293.50 $8,293.50 $8,293.50
Incision of thigh tendon $3,752.25 $3,752.25 $3,752.25 $3,752.25
Incision of tongue fold $1,792.50 $1,792.50 $1,792.50 $1,792.50
Incision tendon sheath $2,124.75 $2,124.75 $2,124.75 $2,124.75
Incisn of toe tndn $2,825.25 $2,825.25 $2,825.25 $2,176.50
Incobotulinumtoxin a $1,889.43 $1,889.43 $1,889.43 $1,889.43
Indigotindisulfonate 8 mg/ml soln 5 ml ampule $586.73 $586.73 $586.73 $586.73
Induced abortion d&c $3,624.75 $3,624.75 $3,624.75 $3,624.75
Induced abortion dilat&evac $6,344.25 $6,344.25 $6,344.25 $6,344.25
Inf agt nucleic acid human papillomavirus separately reported high-risk types pooled result(s) $234.75 $234.75 $234.75 $234.75
Infect ag drug suscept pheno predict $479.25 $479.25 $479.25 $607.20
Infect ag genotype na cytomegalovirus $2,588.25 $2,588.25 $2,588.25 $1,790.40
Infect ag genotype na hiv-1 other region $301.50 $301.50 $301.50 $716.40
Infect ag genotype na hiv-1 revr trn/prt $603.75 $603.75 $603.75 $603.75
Infect ag ia optc obs influenza $101.25 $101.25 $101.25 $101.25
Infect ag if hep delta agent $189.75 $189.75 $189.75 $189.75
Infect ag if legionella pneumophila $85.50 $85.50 $85.50 $85.50
Infect ag na herpes simplex quant $324.75 $324.75 $324.75 $346.50
Infect ag na hpv high-risk types $272.25 $272.25 $272.25 $272.25
Infect ag na influenza r/amp 1st 2 types $175.50 $175.50 $175.50 $259.80
Infect ag na orthopoxvirus amp prb each $180.00 $180.00 $180.00 $180.00
Infect ag na resp virus 12-25 targets $1,414.50 $1,414.50 $1,414.50 $1,414.50
Infect ag phenotype na hiv-1 1-10 drugs $108.00 $108.00 $108.00 $108.00
Infect ag phenotype na hiv-1 ea addl drg $1,288.50 $1,288.50 $1,288.50 $1,288.50
Infectious agent antigen immunoassay ql/sq multi step clostridium difficile toxin $196.50 $196.50 $196.50 $117.00
Infectious agent antigen immunoassay ql/sq multi step cryptococcus neoformans $60.75 $60.75 $60.75 $60.75
Infectious agent antigen immunoassay ql/sq multi step cryptosporidium $96.00 $96.00 $96.00 $96.00
Infectious agent antigen immunoassay ql/sq multi step giardia $87.00 $87.00 $87.00 $90.00
Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn $64.50 $64.50 $64.50 $64.50
Infectious agent antigen immunoassay ql/sq multi step hiv-1 antigen(s) hiv-1&2 antibodies $88.50 $88.50 $88.50 $88.50
Infectious agent antigen immunoassay ql/sq multi step legionella urine $420.75 $420.75 $420.75 $407.40
Infectious agent antigen immunoassay ql/sq multi step rotavirus $126.00 $126.00 $126.00 $126.00
Infectious agent nucleic acid amp probe mycobacterium tuberculosis rifampin resistance $357.75 $357.75 $357.75 $336.00
Infectious agent nucleic acid amplified probe $751.50 $751.50 $751.50 $372.00
Infectious agent nucleic acid amplified probe chlamydia trachomatis $173.25 $173.25 $173.25 $186.00
Infectious agent nucleic acid amplified probe clostridium difficile toxin gene(s) $141.00 $141.00 $141.00 $202.50
Infectious agent nucleic acid amplified probe cns pathogen 12-25 targets $861.00 $861.00 $861.00 $861.00
Infectious agent nucleic acid amplified probe hsv-1 $306.75 $306.75 $306.75 $306.75
Infectious agent nucleic acid amplified probe methicillin resistant staphylococcus aureus $129.00 $129.00 $129.00 $194.40
Infectious agent nucleic acid amplified probe mycobacteria tuberculosis $596.25 $596.25 $596.25 $403.80
Infectious agent nucleic acid amplified probe neisseria gonorrhoeae $168.75 $168.75 $168.75 $186.00
Infectious agent nucleic acid amplified probe sars-cov-2/covid-19 $141.00 $141.00 $141.00 $75.00
Infectious agent nucleic acid amplified probe sars-cov-2/inf a & b $299.25 $299.25 $299.25 $299.25
Infectious agent nucleic acid amplified probe sars-cov-2/inf a&b/rsv $299.25 $299.25 $299.25 $210.00
Infectious agent nucleic acid amplified probe streptococcus group a $88.50 $88.50 $88.50 $88.50
Infectious agent nucleic acid amplified probe trichomonas vaginalis $129.00 $129.00 $129.00 $129.00
Infectious agent nucleic acid multiplex amplified probe gi pathogen 12-25 targets $984.00 $984.00 $984.00 $876.60
Infectious agent nucleic acid multiplex amplified probe gi pathogen 3-5 targets $436.50 $436.50 $436.50 $436.50
Infectious agent nucleic acid multiplex amplified probe gi pathogen 6-11 targets $261.75 $261.75 $261.75 $262.99
Infectious agent nucleic acid quantification bk virus $1,929.00 $1,929.00 $1,929.00 $517.80
Infectious agent nucleic acid quantification hepatitis b $307.50 $307.50 $307.50 $328.50
Infectious agent nucleic acid quantification hepatitis c $1,154.25 $1,154.25 $1,154.25 $778.80
Infectious agent nucleic acid quantification hiv-1 $588.00 $588.00 $588.00 $627.75
Infectious agent nucleic acid respiratory virus multiplex amplified probe 3-5 targets $225.75 $225.75 $225.75 $248.25
Infliximab 100 mg intravenous solution $1,702.78 $1,702.78 $1,702.78 $1,702.78
Infliximab-dyyb 100 mg intravenous solution $1,713.99 $1,713.99 $1,713.99 $1,713.99
Ingest challenge ea addl 60 min $274.50 $274.50 $274.50 $274.50
Ingest challenge ini 120 min $547.50 $547.50 $547.50 $547.50
Inhalation aerosol pentamidine pneumocystis pneumonia treatment/prophylaxis $386.25 $386.25 $386.25 $386.25
Initiation & management bipap/cpap initial day $576.00 $576.00 $576.00 $512.25
Inj allopurinol sodium 1 mg $5,937.23 $5,937.23 $5,937.23 $5,937.23
Inj anifrolumab-fnia 1mg $20,116.77 $20,116.77 $20,116.77 $20,116.77
Inj bimatoprost itc imp1mcg $7,487.44 $7,487.44 $7,487.44 $7,487.44
Inj calcitriol per 0.1 mcg $22.16 $22.16 $22.16 $22.16
Inj ceftolozane tazobactam $597.69 $597.69 $597.69 $487.80
Inj cntr knee arthro incl ct/mri $461.25 $461.25 $461.25 $461.25
Inj disk cerv-thor ea lev $3,232.50 $3,232.50 $3,232.50 $3,232.50
Inj dupuytren cord w/enzyme $592.50 $592.50 $592.50 $592.50
Inj dx for sinogram $1,089.75 $1,089.75 $1,089.75 $1,089.75
Inj epidural sgl cerv-thor without img $2,184.75 $2,184.75 $2,184.75 $1,920.60
Inj epidural sgl lumb-sacral without img $1,623.75 $1,623.75 $1,623.75 $1,541.40
Inj for ext venography $1,434.75 $1,434.75 $1,434.75 $1,056.80
Inj for mammo ductogram $150.00 $150.00 $150.00 $150.00
Inj givosiran 0.5 mg $162,298.07 $162,298.07 $162,298.07 $162,298.07
Inj hrt cath w/s&i nonsel p-art angrp $1,110.00 $1,110.00 $1,110.00 $1,110.00
Inj hrt cath w/s&i sel hrt ang $2,622.00 $2,622.00 $2,622.00 $2,622.00
Inj hrt cath w/s&i sel hrt art $1,192.50 $1,192.50 $1,192.50 $1,192.50
Inj hrt cath w/s&i sel left vent $1,239.00 $1,239.00 $1,239.00 $1,239.00
Inj hrt cath w/s&i sel right vent $5,894.25 $5,894.25 $5,894.25 $5,894.25
Inj human fibrinogen con nos $4,326.08 $4,326.08 $4,326.08 $4,326.08
Inj imip 4 cilas 4 releb 2mg $1,083.72 $1,083.72 $1,083.72 $1,083.72
Inj intralesional <= 7 lsn(s) $206.25 $206.25 $206.25 $206.25
Inj intralesional > 7 lsns $222.75 $222.75 $222.75 $222.75
Inj ivig privigen 500 mg $4,194.45 $4,194.45 $4,194.45 $4,194.45
Inj levocarnitine per 1 gm $122.28 $122.28 $122.28 $205.60
Inj lwr xtr fscl pln blk uni w/wo image $1,471.50 $1,471.50 $1,471.50 $1,471.50
Inj melpha hydroch nos 50 mg $1,713.99 $1,713.99 $1,713.99 $1,713.99
Inj mepivacaine hcl/10 ml $28.41 $28.41 $28.41 $28.41
Inj mogamulizumab-kpkc, 1 mg $17,682.90 $17,682.90 $17,682.90 $558.40
Inj multihance $166.47 $166.47 $166.47 $166.47
Inj nephrosto/ureterogram w/img exstng access $522.75 $522.75 $522.75 $667.47
Inj non-compmd foam sclrsnt mlt trncl veins same leg $2,371.50 $2,371.50 $2,371.50 $2,371.50
Inj non-compmd foam sclrsnt sgl trncl vein $1,569.00 $1,569.00 $1,569.00 $1,569.00
Inj ogivri 10 mg $8,661.59 $8,661.59 $8,661.59 $8,661.59
Inj pegfilgrastim-bmez 0.5mg $12,400.57 $12,400.57 $12,400.57 $6,614.40
Inj proc ankle arthr $219.00 $219.00 $219.00 $405.60
Inj proc elbow arthro $212.25 $212.25 $212.25 $381.60
Inj proc lumbr disk ea lvl $3,232.50 $3,232.50 $3,232.50 $3,232.50
Inj proc myelogram lumbar $1,300.50 $1,300.50 $1,300.50 $1,300.50
Inj progesterone per 50 mg $123.09 $123.09 $123.09 $123.09
Inj retro urethrocysto $629.25 $629.25 $629.25 $629.25
Inj scleros sol mult veins $520.50 $520.50 $520.50 $520.50
Inj scleros sol sgl vein $489.00 $489.00 $489.00 $489.00
Inj secretin synthetic human $2,444.05 $2,444.05 $2,444.05 $2,444.05
Inj sulf hexa lipid microsph $336.56 $336.56 $336.56 $336.56
Inj testosterone cypionate $473.66 $473.66 $473.66 $97.20
Inj thiotepa nos 1 mg $8,689.13 $8,689.13 $8,689.13 $8,689.13
Inj thrc fascial pln blk bi w/wo image $2,207.25 $2,207.25 $2,207.25 $2,207.25
Inj thrc fascial pln blk uni w/wo image $1,471.50 $1,471.50 $1,471.50 $1,471.50
Inj w/fluor eval cv device $1,032.00 $1,032.00 $1,032.00 $866.40
Inj(s) sclerosant spider veins limb/trunk $467.25 $467.25 $467.25 $467.25
Inj, abilify maintena, 1 mg $9,281.66 $9,281.66 $9,281.66 $9,281.66
Inj, artesunate, 1mg $39,774.01 $39,774.01 $39,774.01 $39,774.01
Inj, bupivacaine liposome $1,326.75 $1,326.75 $1,326.75 $7.20
Inj, cefiderocol, 10 mg $846.06 $846.06 $846.06 $846.06
Inj, durolane 1 mg $4,122.72 $4,122.72 $4,122.72 $4,122.72
Inj, factor x, (human), 1iu $33.28 $33.28 $33.28 $33.28
Inj, fulvestrant (fresenius) $1,713.99 $1,713.99 $1,713.99 $1,713.99
Inj, levothyroxine, freskabi $244.63 $244.63 $244.63 $244.63
Inj, rimabotulinumtoxinb $2,348.22 $2,348.22 $2,348.22 $2,348.22
Inj. herceptin hylecta, 10mg $17,286.71 $17,286.71 $17,286.71 $17,286.71
Inj. inebilizumab-cdon, 1 mg $172,856.28 $172,856.28 $172,856.28 $172,856.28
Inj. mycophenolate mofetil $387.27 $387.27 $387.27 $387.27
Inj. naxitamab-gqgk, 1 mg $96,378.67 $96,378.67 $96,378.67 $96,378.67
Inj. tagraxofusp-erzs 10 mcg $124,816.51 $124,816.51 $124,816.51 $124,816.51
Inj. teprotumumab-trbw 10 mg $66,625.08 $66,625.08 $66,625.08 $66,625.08
Inj., benralizumab, 1 mg $19,707.27 $19,707.27 $19,707.27 $19,707.27
Inj., emicizumab-kxwh 0.5 mg $58,842.17 $58,842.17 $58,842.17 $58,842.17
Inj., meropenem, vaborbactam $759.87 $759.87 $759.87 $759.87
Inj., patisiran, 0.1 mg $36,180.04 $36,180.04 $36,180.04 $36,180.04
Inj/inf neurolyt sbst spinal canal lesion 62282 $2,233.50 $2,233.50 $2,233.50 $2,233.50
Inject sacroiliac joint $492.00 $492.00 $492.00 $492.00
Injection anesthetic agent(s) and/or steroid genicular nerve branches w/guidance (both sides) $678.75 $678.75 $678.75 $678.75
Injection arthrography hip without anesthesia (both sides) $660.00 $660.00 $660.00 $660.00
Injection carpal tunnel therapeutic (both sides) $853.50 $853.50 $853.50 $741.00
Injection during cath supravalvular aortography $2,211.75 $2,211.75 $2,211.75 $2,211.75
Injection epidural blood patch or clot $1,618.50 $1,618.50 $1,618.50 $1,499.25
Injection eye drug $387.00 $387.00 $387.00 $387.00
Injection for arthrography wrist (both sides) $551.25 $551.25 $551.25 $551.25
Injection for bladder x-ray $498.00 $498.00 $498.00 $585.00
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides) $540.75 $540.75 $540.75 $540.75
Injection for ureter x-ray $544.50 $544.50 $544.50 $603.00
Injection glatiramer acetate $1,749.29 $1,749.29 $1,749.29 $1,749.29
Injection into hemorrhoid(s) $1,058.25 $1,058.25 $1,058.25 $1,058.25
Injection jugular $1,890.00 $1,890.00 $1,890.00 $1,890.00
Injection of sinus tract $1,670.25 $1,670.25 $1,670.25 $1,670.25
Injection px peyronie ds $287.25 $287.25 $287.25 $287.25
Injection radioactive tracer sentinel node (both sides) $787.50 $787.50 $787.50 $787.50
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug $609.75 $609.75 $609.75 $306.00
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug $573.00 $573.00 $573.00 $238.80
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug $573.00 $573.00 $573.00 $238.80
Injection therapeutic/prophylactic/diagnostic subcutaneous/im $174.00 $174.00 $174.00 $147.00
Injection treatment of nerve $2,708.25 $2,708.25 $2,708.25 $2,708.25
Injection treatment of nerve $2,238.00 $2,238.00 $2,238.00 $2,238.00
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left $1,471.50 $1,471.50 $1,471.50 $1,471.50
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides) $1,567.50 $1,567.50 $1,567.50 $1,470.60
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides) $1,668.00 $1,668.00 $1,668.00 $1,668.00
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level $1,236.75 $1,236.75 $1,236.75 $1,271.25
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level $1,777.50 $1,777.50 $1,777.50 $1,777.50
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance $1,334.25 $1,334.25 $1,334.25 $1,334.25
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level $1,512.75 $1,512.75 $1,512.75 $1,512.75
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance $2,233.50 $2,233.50 $2,233.50 $2,233.50
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance $1,943.25 $1,943.25 $1,943.25 $1,943.25
Injection(s) tendon sheath/ligament aponeurosis single (both sides) $255.00 $255.00 $255.00 $616.20
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s) $1,078.50 $1,078.50 $1,078.50 $825.60
Injection(s) trigger point(s) single/multiple >= 3 muscle(s) $656.25 $656.25 $656.25 $656.25
Injection, belinostat, 10mg $9,355.72 $9,355.72 $9,355.72 $9,355.72
Injection, cangrelor $3,425.21 $3,425.21 $3,425.21 $3,425.21
Injection, doxercalciferol $23.86 $23.86 $23.86 $23.86
Injection, fulvestrant $3,584.82 $3,584.82 $3,584.82 $3,584.82
Injection, isavuconazonium $1,350.22 $1,350.22 $1,350.22 $1,350.22
Injection, peramivir $1,257.68 $1,257.68 $1,257.68 $1,257.68
Injection, renflexis $2,582.56 $2,582.56 $2,582.56 $1,624.80
Injection, siltuximab $23,535.37 $23,535.37 $23,535.37 $23,535.37
Injection,onabotulinumtoxina $4,814.15 $4,814.15 $4,814.15 $4,156.80
Inotuzumab ozogamicin 0.9 mg(0.25 mg/ml initial concentration) IV soln $88,429.23 $88,429.23 $88,429.23 $88,429.23
Ins cath ren art 1st bi $6,033.75 $6,033.75 $6,033.75 $6,033.75
Ins cath ren art 1st uni $5,074.50 $5,074.50 $5,074.50 $5,074.50
Ins cath ren art 2nd+ bi $7,922.25 $7,922.25 $7,922.25 $7,922.25
Ins cath ren art 2nd+ uni $5,184.00 $5,184.00 $5,184.00 $5,184.00
Ins cerv dilator (sep proc) $1,127.25 $1,127.25 $1,127.25 $1,127.25
Ins icd gen exist mlt leads $26,801.25 $26,801.25 $26,801.25 $26,801.25
Ins icd gen exist sgl lead $23,742.75 $23,742.75 $23,742.75 $23,742.75
Ins lv lead exist pm/icd $9,178.50 $9,178.50 $9,178.50 $9,178.50
Ins mark abd/pel for right perq $2,376.00 $2,376.00 $2,376.00 $2,376.00
Ins mark thor for right perq $2,831.25 $2,831.25 $2,831.25 $2,831.25
Ins picad w subq port 5yr> $5,089.50 $5,089.50 $5,089.50 $4,228.20
Ins picc wo subq prt/pmp w image guidnc <5yr $728.25 $728.25 $728.25 $728.25
Ins pm gen exist dual lead $19,065.75 $19,065.75 $19,065.75 $19,065.75
Ins pm gen w/exist mlt leads $15,600.75 $15,600.75 $15,600.75 $15,600.75
Ins pq tunnld ip cath w/img $4,113.75 $4,113.75 $4,113.75 $5,122.50
Ins tun cv cath wo subq prt/pm $4,564.50 $4,564.50 $4,564.50 $4,564.50
Ins tun cv cath wo subq prt/pm $4,218.00 $4,218.00 $4,218.00 $4,201.80
Ins tun intraperit dia cath $4,896.00 $4,896.00 $4,896.00 $4,707.75
Ins/rpl ldless pm right vent w img & eval $14,352.75 $14,352.75 $14,352.75 $14,857.20
Ins/rpl pm gen exist dual lead $11,005.50 $11,005.50 $11,005.50 $11,005.50
Ins/rpl pm gen exist sgl lead $7,319.25 $7,319.25 $7,319.25 $8,275.98
Ins/rpl pm w/tv ld atrl $8,724.00 $8,724.00 $8,724.00 $8,724.00
Ins/rpl prph sac/gstr npg/r $25,362.75 $25,362.75 $25,362.75 $25,362.75
Ins/rpl wireless pulm art sensor incl s&i $22,814.25 $22,814.25 $22,814.25 $22,814.25
Ins/rplc spi npg/rcvr pocket $36,000.00 $36,000.00 $36,000.00 $30,473.59
Insert abdomen-venous drain $7,121.25 $7,121.25 $7,121.25 $7,121.25
Insert cath pleura with image $1,734.75 $1,734.75 $1,734.75 $2,040.00
Insert cath pleura without image $2,019.00 $2,019.00 $2,019.00 $2,019.00
Insert drug delivery implant $1,418.25 $1,418.25 $1,418.25 $1,418.25
Insert hepatic shunt (tips) $10,536.00 $10,536.00 $10,536.00 $10,154.40
Insert intrauterine device iud $723.75 $723.75 $723.75 $669.00
Insert pessary/other device $332.25 $332.25 $332.25 $332.25
Insert picvad cath $2,907.75 $2,907.75 $2,907.75 $2,907.75
Insert pm/icd lead dual $6,880.50 $6,880.50 $6,880.50 $6,880.50
Insert sq defib electrode $6,820.50 $6,820.50 $6,820.50 $8,275.98
Insert swan-ganz cath $6,580.50 $6,580.50 $6,580.50 $4,443.00
Insert tunneled cv 2cath 2sits without port/pmp 36565 $5,018.25 $5,018.25 $5,018.25 $5,018.25
Insert tunneled cv cath $3,252.75 $3,252.75 $3,252.75 $3,252.75
Insert vad art access left hrt art & vein access $15,454.50 $15,454.50 $15,454.50 $15,454.50
Insert vad art access left hrt arterial access $5,240.25 $5,240.25 $5,240.25 $5,240.25
Insert/repl sq defib w/eltrd $26,801.25 $26,801.25 $26,801.25 $26,801.25
Insertion catheter bladder non indwelling $327.75 $327.75 $327.75 $309.00
Insertion catheter bladder temporary simple $323.25 $323.25 $323.25 $323.25
Insertion catheter pleural indwelling tunneled with cuff $4,782.00 $4,782.00 $4,782.00 $4,782.00
Insertion intra aortic balloon assist device percutaneous $3,576.75 $3,576.75 $3,576.75 $3,576.75
Insertion intravascular vena cava (ivc) access supervision & interpretation w/imaging guidance $6,702.00 $6,702.00 $6,702.00 $6,702.00
Insertion nontunneled centrally inserted central venous catheter >= 5 years old $2,712.75 $2,712.75 $2,712.75 $2,712.75
Insertion of catheter vein $2,687.25 $2,687.25 $2,687.25 $2,687.25
Insertion of catheter vein $2,808.00 $2,808.00 $2,808.00 $2,808.00
Insertion of heart electrode 33211 $6,820.50 $6,820.50 $6,820.50 $6,820.50
Insertion of new/replacement ppm w/transvenous electrode(s) atrial & ventricular $11,024.25 $11,024.25 $11,024.25 $11,024.25
Insertion of new/replacement ppm w/transvenous electrode(s) ventricular $8,834.25 $8,834.25 $8,834.25 $8,834.25
Insertion pacing electrode lv pacing w/insertion of ppm/implantable defibrillator $9,855.00 $9,855.00 $9,855.00 $9,855.00
Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years $3,077.25 $3,077.25 $3,077.25 $2,618.40
Insertion picc without port or pump with imaging guidance=>5y $1,242.75 $1,242.75 $1,242.75 $1,267.20
Insertion single tranvenous electrode/ppm/implantable defibrillator $6,820.50 $6,820.50 $6,820.50 $6,820.50
Insertion subcutaneous cardiac rhythm monitor $7,037.25 $7,037.25 $7,037.25 $7,037.25
Insertion tunneled centrally inserted central venous access device with port >= 5 years old (both sides) $4,604.25 $4,604.25 $4,604.25 $4,450.80
Insertion/replacement implantable defibrillator w/lead(s) single/dual chamber $26,801.25 $26,801.25 $26,801.25 $26,801.25
Insertion/replacement temporary single chamber electrode/pacemaker catheter $6,820.50 $6,820.50 $6,820.50 $6,820.50
Insitu hybridization (fish) $907.50 $907.50 $907.50 $907.50
Insitu hybridization manual $459.75 $459.75 $459.75 $512.40
Insj phrnc nrv stim sys $54,756.75 $54,756.75 $54,756.75 $54,756.75
Insj stablj dev without dcmprn $15,258.00 $15,258.00 $15,258.00 $15,258.00
Insole orthotic freedom sz6 6816 $38.25 $38.25 $38.25 $38.25
Inst fibrinolysis agent ini day $1,359.75 $1,359.75 $1,359.75 $1,236.00
Inst fibrinolysis agent sbsq d $1,025.25 $1,025.25 $1,025.25 $1,025.25
Inst via cath agent pleurds $2,517.75 $2,517.75 $2,517.75 $2,517.75
Instillation anticarcinogenic agent bladder $970.50 $970.50 $970.50 $970.50
Insulin total $103.50 $103.50 $103.50 $103.50
Int hrhc lig 1 hroid without img $3,491.25 $3,491.25 $3,491.25 $3,102.75
Int hrhc lig 2+hroid without img $3,767.25 $3,767.25 $3,767.25 $2,810.40
Integra matrix wnd inj flowable 3cc-q4114-cost per sq cm $9,970.16 $9,970.16 $9,970.16 $9,970.16
Integra meshed bil wound mat $35,280.97 $35,280.97 $35,280.97 $35,280.97
Integra os putty 2.5cc - cost per 0.5cc $6,018.75 $6,018.75 $6,018.75 $6,018.75
Interdental fixation $1,733.25 $1,733.25 $1,733.25 $1,733.25
Interdiscal perq aspir dx $822.75 $822.75 $822.75 $822.75
Interferon beta-1a 30 mcg/0.5 ml im injection (wrapper) $29,609.96 $29,609.96 $29,609.96 $29,609.96
Intermediate visual field xm $73.50 $73.50 $73.50 $73.50
Interrog dev eval icpms ip $112.50 $112.50 $112.50 $112.50
Interrog dev eval scrms ip $285.75 $285.75 $285.75 $234.00
Interrog device eval heart $636.75 $636.75 $636.75 $235.80
Interrog evl pm/ldls pm ip $202.50 $202.50 $202.50 $202.50
Interrog without prgrmg ipnss $108.00 $108.00 $108.00 $108.00
Interrog&prgrmg ipnss $108.00 $108.00 $108.00 $108.00
Interrogate subq defib $336.75 $336.75 $336.75 $336.75
Intra-atrial pacing $5,625.00 $5,625.00 $5,625.00 $5,625.00
Intra-atrial recording $6,184.50 $6,184.50 $6,184.50 $6,184.50
Intracard echo interv w/s&i $4,089.00 $4,089.00 $4,089.00 $4,089.00
Intracranial angioplasty $9,051.00 $9,051.00 $9,051.00 $9,051.00
Intracranial complete study $1,464.00 $1,464.00 $1,464.00 $1,464.00
Intracranial limited study $1,091.25 $1,091.25 $1,091.25 $906.00
Intranasal biopsy 30100 $3,322.50 $3,322.50 $3,322.50 $3,322.50
Intrapul surf admin endo tube $256.50 $256.50 $256.50 $256.50
Intrauterine transfusion ftl $1,788.00 $1,788.00 $1,788.00 $1,788.00
Intraventricular pacing $5,625.00 $5,625.00 $5,625.00 $5,625.00
Intrinsic factor antibody $77.25 $77.25 $77.25 $96.00
Intrm oph exam est patient $161.25 $161.25 $161.25 $161.25
Intro cath dialysis circuit $1,643.25 $1,643.25 $1,643.25 $2,317.80
Intro cath dialysis circuit w/pta $8,422.50 $8,422.50 $8,422.50 $8,240.40
Intro cath dialysis circuit w/stent plcmnt $13,140.75 $13,140.75 $13,140.75 $13,140.75
Intro cath svc/ivc $1,942.50 $1,942.50 $1,942.50 $1,942.50
Intro catheter aorta $2,623.50 $2,623.50 $2,623.50 $2,623.50
Intro long gi tube $876.00 $876.00 $876.00 $876.00
Intrvasc Ultrasound noncoronary 1st vessel $3,510.75 $3,510.75 $3,510.75 $3,510.75
Intrvasc Ultrasound noncoronary addl vessel $978.00 $978.00 $978.00 $978.00
Intubation endotracheal emergency procedure $934.50 $934.50 $934.50 $934.50
Ionm in operatng room 15 min $320.25 $320.25 $320.25 $264.00
Ionm remote/>1 pt or per hr $1,336.50 $1,336.50 $1,336.50 $1,336.50
Iopamidol 250 mg iodine/ml (51 %) intravenous solution $199.60 $199.60 $199.60 $199.60
Iopamidol 300 mg iodine/ml (61 %) intravenous solution $244.04 $244.04 $244.04 $244.04
Ipilimumab 5 mg/ml intravenous solution (wrapper) $133,919.31 $133,919.31 $133,919.31 $133,919.31
Ipratropium bromide non-comp $2.43 $2.43 $2.43 $2.43
Irinotecan 20 mg/ml intravenous solution (wrapper) $378.32 $378.32 $378.32 $719.20
Irinotecan liposomal 4.3 mg/ml intravenous $11,014.86 $11,014.86 $11,014.86 $11,014.86
Iron $428.25 $428.25 $428.25 $83.40
Iron binding capacity $89.25 $89.25 $89.25 $89.25
Iron dextran 50 mg/ml injection solution $140.34 $140.34 $140.34 $140.34
Iron sucrose 20 mg iron/ml intravenous solution (wrapper) $133.11 $133.11 $133.11 $133.11
Irradiation of blood product each unit reference $206.25 $206.25 $206.25 $138.75
Irrigation implantable venous access device for drug delivery systems $153.75 $153.75 $153.75 $150.60
Isatuximab-irfc 20 mg/ml intravenous solution $15,760.97 $15,760.97 $15,760.97 $15,760.97
Ivc venogram s&i $4,438.50 $4,438.50 $4,438.50 $3,524.25
Ixabepilone 15 mg intravenous solution $22,346.52 $22,346.52 $22,346.52 $22,346.52
J-tube placement $904.50 $904.50 $904.50 $904.50
Jejunstmy tube plcmt $3,895.50 $3,895.50 $3,895.50 $3,895.50
Ketamine and metabolite screen - quest $136.50 $136.50 $136.50 $136.50
Ketone body(s) beta-hydroxybutyrate quantitative $285.75 $285.75 $285.75 $211.20
Ketorolac 15 mg/ml injection (wrapper) $17.11 $17.11 $17.11 $17.11
Kidney (Retroperitoneal) Ultrasound (complete) $972.75 $972.75 $972.75 $690.00
Kidney function study $1,133.25 $1,133.25 $1,133.25 $1,133.25
Kidney imaging morphology $1,238.25 $1,238.25 $1,238.25 $1,238.25
Kidney img w/bldflw sgl without rx $1,584.75 $1,584.75 $1,584.75 $1,565.25
Kit case 4.2mm spinejack $9,652.39 $9,652.39 $9,652.39 $9,652.39
Kit cath ivl 2.5x40mm 135cm shockwave s4 $10,575.00 $10,575.00 $10,575.00 $10,575.00
Kit gene analys d816 variant $268.50 $268.50 $268.50 $721.80
Kit hfx iq ipg bundle $58,500.00 $58,500.00 $58,500.00 $58,500.00
Kit ipg optimizer smart $51,750.00 $51,750.00 $51,750.00 $51,750.00
Kit lead specify 5-6-5 $73,912.50 $73,912.50 $73,912.50 $41,212.80
Kit montgmry thyrplasty impl f 5 implants 1meas dev inst set $801.57 $801.57 $801.57 $801.57
Kit tissue closure sealant adhesive air leak progel 4 ml pleura $2,836.08 $2,836.08 $2,836.08 $2,836.08
Knee MRI (with and without contrast) $2,628.75 $2,628.75 $2,628.75 $3,008.26
Knee MRI (with contrast) $2,259.00 $2,259.00 $2,259.00 $2,394.58
Knee MRI (without contrast) $2,628.75 $2,628.75 $2,628.75 $2,209.22
Knee X-ray $508.50 $508.50 $508.50 $388.44
Kyleena, 19.5 mg $4,491.10 $4,491.10 $4,491.10 $4,491.10
Labetalol 5 mg/ml IV (wrapper) $22.19 $22.19 $22.19 $22.19
Lacosamide 200 mg/20 ml intravenous solution $237.75 $237.75 $237.75 $237.75
Lactate dehydrogenase (ldh) $65.25 $65.25 $65.25 $60.75
Lactated ringers intravenous solution $22.19 $22.19 $22.19 $32.40
Lactic acid $209.25 $209.25 $209.25 $129.60
Lactoferrin fecal qualitative $72.75 $72.75 $72.75 $72.75
Lanreotide 120 mg/0.5 ml subcutaneous syringe $35,355.50 $35,355.50 $35,355.50 $35,355.50
Lanthanum carbonate oral 5mg $2,066.54 $2,066.54 $2,066.54 $2,066.54
Laparoscopye procstom 43659 $6,827.25 $6,827.25 $6,827.25 $6,827.25
Largsc w/laser dstrj les $6,297.75 $6,297.75 $6,297.75 $6,297.75
Largsc w/njx augmentation $3,180.00 $3,180.00 $3,180.00 $3,180.00
Largsc w/removal lesion $8,732.25 $8,732.25 $8,732.25 $8,732.25
Largsc w/ther injection $3,151.50 $3,151.50 $3,151.50 $3,151.50
Laronidase injection $4,116.73 $4,116.73 $4,116.73 $4,116.73
Laryngeal function studies $360.00 $360.00 $360.00 $360.00
Laryngoscope w/vc inj $4,485.00 $4,485.00 $4,485.00 $4,485.00
Laryngoscopy direct w/wo tracheoscopy dx exc newborn $1,968.00 $1,968.00 $1,968.00 $2,131.80
Laryngoscopy telescopic $1,185.75 $1,185.75 $1,185.75 $1,185.75
Laryngoscopy w/exc of tumor $7,290.00 $7,290.00 $7,290.00 $7,290.00
Laryngoscopy w/fb removal $2,017.50 $2,017.50 $2,017.50 $2,017.50
Laryngoscopy w/w/o tracheoscopy aspiration $473.25 $473.25 $473.25 $473.25
Laryngoscopy with biopsy $8,027.25 $8,027.25 $8,027.25 $8,027.25
Lavage cannulation maxillary sinus $1,871.25 $1,871.25 $1,871.25 $1,871.25
Lead acuity x4 spiral l 86cm $4,863.24 $4,863.24 $4,863.24 $4,863.24
Lead capillary $101.25 $101.25 $101.25 $93.00
Lead ingevity 45cm pfret MRI $7,616.25 $7,616.25 $7,616.25 $5,084.40
Lead tachy durata sj4 58cm $13,488.75 $13,488.75 $13,488.75 $13,488.75
Leg Vein Ultrasound (DVT study, both legs) $1,209.00 $1,209.00 $1,209.00 $1,090.23
Leishmania antibody $182.25 $182.25 $182.25 $182.25
Lens iol 23.0 d 1.5 cyl eyhance toric $2,238.75 $2,238.75 $2,238.75 $789.00
Lens iol ant bicnvx 24.0 multi $1,136.25 $1,136.25 $1,136.25 $1,136.25
Lens iol ant chamb 10.5 $191.25 $191.25 $191.25 $191.25
Leucovorin calcium 100 mg solution for injection (1 mg rounding) $83.13 $83.13 $83.13 $83.13
Leuprolide 3.75 mg intramuscular syringe kit $42,325.47 $42,325.47 $42,325.47 $4,876.80
Leuprolide 30 mg (4 month) intramuscular syringe kit $30,791.46 $30,791.46 $30,791.46 $6,275.40
Levalbuterol non-comp unit $5.40 $5.40 $5.40 $5.40
Levetiracetam 500 mg/5 ml intravenous solution $97.62 $97.62 $97.62 $97.62
Levetiracetam therapeutic drug level $215.25 $215.25 $215.25 $210.00
Levofloxacin 250 mg/50 ml in 5 % dextrose intravenous piggyback $47.70 $47.70 $47.70 $47.70
Levothyroxine 100 mcg intravenous powder for solution $652.50 $652.50 $652.50 $652.50
Liberta rc ipg $63,376.43 $63,376.43 $63,376.43 $63,376.43
Lidocaine (pf) 4 mg/ml (0.4 %) in 5 % dextrose intravenous solution $25.89 $25.89 $25.89 $0.20
Lidocaine therapeutic drug level $78.00 $78.00 $78.00 $78.00
Lig/band angioaccess av fistula $3,213.75 $3,213.75 $3,213.75 $3,213.75
Liletta, 52 mg $3,445.08 $3,445.08 $3,445.08 $3,445.08
Limited visual field xm $96.75 $96.75 $96.75 $96.75
Linezolid in 5% dextrose in water 600 mg/300 ml intravenous piggyback $119.81 $119.81 $119.81 $164.00
Lipase $177.75 $177.75 $177.75 $177.75
Lipoprotein blood quant $254.25 $254.25 $254.25 $254.25
Lipoprotein direct measurement hdl $93.75 $93.75 $93.75 $70.20
Lipoprotein direct measurement ldl $104.25 $104.25 $104.25 $104.25
Lithium therapeutic drug level $94.50 $94.50 $94.50 $94.50
Lithotripsy transluminal coronary percutaneous $3,650.25 $3,650.25 $3,650.25 $3,650.25
Liver Function Test $141.75 $141.75 $141.75 $93.60
Liver ds alys 3 bmrk srm alg $812.25 $812.25 $812.25 $812.25
Liver elastography 91200 $552.75 $552.75 $552.75 $552.75
Liver imaging $1,241.25 $1,241.25 $1,241.25 $1,241.25
Liver/spleen imag static only $1,856.25 $1,856.25 $1,856.25 $1,308.60
Loncastuximab tesirine-lpyl 10 mg intravenous solution $104,719.60 $104,719.60 $104,719.60 $104,719.60
Lorazepam 2 mg/ml injection (wrapper) $49.14 $49.14 $49.14 $49.14
Lower Back (Lumbar Spine) CT scan (with and without contrast) $1,817.25 $1,817.25 $1,817.25 $1,818.60
Lower Back (Lumbar Spine) CT scan (with contrast) $1,829.25 $1,829.25 $1,829.25 $1,829.25
Lower Back (Lumbar Spine) CT scan (without contrast) $1,734.75 $1,734.75 $1,734.75 $1,517.10
Lower Back (Lumbar Spine) MRI (with and without contrast) $2,590.50 $2,590.50 $2,590.50 $2,713.80
Lower Back (Lumbar Spine) MRI (with contrast) $2,441.25 $2,441.25 $2,441.25 $2,415.68
Lower Back (Lumbar Spine) MRI (without contrast) $2,265.75 $2,265.75 $2,265.75 $2,013.08
Lower Back (Lumbar Spine) X-ray $439.50 $439.50 $439.50 $341.64
Lumbar diskogram s&i $2,909.25 $2,909.25 $2,909.25 $2,909.25
Lumizyme injection $3,672.96 $3,672.96 $3,672.96 $3,672.96
Lung Function Test (Spirometry) $478.50 $478.50 $478.50 $296.91
Lung function test (mbc/mvv) $220.50 $220.50 $220.50 $115.80
Lung perfusion imaging $1,789.50 $1,789.50 $1,789.50 $1,228.80
Lurbinectedin 4 mg intravenous solution $30,504.38 $30,504.38 $30,504.38 $30,504.38
Luspatercept-aamt 25 mg subcutaneous solution $45,624.83 $45,624.83 $45,624.83 $87.60
Lvad shower bag heartmate $1,059.75 $1,059.75 $1,059.75 $1,059.75
Lymph vessel x-ray arm/leg $2,379.00 $2,379.00 $2,379.00 $2,379.00
Lymph vessel x-ray arms/legs $2,379.00 $2,379.00 $2,379.00 $2,379.00
Lymph vessel x-ray trunk $2,489.25 $2,489.25 $2,489.25 $2,489.25
Lymph vessel x-ray trunk $2,489.25 $2,489.25 $2,489.25 $2,489.25
Lymphatics/lymph node imaging $2,091.75 $2,091.75 $2,091.75 $1,681.50
Lymphocyte transformation mitogen $858.75 $858.75 $858.75 $630.00
Lysis intranasal synechia 30560 $3,098.25 $3,098.25 $3,098.25 $3,098.25
M.avium-intra dna amp prob $489.75 $489.75 $489.75 $489.75
M/phmtrc alys ishquant/semiq $435.00 $435.00 $435.00 $435.00
MRA abdomen post contrast $2,229.00 $2,229.00 $2,229.00 $2,229.00
MRA aorta thoracic w/wo contrast $2,121.75 $2,121.75 $2,121.75 $2,121.75
MRA ext low(run-off)pst cntrst $2,229.00 $2,229.00 $2,229.00 $2,229.00
MRA pelvis $2,229.00 $2,229.00 $2,229.00 $2,229.00
MRA spinal canal $1,320.00 $1,320.00 $1,320.00 $1,320.00
MRA upper extremity post contrast-bil $1,574.25 $1,574.25 $1,574.25 $1,574.25
MRI brain without & w/dye $2,608.50 $2,608.50 $2,608.50 $2,608.50
MRI breast c-+ w/cad uni $303.75 $303.75 $303.75 $303.75
MRI breast w IV cont bi $303.75 $303.75 $303.75 $303.75
MRI breast without cont bi $262.50 $262.50 $262.50 $262.50
MRI cardiac morph & func wo IV cont $2,379.00 $2,379.00 $2,379.00 $2,379.00
MRI cardiac morph & func wwo IV cont $2,945.25 $2,945.25 $2,945.25 $2,945.25
MRI cardiac morph & func wwo IV cont w/stress img $3,879.75 $3,879.75 $3,879.75 $3,879.75
MRI chest w IV cont $2,105.25 $2,105.25 $2,105.25 $2,580.00
MRI chest without & w/contrast $2,877.75 $2,877.75 $2,877.75 $3,008.25
MRI chest without contrast $1,818.00 $1,818.00 $1,818.00 $2,205.00
MRI guid ndl plc s&i $1,454.25 $1,454.25 $1,454.25 $1,454.25
MRI loex nonjt w IV cont $2,259.00 $2,259.00 $2,259.00 $2,713.80
MRI lower extremity other than joint without & w/contrast (both sides) $2,628.75 $2,628.75 $2,628.75 $2,854.50
MRI lower extremity other than joint without contrast (both sides) $2,127.00 $2,127.00 $2,127.00 $2,205.00
MRI orbit fac&nck w IV cont $2,776.50 $2,776.50 $2,776.50 $2,776.50
MRI orbit/face/neck without & w/contrast $2,181.00 $2,181.00 $2,181.00 $2,854.80
MRI orbit/face/neck without contrast $1,883.25 $1,883.25 $1,883.25 $2,100.00
MRI tmj $1,860.00 $1,860.00 $1,860.00 $2,280.75
MRI upper extremity other than joint without & w/contrast (both sides) $2,628.75 $2,628.75 $2,628.75 $2,854.50
MRI upper extremity other than joint without contrast (both sides) $2,127.00 $2,127.00 $2,127.00 $2,127.00
MRI upper extremity w/dye $2,550.75 $2,550.75 $2,550.75 $3,051.00
Magnesium $96.00 $96.00 $96.00 $91.20
Magnesium sulfate 2 gram/50 ml (4 %) in water intravenous piggyback $23.30 $23.30 $23.30 $23.30
Manipulat palm cord post inj $532.50 $532.50 $532.50 $532.50
Manipulation chest wall demonstration/evaluation subsequent $216.75 $216.75 $216.75 $193.20
Manipulation chest wall initial demonstration/evaluation $219.00 $219.00 $219.00 $219.00
Map tachycard site(s) $10,926.00 $10,926.00 $10,926.00 $10,926.00
Mapping functional cort/subcort ea add'l hr $1,137.75 $1,137.75 $1,137.75 $1,137.75
Margetuximab-cmkb 25 mg/ml intravenous solution $9,885.94 $9,885.94 $9,885.94 $9,885.94
Marker biop eviva buckle ss $819.00 $819.00 $819.00 $819.00
Mastoids complete $524.25 $524.25 $524.25 $465.75
Mayo a1app alpha 1 antitrypsin phenotype $117.00 $117.00 $117.00 $117.00
Mayo aathr protein s free $226.50 $226.50 $226.50 $226.50
Mayo activated protein c resistance assay $170.25 $170.25 $170.25 $170.25
Mayo adalimumab (humira) therapeutic drug level $3,813.75 $3,813.75 $3,813.75 $205.80
Mayo alcohol biomarkers definitive assay 1 or 2 phosphatidylethanol confirmation $70.50 $70.50 $70.50 $70.50
Mayo alcohol definitive assay volatile screen $627.75 $627.75 $627.75 $627.75
Mayo alkaline phosphatase isoenzyme $222.00 $222.00 $222.00 $156.60
Mayo alkaloids definitive assay nicotine/cotinine $270.75 $270.75 $270.75 $270.75
Mayo alpha 1 antitrypsin $398.25 $398.25 $398.25 $238.40
Mayo amikacin trough therapeutic drug level $207.75 $207.75 $207.75 $207.75
Mayo amphu amphetamines definitive assay 3 or 4 urine $94.50 $94.50 $94.50 $94.50
Mayo amphu methylenedioxyamphetamines definitive assay urine $102.75 $102.75 $102.75 $102.75
Mayo analysis gene jak2 p.val617phe variant $215.25 $215.25 $215.25 $215.25
Mayo analysis gene smn1 dosage/deletion $368.25 $368.25 $368.25 $730.20
Mayo analysis microarray cytogenomic copy number/snp variants $1,416.75 $1,416.75 $1,416.75 $1,416.75
Mayo androstenedione $249.00 $249.00 $249.00 $223.20
Mayo angiotensin 1 converting enzyme (ace) csf $59.25 $59.25 $59.25 $59.25
Mayo antithrombin iii antigen $88.50 $88.50 $88.50 $97.20
Mayo aspergillus fumigatus antibody $106.50 $106.50 $106.50 $106.50
Mayo avwpr vw factor activity $911.25 $911.25 $911.25 $766.20
Mayo babpb infectious agent nucleic acid amplified probe babesia microti $105.00 $105.00 $105.00 $105.00
Mayo barbiturates definitive assay confirmation urine $501.00 $501.00 $501.00 $501.00
Mayo bart bartonella henselae antibody igg $104.25 $104.25 $104.25 $100.20
Mayo bcrfx analysis translocation bcr/abl1 minor breakpoint qualitative/quantitative $318.75 $318.75 $318.75 $318.75
Mayo blastomyces antibody immunodiffusion $262.50 $262.50 $262.50 $192.60
Mayo bnzu sedative hypnotics definitive urine $128.25 $128.25 $128.25 $128.25
Mayo bordetella pertussis antibody igg $135.75 $135.75 $135.75 $121.60
Mayo brcmg brucella antibody igm $324.75 $324.75 $324.75 $144.00
Mayo c1 esterase inhibitor $183.00 $183.00 $183.00 $149.25
Mayo cannabinoids natural definitive assay thc confirmation urine $333.75 $333.75 $333.75 $333.75
Mayo carnitine total and free quantitative each specimen plasma $110.25 $110.25 $110.25 $156.00
Mayo cd20b mononuclear cell antigen nos quantitative each $773.25 $773.25 $773.25 $538.20
Mayo cdcom hla class ii typing low resolution one locus each $333.00 $333.00 $333.00 $333.00
Mayo ceruloplasmin $117.75 $117.75 $117.75 $104.25
Mayo chemiluminescent parathyroid related peptide $377.25 $377.25 $377.25 $377.25
Mayo chikv chikungunya antibodies igg $423.00 $423.00 $423.00 $406.50
Mayo chlap chlamydia pneumoniae antibody igg $128.25 $128.25 $128.25 $128.25
Mayo chlap chlamydia pneumoniae antibody igm $93.00 $93.00 $93.00 $93.00
Mayo chrcb tissue culture non-neoplastic disorders lymphocyte $519.00 $519.00 $519.00 $657.75
Mayo chromium $129.75 $129.75 $129.75 $129.75
Mayo cocaine definitive assay confirmation urine $297.00 $297.00 $297.00 $297.00
Mayo coccidioides antibody $124.50 $124.50 $124.50 $124.50
Mayo cocou cortisone urine $1,213.50 $1,213.50 $1,213.50 $711.60
Mayo cortisol free $183.00 $183.00 $183.00 $166.80
Mayo covid-19 antibody nucleocapsid total $122.25 $122.25 $122.25 $122.25
Mayo coxiella brunetii (q fever) igg antibody $110.25 $110.25 $110.25 $110.25
Mayo csmpu benzodiazepines definitive assay >=13 urine $156.00 $156.00 $156.00 $156.00
Mayo csmpu opiod/analogs definitive assay >=5 urine $161.25 $161.25 $161.25 $161.25
Mayo cyanide $170.25 $170.25 $170.25 $170.25
Mayo deoxyribonuclease antibody titer $96.00 $96.00 $96.00 $96.00
Mayo dhea (dehydroepiandrosterone) $276.75 $276.75 $276.75 $276.75
Mayo dihydrotestosterone $169.50 $169.50 $169.50 $169.50
Mayo efpo chloride stool $102.00 $102.00 $102.00 $102.00
Mayo estriol $173.25 $173.25 $173.25 $147.20
Mayo estrone $123.00 $123.00 $123.00 $126.60
Mayo ethosuximide therapeutic drug level $138.75 $138.75 $138.75 $138.75
Mayo everolimus therapeutic drug level $245.25 $245.25 $245.25 $245.25
Mayo factor ii $190.50 $190.50 $190.50 $122.40
Mayo factor v $219.00 $219.00 $219.00 $213.00
Mayo factor vii $204.00 $204.00 $204.00 $201.00
Mayo factor viii vw factor antigen $150.00 $150.00 $150.00 $150.00
Mayo factor viii vw factor multimetric analysis $656.25 $656.25 $656.25 $304.80
Mayo factor viii vw factor ristocetin cofactor $414.75 $414.75 $414.75 $305.25
Mayo factor x $250.50 $250.50 $250.50 $250.50
Mayo factor xi $288.75 $288.75 $288.75 $201.00
Mayo fat/lipids feces quantitative $62.25 $62.25 $62.25 $110.40
Mayo fbl culture fungi blood $127.50 $127.50 $127.50 $127.50
Mayo ffspg allergen clam igg $57.75 $57.75 $57.75 $57.75
Mayo fibrinogen antigen $230.25 $230.25 $230.25 $120.00
Mayo gabapentin bld/srm/plasma therapeutic drug level $159.75 $159.75 $159.75 $159.75
Mayo gamma-globin full gene sequencing $7,125.00 $7,125.00 $7,125.00 $7,746.60
Mayo hemosiderin qualitative urine $50.25 $50.25 $50.25 $50.25
Mayo hip12 infectious agent nucleic acid amplified probe hiv-1 rna qualitative $237.75 $237.75 $237.75 $274.50
Mayo hiser histoplasma antibodies immunodiffusion $161.25 $161.25 $161.25 $161.25
Mayo hvdip HIV 1 antibody $274.50 $274.50 $274.50 $149.40
Mayo hydroxyprogesterone 17-d $120.75 $120.75 $120.75 $137.40
Mayo immunoassay c1 esterase inhibitor antibody quantitative $1,192.50 $1,192.50 $1,192.50 $282.60
Mayo immunoassay infectious agent antibody quantitative diptheria igg $154.50 $154.50 $154.50 $154.50
Mayo immunoassay tumor antigen quantitative ca 27.29 $83.25 $83.25 $83.25 $100.50
Mayo immunoassay tumor antigen quantitative chromogranin a $186.75 $186.75 $186.75 $186.75
Mayo infectious agent antigen immunoassay direct optical observation cryptococcus $141.75 $141.75 $141.75 $141.75
Mayo infectious agent antigen immunoassay ql/sq multi step aspergillus bal $351.00 $351.00 $351.00 $351.00
Mayo infectious agent nucleic acid amplified probe enterovirus $554.25 $554.25 $554.25 $554.25
Mayo infectious agent nucleic acid amplified probe mycoplasma genitalium urine $98.25 $98.25 $98.25 $98.25
Mayo infectious agent nucleic acid amplified probe mycoplasma pneumoniae $744.75 $744.75 $744.75 $476.40
Mayo infectious agent nucleic acid amplified probe pneumocystis jirovecii $292.50 $292.50 $292.50 $292.50
Mayo infectious agent nucleic acid quantification cytomegalovirus $546.75 $546.75 $546.75 $433.50
Mayo infectious disease hepatitis c chronic six biochemical assays $258.75 $258.75 $258.75 $258.75
Mayo infliximab therapeutic drug level $4,117.50 $4,117.50 $4,117.50 $699.60
Mayo inhab inhibin a $309.75 $309.75 $309.75 $309.75
Mayo insft insulin free $56.25 $56.25 $56.25 $69.75
Mayo insulin antibodies $117.00 $117.00 $117.00 $117.00
Mayo iodine $571.50 $571.50 $571.50 $325.20
Mayo itraconazole therapeutic drug level $159.00 $159.00 $159.00 $159.00
Mayo lacosamide therapeutic drug level $265.50 $265.50 $265.50 $205.80
Mayo lamotrigine therapeutic drug level $171.00 $171.00 $171.00 $171.00
Mayo ld_i lactate dehydrogenase isoenzymes $104.25 $104.25 $104.25 $104.25
Mayo legionella antibody $87.00 $87.00 $87.00 $99.00
Mayo leptospira antibody igm $82.50 $82.50 $82.50 $82.50
Mayo lipoprotein electrophoresis $45.75 $45.75 $45.75 $45.75
Mayo lywb borrelia burgdorferi (lyme disease) antibody igg confirmatory $180.00 $180.00 $180.00 $180.00
Mayo manganese $148.50 $148.50 $148.50 $117.00
Mayo metanephrines plasma $803.25 $803.25 $803.25 $495.60
Mayo methadone definitive assay confirmation urine $127.50 $127.50 $127.50 $127.50
Mayo mgle voltage-gated calcium channel antibody each $507.00 $507.00 $507.00 $300.00
Mayo microsomal antibody liver-kidney $177.00 $177.00 $177.00 $177.00
Mayo mitotane (lysodren) therapeutic drug level $503.25 $503.25 $503.25 $298.80
Mayo molecular pathology procedure level 2 apoe genotype $886.50 $886.50 $886.50 $886.50
Mayo muramidase $96.75 $96.75 $96.75 $96.75
Mayo muscle-specific kinase (musk) antibody $1,833.00 $1,833.00 $1,833.00 $300.00
Mayo mycophenolic acid therapeutic drug level $581.25 $581.25 $581.25 $418.50
Mayo myoglobin $165.00 $165.00 $165.00 $165.00
Mayo nickel $90.00 $90.00 $90.00 $90.75
Mayo opatu opiates definitive assay >=1 $99.00 $99.00 $99.00 $99.00
Mayo opatu opioid/analogs definitive assay 1 or 2 $86.25 $86.25 $86.25 $86.25
Mayo opatu oxycodone definitive assay $111.00 $111.00 $111.00 $111.00
Mayo organic acid methylmalonic single quantitative $375.75 $375.75 $375.75 $375.75
Mayo oxalate 24 hour urine $183.00 $183.00 $183.00 $183.00
Mayo parvs parvovirus b19 antibody igg $136.50 $136.50 $136.50 $136.50
Mayo paval fluorescent antibody screen agna type 1 $1,833.00 $1,833.00 $1,833.00 $383.40
Mayo pborb infectious agent nucleic acid amplified probe borrelia burgdorferi (lyme) $735.00 $735.00 $735.00 $620.40
Mayo phospholipid neutralization hexagonal lupus anticoagulant $255.75 $255.75 $255.75 $232.20
Mayo pntft phenytoin free therapeutic drug level $120.75 $120.75 $120.75 $98.40
Mayo pqnu porphobilinogen urine quantitative 24 hour urine $131.25 $131.25 $131.25 $131.25
Mayo pregnenolone $175.50 $175.50 $175.50 $189.60
Mayo prmb primidone therapeutic drug level $157.50 $157.50 $157.50 $130.20
Mayo proinsulin $206.25 $206.25 $206.25 $206.25
Mayo psaft prostate specific antigen free $128.25 $128.25 $128.25 $128.25
Mayo radioimmunoassay procollagen i intact n-terminal antibody quantitative $1,768.50 $1,768.50 $1,768.50 $700.00
Mayo rbcme osmotic fragility rbc incubated $277.50 $277.50 $277.50 $277.50
Mayo receptor assay transferrin soluble $159.00 $159.00 $159.00 $192.60
Mayo renin $147.75 $147.75 $147.75 $147.75
Mayo repu protein electrophoresis urine $69.00 $69.00 $69.00 $91.20
Mayo selenium $177.00 $177.00 $177.00 $177.00
Mayo serotonin $202.50 $202.50 $202.50 $209.25
Mayo sfgp rickettsia rickettsii antibody igg $122.25 $122.25 $122.25 $115.50
Mayo sirolimus therapeutic drug level $250.50 $250.50 $250.50 $236.40
Mayo streptococcus pneumoniae antibody igg 23 serotypes multiplex immunoassay quantitative $137.25 $137.25 $137.25 $137.25
Mayo syphilis test non-treponemal antibody qualitative vdrl $52.50 $52.50 $52.50 $51.00
Mayo tau phosphorylated 217 each $504.00 $504.00 $504.00 $366.00
Mayo tcgr analysis gene rearrangement trb@ abnormal clonal population(s) amplification $501.75 $501.75 $501.75 $501.75
Mayo tgrp testosterone free $121.50 $121.50 $121.50 $121.50
Mayo tgrp testosterone total $193.50 $193.50 $193.50 $193.50
Mayo thyroglobulin $665.25 $665.25 $665.25 $400.80
Mayo ticks anaplasma phagocytophilum antibody igg $189.00 $189.00 $189.00 $118.40
Mayo ticks babesia microti antibody igg $153.75 $153.75 $153.75 $134.40
Mayo tramadol definitive assay w metabolite quantitative urine $69.75 $69.75 $69.75 $69.75
Mayo tulab francisella tularensis antibody igg $55.50 $55.50 $55.50 $58.50
Mayo valpg valproic acid free therapeutic drug level $126.00 $126.00 $126.00 $126.00
Mayo vasoactive intestinal peptide $326.25 $326.25 $326.25 $326.25
Mayo vitamin b-2 (riboflavin) $104.25 $104.25 $104.25 $133.50
Mayo vitamin b3 (niacin) $147.00 $147.00 $147.00 $147.00
Mayo vitamin k $458.25 $458.25 $458.25 $320.40
Mayo zonisamide therapeutic drug level $300.00 $300.00 $300.00 $300.00
Measurement post void urine by ultrasound $266.25 $266.25 $266.25 $199.50
Med physic dos eval rad exps $621.00 $621.00 $621.00 $621.00
Medroxyprogesterone 150 mg/ml im injection (wrapper) $252.10 $252.10 $252.10 $252.10
Membrane affinity fresh amniotic 2.5x2.5cm -cost per sq cm $3,037.50 $3,037.50 $3,037.50 $3,037.50
Membrane amnio clarix 4x3cm 1k -cost per sq cm $4,218.75 $4,218.75 $4,218.75 $4,218.75
Membrane collgn porcine maci w/autologous cult chondrocytes $235,134.00 $235,134.00 $235,134.00 $235,134.00
Meperidine (pf) 25 mg/ml injection (wrapper) $23.88 $23.88 $23.88 $23.40
Mepolizumab 100 mg/ml subcutaneous auto-injector $11,523.04 $11,523.04 $11,523.04 $11,523.04
Meropenem 1 gram intravenous solution $102.84 $102.84 $102.84 $102.84
Mesna 100 mg/ml intravenous solution $73.95 $73.95 $73.95 $73.95
Metabolic Blood Panel (Basic) $123.00 $123.00 $123.00 $97.60
Metabolic Blood Panel (Comprehensive) $198.00 $198.00 $198.00 $135.20
Metabolic panel ionized ca $121.50 $121.50 $121.50 $132.75
Methacholine chloride 0.0625 mg/ml nebulization soln $2,776.62 $2,776.62 $2,776.62 $2,561.40
Methadone injection $725.09 $725.09 $725.09 $725.09
Methocarbamol ivpb 250 mg in 50 ml ns - cnr (headpain) $38.39 $38.39 $38.39 $38.39
Methotrexate sodium (pf) 1 gram solution for injection $215.83 $215.83 $215.83 $215.83
Methotrexate sodium 2.5 mg tablet $466.63 $466.63 $466.63 $28.65
Methotrexate therapeutic drug level $66.75 $66.75 $66.75 $67.20
Methylene blue (antidote) 5 mg/ml intravenous solution $4,037.33 $4,037.33 $4,037.33 $4,037.33
Methylergonovine 0.2 mg/ml (1 ml) injection solution $76.59 $76.59 $76.59 $53.00
Methylnaltrexone 12 mg/0.6 ml subcutaneous injection (wrapper) $582.48 $582.48 $582.48 $504.60
Methylprednisolone 4 mg tablet $685.89 $685.89 $685.89 $114.60
Methylprednisolone acetate 40 mg/ml suspension for injection $67.62 $67.62 $67.62 $1.20
Methylprednisolone sodium succinate 1,000 mg intravenous solution $306.72 $306.72 $306.72 $6.80
Metoclopramide in d5w IV syringe 0.2 mg/ml (neo/ped) - cnr $12.40 $12.40 $12.40 $12.40
Metoprolol tartrate 5 mg/5 ml intravenous (wrapper) $7.59 $7.59 $7.59 $7.59
Metronidazole 500 mg/100 ml in sodium chlor(iso) intravenous piggyback $11.84 $11.84 $11.84 $3.60
Mgmt promoter methylation analysis $261.75 $261.75 $261.75 $227.40
Micafungin 100 mg intravenous solution $691.44 $691.44 $691.44 $26.20
Microdissection manual $262.50 $262.50 $262.50 $367.50
Microvolt t-wave assess $1,542.00 $1,542.00 $1,542.00 $1,542.00
Midazolam 1 mg/ml in sodium chloride IV infusion (wrapper) $102.80 $102.80 $102.80 $102.80
Midazolam 1 mg/ml injection solution $97.25 $97.25 $97.25 $97.20
Middle cerebral artery echo $645.75 $645.75 $645.75 $645.75
Milrinone 20 mg/100 ml(200 mcg/ml) in 5 % dextrose intravenous piggybk $58.43 $58.43 $58.43 $58.43
Minocycline hydrochloride $884.76 $884.76 $884.76 $884.76
Mitomycin 40 mg intravenous solution $4,332.81 $4,332.81 $4,332.81 $3,278.40
Mitoxantrone 2 mg/ml concentrate,intravenous $437.16 $437.16 $437.16 $437.16
Mlh1 gene $290.25 $290.25 $290.25 $292.50
Mog-igg1 antb flo cytmtry ea $924.00 $924.00 $924.00 $665.25
Monitor reveal linq ii cardiac $10,575.00 $10,575.00 $10,575.00 $10,575.00
Monovisc inj per dose $2,155.28 $2,155.28 $2,155.28 $2,155.28
Mopath procedure level 1 $1,012.50 $1,012.50 $1,012.50 $1,012.50
Mopath procedure level 5 $1,825.50 $1,825.50 $1,825.50 $1,825.50
Mopath procedure level 6 $2,340.75 $2,340.75 $2,340.75 $2,340.75
Mopath procedure level 7 $2,340.75 $2,340.75 $2,340.75 $2,340.75
Mopath procedure level 8 $1,587.00 $1,587.00 $1,587.00 $1,587.00
Mopath procedure level 9 $2,250.00 $2,250.00 $2,250.00 $2,250.00
Morphine (pf) 0.25 mg/0.5 ml injection (neo/ped) - cnr $1,132.55 $1,132.55 $1,132.55 $918.00
Morphine 4 mg/ml injection (wrapper) $46.08 $46.08 $46.08 $46.08
Morphine 4 mg/ml injection (wrapper)|discarded drug not administered $8.37 $8.37 $8.37 $8.37
Morphometric analysis tumor ihc qn/sq per specimen each single antibody stain computer-assisted $311.25 $311.25 $311.25 $398.25
Morphometric analysis tumor ihc qn/sq per specimen each single antibody stain manual $311.25 $311.25 $311.25 $311.25
Mr safety determination physician/other qhp $102.75 $102.75 $102.75 $160.20
Mr safety implant elec prepj $108.00 $108.00 $108.00 $166.80
Mr safety implt pos&/immoblj $70.50 $70.50 $70.50 $70.50
Mr sfty implt&/fb asmt stf 1 $30.00 $30.00 $30.00 $44.40
Mr sfty med physics xm cstmz $283.50 $283.50 $283.50 $439.80
Mr spectroscopy $1,610.25 $1,610.25 $1,610.25 $1,610.25
Mra, w/dye, upper extremity $1,976.25 $1,976.25 $1,976.25 $1,976.25
Mra, w/o&w/dye, spinal canal $417.75 $417.75 $417.75 $417.75
Mra, without dye, spinal canal $1,867.50 $1,867.50 $1,867.50 $1,867.50
Mra, without dye, upper extr $1,833.75 $1,833.75 $1,833.75 $1,833.75
Mthfr gene analy common variants $986.25 $986.25 $986.25 $357.60
Mucopolysaccharides $911.25 $911.25 $911.25 $911.25
Multi family grp psychotherapy $370.50 $370.50 $370.50 $370.50
Multiple sleep latency test $2,395.50 $2,395.50 $2,395.50 $2,754.75
Mumps antibody igg $148.50 $148.50 $148.50 $148.50
Muscle test cran nerv unilat $773.25 $773.25 $773.25 $751.50
Muscle test hemidiaphragm $733.50 $733.50 $733.50 $733.50
Muscle test larynx $771.00 $771.00 $771.00 $768.00
Muscle test one fiber $645.75 $645.75 $645.75 $645.75
Mycobacteria dna amp probe $444.75 $444.75 $444.75 $444.75
Mycophenolate mofetil 250 mg capsule $6,452.88 $6,452.88 $6,452.88 $79.60
Mycophenolic acid $6,135.49 $6,135.49 $6,135.49 $6,135.49
Mycoplasma antibody igm $183.00 $183.00 $183.00 $181.20
Myd88 gene p.leu265pro vrnt $370.50 $370.50 $370.50 $370.50
Myelography via inj w/s&i 2+ regions $3,226.50 $3,226.50 $3,226.50 $3,226.50
Myelography via inj w/s&i cervical $3,186.00 $3,186.00 $3,186.00 $3,186.00
Myelography via inj w/s&i lumbosacral $2,333.25 $2,333.25 $2,333.25 $2,333.25
Myelography via inj w/s&i thoracic $3,226.50 $3,226.50 $3,226.50 $2,874.60
Myeloperoxidase ab multi step qualitative/semiquantitative $911.25 $911.25 $911.25 $152.00
Myocrd img pet 1std rst/strs $4,928.25 $4,928.25 $4,928.25 $4,928.25
Myocrd img pet mlt rst&strs $5,301.00 $5,301.00 $5,301.00 $5,301.00
N block inj hypogas plxs $2,031.75 $2,031.75 $2,031.75 $2,031.75
N-invas est c ffr sw aly cta $2,020.50 $2,020.50 $2,020.50 $2,020.50
Nafcillin 2 gram solution for injection $79.98 $79.98 $79.98 $79.98
Nalbuphine 10 mg/ml injection solution $178.93 $178.93 $178.93 $24.00
Naloxone 0.4 mg/ml injection (wrapper) $116.48 $116.48 $116.48 $116.48
Naltrexone, depot form $5,794.40 $5,794.40 $5,794.40 $5,794.40
Nasal endoscopy dx uni/bi separate proc $600.00 $600.00 $600.00 $600.00
Nasal endoscopy with removal of nasal foreign body $283.50 $283.50 $283.50 $227.25
Nasal/sinus endoscopy surg w/bx 31237 $4,086.00 $4,086.00 $4,086.00 $4,086.00
Nasopharyngoscopy w/endoscope $279.75 $279.75 $279.75 $303.75
Natalizumab 300 mg/15 ml intravenous solution $32,830.92 $32,830.92 $32,830.92 $32,830.92
Natriuretic peptide $206.25 $206.25 $206.25 $230.25
Natural killer cells total count $262.50 $262.50 $262.50 $262.50
Navigational bronchoscopy 31627 $190.50 $190.50 $190.50 $190.50
Ndl emg musc 1 xtr/non-limb $376.50 $376.50 $376.50 $247.80
Ndl insj without njx 1 or 2 musc $22.50 $22.50 $22.50 $22.50
Ndl insj without njx 3+ musc $34.50 $34.50 $34.50 $34.50
Ndl round specialty proguide $27.00 $27.00 $27.00 $27.00
Neck (Cervical Spine) CT scan (with contrast) $1,732.50 $1,732.50 $1,732.50 $1,719.75
Neck (Cervical Spine) CT scan (without contrast) $1,568.25 $1,568.25 $1,568.25 $1,513.95
Neck (Cervical Spine) MRI (with and without contrast) $2,590.50 $2,590.50 $2,590.50 $2,667.68
Neck (Cervical Spine) MRI (with contrast) $2,373.75 $2,373.75 $2,373.75 $2,231.16
Neck (Cervical Spine) MRI (without contrast) $2,194.50 $2,194.50 $2,194.50 $1,947.58
Neck MRA (blood vessel MRI, with and without contrast) $2,229.00 $2,229.00 $2,229.00 $2,719.39
Neck MRA (blood vessel MRI, with contrast) $1,998.00 $1,998.00 $1,998.00 $2,030.23
Neck MRA (blood vessel MRI, without contrast) $1,779.75 $1,779.75 $1,779.75 $1,790.58
Needle emg guid w/chemodenervation add-on $182.25 $182.25 $182.25 $182.25
Neisseria meningitidis $433.50 $433.50 $433.50 $417.00
Nelarabine injection $2,265.28 $2,265.28 $2,265.28 $2,265.28
Neostigmine methylsulfate 1 mg/ml injection (wrapper) $99.51 $99.51 $99.51 $99.51
Nerobehav stas exam by psy/md f2f 1st hr $323.25 $323.25 $323.25 $323.25
Nerobehav stas exam phys/qhp f2f ea l hr $127.50 $127.50 $127.50 $127.50
Nerve conduction 7-8 studies $2,176.50 $2,176.50 $2,176.50 $1,937.25
Nerve conduction studies 1-2 $797.25 $797.25 $797.25 $673.50
Nerve conduction studies 11-12 $3,818.25 $3,818.25 $3,818.25 $3,196.50
Nerve conduction studies 13+ $4,900.50 $4,900.50 $4,900.50 $4,327.80
Nerve conduction studies 3-4 $1,221.75 $1,221.75 $1,221.75 $1,178.25
Nerve conduction studies 5-6 $1,914.00 $1,914.00 $1,914.00 $1,666.20
Nerve conduction studies 9-10 $3,230.25 $3,230.25 $3,230.25 $2,634.00
Neuroeltrd stim post tibial $710.25 $710.25 $710.25 $710.25
Neurolysis celiac plexus $2,847.00 $2,847.00 $2,847.00 $3,025.20
Neurolysis trigeminal nerve $1,056.75 $1,056.75 $1,056.75 $1,056.75
Neuromuscular junction testing ea nerve any 1 method $420.00 $420.00 $420.00 $420.00
Nitroglycerin 50 mg/250 ml (200 mcg/ml) in 5 % dextrose intravenous $74.88 $74.88 $74.88 $4.00
Nivolumab 10 mg/ml intravenous solution (wrapper) $29,956.95 $29,956.95 $29,956.95 $29,956.95
Njx aa&/strd nrv nrvtg si jt $801.75 $801.75 $801.75 $727.20
Njx aa&/strd vagus nrv $345.75 $345.75 $345.75 $345.75
Njx cath slct p angrph mapca $1,301.25 $1,301.25 $1,301.25 $1,301.25
Njx cath slct p-art angrp bi $1,951.50 $1,951.50 $1,951.50 $1,951.50
Njx cath slct pulm vn angrph $1,301.25 $1,301.25 $1,301.25 $1,301.25
Njx cth slct p-art angrp uni $1,301.25 $1,301.25 $1,301.25 $1,301.25
Njx interlaminar crv/thrc $1,843.50 $1,843.50 $1,843.50 $1,843.50
Njx interlaminar crv/thrc $2,067.00 $2,067.00 $2,067.00 $2,067.00
Njx interlaminar lmbr/sac $1,970.25 $1,970.25 $1,970.25 $1,970.25
Njx interlaminar lmbr/sac $1,953.00 $1,953.00 $1,953.00 $1,953.00
Njx px nfrosgrm &/urtrgrm $612.00 $612.00 $612.00 $667.47
Nm imaging bone/joint 3 phase study $2,543.25 $2,543.25 $2,543.25 $2,037.60
Nm imaging bone/joint whole body $2,499.75 $2,499.75 $2,499.75 $1,783.20
Nm imaging cardiac blood pooling planar single study at rest or stress $1,746.00 $1,746.00 $1,746.00 $1,746.00
Nm imaging gastric emptying study $1,431.75 $1,431.75 $1,431.75 $1,431.75
Nm imaging gastrointestinal acute blood loss $2,023.50 $2,023.50 $2,023.50 $1,691.40
Nm imaging hepatobiliary system w/pharmacologic intervention $2,326.50 $2,326.50 $2,326.50 $1,956.60
Nm imaging kidney morphology vascular flow/function single study w/pharmacological intervention $1,674.75 $1,674.75 $1,674.75 $1,574.40
Nm imaging pulmonary ventilation/perfusion $2,622.00 $2,622.00 $2,622.00 $2,062.80
Nm imaging thyroid single/multiple uptake(s) quantitative measurement(s) $1,419.00 $1,419.00 $1,419.00 $1,389.75
Nm radiopharmaceutical therapy oral administration $1,642.50 $1,642.50 $1,642.50 $1,142.40
Non-card vasc flow imaging $914.25 $914.25 $914.25 $845.25
Noninv pace analysis $504.00 $504.00 $504.00 $504.00
Noonan spectrum disorders $2,412.00 $2,412.00 $2,412.00 $2,412.00
Npm1 gene $376.50 $376.50 $376.50 $376.50
Npsy fam hlth interv ea addl 15 min $115.50 $115.50 $115.50 $115.50
Npsy grp hlth intrv ea addl 15 min $117.00 $117.00 $117.00 $117.00
Npsy indiv hlth intrv ea addl 15 min $115.50 $115.50 $115.50 $115.50
Npsy tst eval phsy/qhp 1st hr $316.50 $316.50 $316.50 $316.50
Npsy tst eval phsy/qhp ea l hr $153.75 $153.75 $153.75 $153.75
Nsl/sinus ndsc cryoabltj pnn $6,921.00 $6,921.00 $6,921.00 $6,921.00
Nuclear Stress Test (Heart) $5,417.25 $5,417.25 $5,417.25 $3,842.40
Nuclear exam of tear flow $951.75 $951.75 $951.75 $914.25
Nuclear rx IV admin $1,315.50 $1,315.50 $1,315.50 $1,315.50
Nuclear rx intra-arterial $1,467.00 $1,467.00 $1,467.00 $1,280.25
Nuclear rx intra-articular $288.75 $288.75 $288.75 $288.75
Nuclear rx intracav admin $1,755.00 $1,755.00 $1,755.00 $1,755.00
Nushield 1 square cm $501.00 $501.00 $501.00 $501.00
Nusinersen (pf) 12 mg/5 ml intrathecal solution $492,978.44 $492,978.44 $492,978.44 $492,978.44
Ob Ultrasound nuchal meas 1 gest $596.25 $596.25 $596.25 $596.25
Ob Ultrasound nuchal meas add-on $409.50 $409.50 $409.50 $409.50
Obinutuzumab 1,000 mg/40 ml intravenous solution $33,278.55 $33,278.55 $33,278.55 $236.00
Observation direct referral from physician office for admission $551.25 $551.25 $551.25 $420.00
Observation per hour $3,767.25 $3,767.25 $3,767.25 $925.80
Obtaining screen pap smear $23.25 $23.25 $23.25 $23.25
Ocrelizumab 30 mg/ml intravenous solution $76,319.96 $76,319.96 $76,319.96 $76,319.96
Octreotide acetate 100 mcg/ml injection (wrapper) $887.40 $887.40 $887.40 $688.80
Octreotide,microspheres ER 20 mg intramuscular susp, extended release $23,458.95 $23,458.95 $23,458.95 $23,458.95
Ofatumumab 20 mg/ml intravenous solution (wrapper) $2,224.00 $2,224.00 $2,224.00 $2,224.00
Oil silicone ophth 8.5ml silikon 1000 $857.48 $857.48 $857.48 $857.48
Olanzapine 10 mg intramuscular solution $172.31 $172.31 $172.31 $38.55
Omalizumab 150 mg/ml subcutaneous syringe (wrapper) $5,445.54 $5,445.54 $5,445.54 $5,445.54
Oncology prostate prob score $1,623.75 $1,623.75 $1,623.75 $1,623.75
Oncoprotein dcp $537.00 $537.00 $537.00 $537.00
Oncoprotein her-2/neu $237.00 $237.00 $237.00 $219.00
Ondansetron hcl (pf) 2 mg/ml injection (wrapper) $34.32 $34.32 $34.32 $34.32
Oph Ultrasound dx quan a-scan only $127.50 $127.50 $127.50 $127.50
Ophthalmic mitomycin $1,327.41 $1,327.41 $1,327.41 $1,516.80
Oral aprepitant $3,616.34 $3,616.34 $3,616.34 $1,821.60
Oral everolimus $2,255.34 $2,255.34 $2,255.34 $1,610.40
Organic acids total quant ea spec $508.50 $508.50 $508.50 $337.20
Oritavancin 400 mg intravenous solution $11,913.61 $11,913.61 $11,913.61 $11,913.61
Oropharyngeal biopsy 42800 $3,186.00 $3,186.00 $3,186.00 $1,481.28
Orphenadrine citrate 30 mg/ml injection solution $31.68 $31.68 $31.68 $61.00
Ortho elbow without jnt cstm w/fit&adj $129.00 $129.00 $129.00 $129.00
Ortho hnd without jnt w/fit&adj $52.50 $52.50 $52.50 $52.50
Ortho hnd/fngr w/jnt cstm w/fit&adj $389.25 $389.25 $389.25 $389.25
Ortho hnd/fngr without jnt cstm w/fit&adj $26.25 $26.25 $26.25 $26.25
Ortho whf rigd without jnt cstm w/fit&adj $153.00 $153.00 $153.00 $153.00
Ortho wrst/hnd w/jnt cstm w/fit&adj $72.75 $72.75 $72.75 $72.75
Orthopantogram $270.00 $270.00 $270.00 $270.00
Orthovisc inj per dose $443.85 $443.85 $443.85 $443.85
Oscillation chest wall mechanical per session $237.75 $237.75 $237.75 $237.75
Osmolality blood $77.25 $77.25 $77.25 $77.25
Osmolality urine $75.75 $75.75 $75.75 $75.75
Osteopath manip tx/5-6 body region 98927 $125.25 $125.25 $125.25 $125.25
Osteopath manip tx/7-8 body region 98928 $147.00 $147.00 $147.00 $147.00
Osteopath manip tx/9-10 body region98929 $183.75 $183.75 $183.75 $183.75
Ot evaluation high complexity patient/family $297.00 $297.00 $297.00 $297.00
Ot evaluation low complexity patient/family $297.00 $297.00 $297.00 $272.40
Ot evaluation moderate complexity patient/family $297.00 $297.00 $297.00 $297.00
Ot management orthotic(s)/prosthetic subsequent encounter each 15 minutes $138.00 $138.00 $138.00 $122.25
Ot management/training orthotic(s) upper/lower extremities and/or trunk each 15 minutes $138.75 $138.75 $138.75 $121.20
Ot manual therpy techniques >=1 region each 15 minutes $138.75 $138.75 $138.75 $138.75
Ot re-evaluation patient/family $212.25 $212.25 $212.25 $145.50
Ot therapeutic activities direct patient contact each 15 minutes $156.75 $156.75 $156.75 $130.20
Ot therapeutic interventions cognitive skills direct patient contact each additional 15 minutes $98.25 $98.25 $98.25 $98.25
Ot therapeutic interventions cognitive skills direct patient contact initial 15 minutes $98.25 $98.25 $98.25 $98.25
Ot therapeutic procedure >=1 area therapeutic exercise each 15 minutes $143.25 $143.25 $143.25 $130.20
Ot therapeutic procedure neuromuscular reeducate each 15 minutes $138.75 $138.75 $138.75 $123.75
Ot training self care/home management direct contact each 15 minutes $138.75 $138.75 $138.75 $122.25
Oth resp proc, group $187.50 $187.50 $187.50 $187.50
Other immunoelectrophoresis $186.00 $186.00 $186.00 $186.00
Otolaryngo binocular microscopy 92504 $104.25 $104.25 $104.25 $104.25
Oxaliplatin 5 mg/ml desensitization $342.84 $342.84 $342.84 $342.84
Oxytocin 10 unit/ml injection solution $35.06 $35.06 $35.06 $29.00
PSA (Prostate) Test $127.50 $127.50 $127.50 $103.85
Pacemaker leadless 19.5f 32.2mm ra $57,937.50 $57,937.50 $57,937.50 $57,937.50
Paclitaxel 6 mg/ml concentrate,intravenous $34.43 $34.43 $34.43 $34.43
Paclitaxel protein-bound 100 mg intravenous suspension $5,416.36 $5,416.36 $5,416.36 $5,416.36
Palifermin injection $11,767.98 $11,767.98 $11,767.98 $11,767.98
Paliperidone 117 mg/0.75 ml inj $6,272.41 $6,272.41 $6,272.41 $6,272.41
Palivizumab 50 mg/0.5 ml inj $9,797.53 $9,797.53 $9,797.53 $9,797.53
Palonosetron hcl $184.88 $184.88 $184.88 $184.88
Pamidronate 30 mg/10 ml (3 mg/ml) intravenous solution $148.35 $148.35 $148.35 $148.35
Panitumumab 20 mg/ml intravenous solution (wrapper) $27,287.26 $27,287.26 $27,287.26 $27,287.26
Pantoprazole in ns IV syringe 0.8 mg/ml (neo/ped) - cnr $18.49 $18.49 $18.49 $30.80
Papaverin hcl injection $143.71 $143.71 $143.71 $143.71
Parathormone (pth) intact $500.25 $500.25 $500.25 $385.80
Parathyrd planar w/spect&ct $2,445.00 $2,445.00 $2,445.00 $2,145.00
Parathyroid planar imaging $1,436.25 $1,436.25 $1,436.25 $1,436.25
Parathyroid planar img w/tomo spect $2,424.75 $2,424.75 $2,424.75 $1,949.25
Paricalcitol $35.52 $35.52 $35.52 $35.52
Paring/cutting benign hyperkeratotic lesion single $291.75 $291.75 $291.75 $288.60
Particle matristem matrix 1000mg micron-q4118-cost per mg $7,702.14 $7,702.14 $7,702.14 $7,702.14
Passy muir valve metal trach $1,016.73 $1,016.73 $1,016.73 $1,016.73
Pd hl 3.5in 4d med rbr mld 6432 $7.50 $7.50 $7.50 $7.50
Pdgfra gene $618.00 $618.00 $618.00 $618.00
Pegaspargase injection $82,241.50 $82,241.50 $82,241.50 $82,241.50
Pegfilgrastim 6 mg/0.6 ml (deliverable) wearable subcutaneous injector $16,623.78 $16,623.78 $16,623.78 $12,717.60
Pegfilgrastim-cbqv 6 mg/0.6 ml subcutaneous syringe $11,163.13 $11,163.13 $11,163.13 $10,699.80
Pegfilgrastim-jmdb 6 mg/0.6 ml subcutaneous syringe $6,455.84 $6,455.84 $6,455.84 $6,455.84
Pegloticase 8 mg/ml intravenous solution $113,672.22 $113,672.22 $113,672.22 $113,672.22
Pelvic CT scan (with and without contrast) $1,881.00 $1,881.00 $1,881.00 $1,975.00
Pelvic CT scan (with contrast) $1,710.75 $1,710.75 $1,710.75 $1,710.75
Pelvic CT scan (without contrast) $1,392.75 $1,392.75 $1,392.75 $1,374.84
Pelvic MRI (with and without contrast) $2,590.50 $2,590.50 $2,590.50 $2,663.76
Pelvic MRI (with contrast) $2,373.75 $2,373.75 $2,373.75 $1,989.01
Pelvic MRI (without contrast) $2,221.50 $2,221.50 $2,221.50 $1,810.38
Pelvic Ultrasound (complete) $919.50 $919.50 $919.50 $647.87
Pelvic Ultrasound (limited) $567.00 $567.00 $567.00 $476.50
Pembrolizumab 25 mg/ml intravenous solution $21,806.82 $21,806.82 $21,806.82 $21,806.82
Pemetrexed disodium 100 mg intravenous powder for solution $13,859.24 $13,859.24 $13,859.24 $13,859.24
Penicillin g benzathine 1,200,000 unit/2 ml intramuscular syringe $2,592.13 $2,592.13 $2,592.13 $1,494.00
Penicillin g potassium in ns IV syringe 100,000 units/ml (neo/ped) - cnr $203.37 $203.37 $203.37 $203.37
Penile injection $306.75 $306.75 $306.75 $306.75
Penile rear tip xtnd 0.5cm $26,765.44 $26,765.44 $26,765.44 $26,765.44
Penile vascular study $1,240.50 $1,240.50 $1,240.50 $1,009.50
Penile vascular study $792.00 $792.00 $792.00 $759.00
Pentamidine 300 mg solution for injection $572.10 $572.10 $572.10 $572.10
Pentamidine non-comp unit $396.65 $396.65 $396.65 $396.65
Pentobarbital sodium inj $3,170.80 $3,170.80 $3,170.80 $3,170.80
Pentostatin 10 mg intravenous solution $8,715.64 $8,715.64 $8,715.64 $8,715.64
Perc cryo ablate renal tum $6,669.00 $6,669.00 $6,669.00 $6,669.00
Perc d-e cor revasc chro sin $32,979.75 $32,979.75 $32,979.75 $24,161.40
Perc d-e cor revasc t cabg b $27,913.50 $27,913.50 $27,913.50 $23,537.40
Perc d-e cor revasc t cabg s $32,979.75 $32,979.75 $32,979.75 $23,282.40
Perc d-e cor stent ather br $27,915.00 $27,915.00 $27,915.00 $24,949.80
Perc d-e cor stent ather s $32,979.75 $32,979.75 $32,979.75 $23,282.40
Perc drug-el cor stent bran $16,054.50 $16,054.50 $16,054.50 $16,054.50
Perc drug-el cor stent sing $16,258.50 $16,258.50 $16,258.50 $16,258.50
Perc rf ablate renal tumor $5,724.00 $5,724.00 $5,724.00 $5,724.00
Percut ablate liver rf $6,566.25 $6,566.25 $6,566.25 $6,566.25
Perflutren lipid microspheres 1.1 mg/ml intravenous suspension $321.71 $321.71 $321.71 $793.80
Peri-proc device eval icd $609.75 $609.75 $609.75 $609.75
Peri-proc device eval pm $327.75 $327.75 $327.75 $327.75
Pericardial drain w/cath pq w/ct guid $3,796.50 $3,796.50 $3,796.50 $3,796.50
Pericardiocentesis wwo imaging $2,472.75 $2,472.75 $2,472.75 $2,472.75
Peripheral vascular rehab $184.50 $184.50 $184.50 $184.50
Perq art m-thrombect &/nfs $9,473.25 $9,473.25 $9,473.25 $9,473.25
Perq clsr tcat l atr apndge $7,520.25 $7,520.25 $7,520.25 $7,520.25
Perq dev breast 1st mr guide $4,497.00 $4,497.00 $4,497.00 $4,495.50
Perq dev breast 1st strtctc $3,114.75 $3,114.75 $3,114.75 $2,148.75
Perq p-art revsc 1 abnor bi $27,235.50 $27,235.50 $27,235.50 $27,235.50
Perq p-art revsc 1 abnor uni $44,278.50 $44,278.50 $44,278.50 $44,278.50
Perq p-art revsc 1 nm nt bi $27,235.50 $27,235.50 $27,235.50 $27,235.50
Perq p-art revsc 1 nm nt uni $27,235.50 $27,235.50 $27,235.50 $27,235.50
Perq p-art revsc each addl $13,844.25 $13,844.25 $13,844.25 $13,844.25
Perq plmt bile duct stent $4,355.25 $4,355.25 $4,355.25 $5,834.36
Perq plmt bile duct stent $4,355.25 $4,355.25 $4,355.25 $4,355.25
Perq plmt bile duct stent $4,355.25 $4,355.25 $4,355.25 $5,834.36
Perq rplcmt g-tube req revsn gstrst trk $1,159.50 $1,159.50 $1,159.50 $1,159.50
Perq transcath closure each $12,118.50 $12,118.50 $12,118.50 $12,118.50
Perq transcath septal reduxn $15,793.50 $15,793.50 $15,793.50 $15,793.50
Pertuzu, trastuzu, 10 mg $51,456.39 $51,456.39 $51,456.39 $51,456.39
Pertuzumab 30 mg/ml desensitization $25,218.78 $25,218.78 $25,218.78 $25,218.78
Pet CT skull-mid thgh initial $4,854.75 $4,854.75 $4,854.75 $4,854.75
Pet CT whole body initial $4,915.50 $4,915.50 $4,915.50 $4,915.50
Pet fdg brain metoblic eval sb $4,834.50 $4,834.50 $4,834.50 $4,834.50
Pet image ltd area $4,590.75 $4,590.75 $4,590.75 $4,590.75
Pet image w/ct lmtd $4,680.75 $4,680.75 $4,680.75 $4,680.75
Pet scan brain perf study $4,525.50 $4,525.50 $4,525.50 $4,525.50
Pfc sigma fem post aug sz3 8mm $1,024,537.50 $1,024,537.50 $1,024,537.50 $26,256.60
Ph body fluid $104.25 $104.25 $104.25 $63.20
Phencyclidine (pcp) $498.00 $498.00 $498.00 $498.00
Phenobarbital in ns IV syringe 10 mg/ml (neonate) - cnr $203.37 $203.37 $203.37 $128.80
Phenobarbital therapeutic drug level $153.00 $153.00 $153.00 $153.00
Phentolaine mesylate inj $1,028.40 $1,028.40 $1,028.40 $1,028.40
Phenylephrine 10 mg/ml injection solution $58.80 $58.80 $58.80 $0.14
Phenytoin in ns IV syringe 5 mg/ml (neo/ped) - cnr $7.71 $7.71 $7.71 $7.71
Phenytoin total therapeutic drug level $135.00 $135.00 $135.00 $132.75
Phleb veins 1 extrm 10-20 stab $3,682.50 $3,682.50 $3,682.50 $3,682.50
Phleb veins 1 extrm >20 stab $3,629.25 $3,629.25 $3,629.25 $3,629.25
Phlebotomy therapeutic $308.25 $308.25 $308.25 $308.25
Phosphorus $57.75 $57.75 $57.75 $57.75
Phosphorus 24 hour urine $108.75 $108.75 $108.75 $108.60
Phytonadione (vitamin k1) 10 mg/ml injection solution $158.14 $158.14 $158.14 $158.14
Pin caspar distraction 12mm $53,100.00 $53,100.00 $53,100.00 $53,100.00
Pinworm exam $40.50 $40.50 $40.50 $40.50
Piperacillin-tazobactam 3.375 gram intravenous solution $407.95 $407.95 $407.95 $407.95
Place cath intracranial art $7,997.25 $7,997.25 $7,997.25 $7,997.25
Place cath xtrnl carotid $6,755.25 $6,755.25 $6,755.25 $6,755.25
Place duod/jej tube perc $1,596.00 $1,596.00 $1,596.00 $1,695.00
Place gastrostomy tube perc $2,093.25 $2,093.25 $2,093.25 $2,093.25
Place ndl musc/tis for right $3,220.50 $3,220.50 $3,220.50 $3,220.50
Place non-slctv cath thoracic arta $4,710.75 $4,710.75 $4,710.75 $4,710.75
Place slctv cath carotd art uni $10,950.75 $10,950.75 $10,950.75 $10,950.75
Place slctv cath carotid/inom art excrn uni $6,498.00 $6,498.00 $6,498.00 $6,498.00
Place slctv cath carotid/inom art intcrn uni $10,186.50 $10,186.50 $10,186.50 $10,186.50
Place slctv cath subclavian art $5,625.00 $5,625.00 $5,625.00 $6,360.60
Place slctv cath vertebral art uni $9,490.50 $9,490.50 $9,490.50 $9,490.50
Placement localization device(s) breast percutaneous mammographic guidance 1st lesion (both sides) $2,732.25 $2,732.25 $2,732.25 $1,771.80
Placement localization device(s) breast percutaneous mammographic guide ea addl lesion left $2,658.00 $2,658.00 $2,658.00 $1,930.80
Placement localization device(s) breast percutaneous ultrasound guidance 1st lesion (both sides) $2,838.00 $2,838.00 $2,838.00 $1,795.50
Placement nephrostomy catheter (both sides) $1,842.00 $1,842.00 $1,842.00 $2,164.80
Placement occlusive device venous/arterial access site post procedure $1,262.25 $1,262.25 $1,262.25 $1,262.25
Placement stent(s) intravascular transcatheter artery initial $12,427.50 $12,427.50 $12,427.50 $12,427.50
Platelet aggregation each agent teg $223.50 $223.50 $223.50 $223.50
Platelet automated $43.50 $43.50 $43.50 $43.50
Platelet pheresis each unit $1,015.50 $1,015.50 $1,015.50 $1,015.50
Platelet pheresis irr ea $2,500.50 $2,500.50 $2,500.50 $2,500.50
Platelets each unit $1,876.50 $1,876.50 $1,876.50 $1,555.50
Platelets pheresis leukocytes reduced each unit $1,982.25 $1,982.25 $1,982.25 $1,982.25
Platelets pheresis leukocytes reduced irradiated each unit $1,989.00 $1,989.00 $1,989.00 $2,860.50
Platelets pheresis pathogen-reduced each unit $2,487.00 $2,487.00 $2,487.00 $1,878.00
Plc pq device breast ea addl lesion MRI guide $4,497.00 $4,497.00 $4,497.00 $4,300.50
Plc pq device breast ea addl lesion Ultrasound guide $2,616.00 $2,616.00 $2,616.00 $1,640.25
Plcmnt biliary drainage cath w/img ext $2,959.50 $2,959.50 $2,959.50 $2,959.50
Plcmnt stent transcath ctrl dialysis seg add-on $10,059.75 $10,059.75 $10,059.75 $10,059.75
Plcmnt ureteral stent pq w/img exstng trct $2,677.50 $2,677.50 $2,677.50 $4,370.40
Plcmnt ureteral stent pq w/img new w/cath $2,677.50 $2,677.50 $2,677.50 $3,657.00
Plcmt dlyd xtn pros 1st vsl $7,148.25 $7,148.25 $7,148.25 $7,148.25
Plcmt sft tiss loc pq w/img 1st lsn $1,124.25 $1,124.25 $1,124.25 $1,124.25
Plcmt sft tiss loc pq w/img ea addl lsn $560.25 $560.25 $560.25 $560.25
Plcmt xtn pros evasc rpr per vsl $5,988.00 $5,988.00 $5,988.00 $5,988.00
Plerixafor injection $36,856.95 $36,856.95 $36,856.95 $36,856.95
Plethysmography lung volumes/airway resistance $368.25 $368.25 $368.25 $368.25
Plmt biliary drainage cath $2,959.50 $2,959.50 $2,959.50 $2,959.50
Plmt nephroureteral catheter $2,677.50 $2,677.50 $2,677.50 $3,448.97
Plmt ureteral stent prq $2,677.50 $2,677.50 $2,677.50 $2,677.50
Pm device progr eval dual $237.75 $237.75 $237.75 $237.75
Pm device progr eval multi $245.25 $245.25 $245.25 $245.25
Pm phone r-strip device eval $181.50 $181.50 $181.50 $181.50
Pmp22 gene dup/delet $1,054.50 $1,054.50 $1,054.50 $1,054.50
Poct blood gases ph pco2 po2 arterial calculated o2 $249.75 $249.75 $249.75 $243.00
Polatuzumab vedotin-piiq 140 mg intravenous solution $68,815.70 $68,815.70 $68,815.70 $68,815.70
Polysomnography sleep staging >=4 parameters age >=6 years w/cpap bipap $6,604.50 $6,604.50 $6,604.50 $6,604.50
Porfimer sodium injection $75,528.84 $75,528.84 $75,528.84 $75,528.84
Postpartum Care Only $255.75 $255.75 $255.75 $501.60
Potassium 24 hour urine $93.00 $93.00 $93.00 $76.50
Potassium chloride 10 meq/100ml in sterile water intravenous piggyback $137.19 $137.19 $137.19 $85.20
Potassium serum/plasma/whole blood $101.25 $101.25 $101.25 $66.60
Pq biliary strict dil s&i $1,803.00 $1,803.00 $1,803.00 $1,803.00
Pq dr cath chg w cont s&i $4,221.75 $4,221.75 $4,221.75 $1,347.00
Pq kyphplsty 1 bdy lumb w/img $9,145.50 $9,145.50 $9,145.50 $9,145.50
Pq thr inj ext pse $993.00 $993.00 $993.00 $993.00
Pq vrtbrplst 1 bdy inj crv-thr w/img ini $3,752.25 $3,752.25 $3,752.25 $3,752.25
Pq vrtbrplst 1 bdy inj crv-thr/lmb-scr w/img addl $2,061.75 $2,061.75 $2,061.75 $2,061.75
Pq vrtbrplst 1 bdy inj lmb-scr w/img ini $2,787.00 $2,787.00 $2,787.00 $2,787.00
Pr application of long arm splint $467.25 $467.25 $467.25 $467.25
Pr application splint static short arm $307.50 $307.50 $307.50 $307.50
Pr assessment emotional/behavioral per instrument brief $39.75 $39.75 $39.75 $39.75
Pr biopsy skin punch single lesion $311.25 $311.25 $311.25 $327.00
Pr counseling smoke/tobacco intermediate greater 3 - 10 minutes $120.75 $120.75 $120.75 $31.20
Pr debridement open wound topical appl/wound asmt per session 20 sq cm/< $578.25 $578.25 $578.25 $429.00
Pr e&m preventive medicine initial comprehensive new patient 12-17 years $167.25 $167.25 $167.25 $167.25
Pr egd flexible transoral w/placement percutaneous gastrostomy tube $3,061.50 $3,061.50 $3,061.50 $3,061.50
Pr evaluation psychiatric diagnostic w/medical services $394.50 $394.50 $394.50 $394.50
Pr exam init preventive phys new visit during 1st 12 mo of mcare enrollment $130.50 $130.50 $130.50 $130.50
Pr excision benign lesion scalp/neck/hands/feet/genitalia <= 0.5 cm $1,533.00 $1,533.00 $1,533.00 $1,620.24
Pr excision benign lesion trunk/arms/legs 3.1 - 4.0 cm $2,709.00 $2,709.00 $2,709.00 $2,709.00
Pr excision nail/nail matrix partial/complete permanent removal $1,716.75 $1,716.75 $1,716.75 $1,470.60
Pr incision & drainage abscess complicated/multiple $382.50 $382.50 $382.50 $589.80
Pr incision & drainage abscess simple/single $561.75 $561.75 $561.75 $510.60
Pr incision & drainage abscess vulva/perineal $465.75 $465.75 $465.75 $825.60
Pr incision & removal foreign body subcutaneous tissues simple $676.50 $676.50 $676.50 $589.80
Pr management transitional care moderate w/in 14 days of discharge $229.50 $229.50 $229.50 $229.50
Pr moderate sedation same physician >= 5 years initial 15 minutes $330.00 $330.00 $330.00 $330.00
Pr planning advance care 1st 30 minutes $176.25 $176.25 $176.25 $176.25
Pr removal drug delivery implant $1,448.25 $1,448.25 $1,448.25 $1,448.25
Pr removal foreign body external auditory canal without anesthesia $313.50 $313.50 $313.50 $313.50
Pr removal intrauterine device $270.75 $270.75 $270.75 $411.00
Pr repair intermediate wounds scalp/axillae/trunk/extremities 2.6 - 7.5 cm $980.25 $980.25 $980.25 $825.60
Pr repair sprfcl wd simple face/ears/eyelids/nose/lips/muc memb 2.6-5.0 cm $335.25 $335.25 $335.25 $388.80
Pr repair sprfcl wd simple face/ears/eyelids/nose/lips/muc memb <= 2.5 cm $317.25 $317.25 $317.25 $366.60
Pr repair sprfcl wounds simple scalp/neck/axillae/gent/trunk/ext <= 2.5 cm $330.00 $330.00 $330.00 $330.00
Pr repair superficial wd simple scalp/neck/ax/gent/trunk/ext 2.6-7.5 cm $352.50 $352.50 $352.50 $388.80
Pr tube thoracostomy w/connection to drainage open $2,108.25 $2,108.25 $2,108.25 $2,172.00
Pralatrexate injection $46,709.38 $46,709.38 $46,709.38 $46,709.38
Pralidoxime 1 gram solution for injection $297.18 $297.18 $297.18 $297.18
Prcrd drg 0-5yr or w/anomly $3,798.00 $3,798.00 $3,798.00 $3,798.00
Prcrd drg 6+yr without anomly $3,798.00 $3,798.00 $3,798.00 $3,798.00
Prealbumin $144.75 $144.75 $144.75 $137.60
Prednisolone sodium phosphate 15 mg/5 ml (3 mg/ml) oral solution $3,856.50 $3,856.50 $3,856.50 $3,856.50
Prednisone 1 mg tablet $398.89 $398.89 $398.89 $10.20
Pregabalin - sendout $65.25 $65.25 $65.25 $64.80
Pregnancy Ultrasound (complete, after first trimester) $867.00 $867.00 $867.00 $610.80
Pregnancy Ultrasound (first trimester) $801.75 $801.75 $801.75 $595.85
Pregnancy associated plasma protein-a $75.00 $75.00 $75.00 $110.25
Prep skin to 100cm2 other $2,049.75 $2,049.75 $2,049.75 $2,049.75
Prep skin to 100cm2 trk/ext $1,410.00 $1,410.00 $1,410.00 $1,410.00
Prep skn trk/ext adl 100cm2 $1,018.50 $1,018.50 $1,018.50 $1,018.50
Pressure max expiratory/inspiratory $260.25 $260.25 $260.25 $243.75
Pressure velocity wire add ves $2,646.00 $2,646.00 $2,646.00 $2,646.00
Pretreat rbc absorption reference $131.25 $131.25 $131.25 $131.25
Pretreat rbc w enzyme reference $270.75 $270.75 $270.75 $270.75
Prgr stim/pace a/iv drug $5,091.75 $5,091.75 $5,091.75 $5,091.75
Prgrmg dev eval impltbl sys $336.75 $336.75 $336.75 $336.75
Prgrmg dev eval pm/ldls pm $204.00 $204.00 $204.00 $191.40
Prgrmg dev eval scrms ip $289.50 $289.50 $289.50 $289.50
Prgrmg eval implantable dfb $300.00 $300.00 $300.00 $257.25
Prgrmg eval implantable dfb $510.00 $510.00 $510.00 $287.25
Prgrmg eval implantable dfb $329.25 $329.25 $329.25 $329.25
Prim art mech thrmbc non-intracranial $18,078.00 $18,078.00 $18,078.00 $18,078.00
Prim art mech thrmbc non-intracranial add-on $5,235.00 $5,235.00 $5,235.00 $5,235.00
Probe cryo 1150mm endo flex ster disp $5,175.00 $5,175.00 $5,175.00 $5,175.00
Procainamide 100 mg/ml injection (wrapper) $1,611.15 $1,611.15 $1,611.15 $533.60
Procalcitonin $99.00 $99.00 $99.00 $133.80
Prochlorperazine edisylate 10 mg/2 ml (5 mg/ml) injection solution $63.42 $63.42 $63.42 $63.42
Proctosigmoidoscopy control bleed 45317 $1,989.75 $1,989.75 $1,989.75 $1,989.75
Proctosigmoidoscopy dx 45300 $2,371.50 $2,371.50 $2,371.50 $1,857.60
Proctosigmoidoscopy removal $2,967.75 $2,967.75 $2,967.75 $2,967.75
Proctosigmoidoscopy w/bx 45305 $2,566.50 $2,566.50 $2,566.50 $2,566.50
Proctosigmoidoscopy w/fb remove 45307 $3,251.25 $3,251.25 $3,251.25 $3,251.25
Progesterone $99.00 $99.00 $99.00 $99.00
Prolactin $162.00 $162.00 $162.00 $162.00
Prolng off/op e/m ea 15 min 99417 $42.00 $42.00 $42.00 $42.00
Promethazine hcl injection $10.99 $10.99 $10.99 $10.99
Proph rta dtchmnt pc $642.00 $642.00 $642.00 $642.00
Propofol infusion 10 mg/ml $35.88 $35.88 $35.88 $35.88
Propranolol in ns IV syringe 0.1 mg/ml (neo/ped) - cnr $16.46 $16.46 $16.46 $16.46
Prostate biopsy, any mthd $711.00 $711.00 $711.00 $525.00
Prosthesis voc advantage 20f 14mm $1,329.00 $1,329.00 $1,329.00 $1,329.00
Protamine 10 mg/ml intravenous solution $112.23 $112.23 $112.23 $112.23
Protector nerve neurawrap 4cm $5,366.25 $5,366.25 $5,366.25 $5,366.25
Protein c activity $87.00 $87.00 $87.00 $116.25
Protein electrophoretic fractionation & quantitation serum $84.00 $84.00 $84.00 $84.00
Protein s total $181.50 $181.50 $181.50 $181.50
Protein total 24 hour urine $62.25 $62.25 $62.25 $45.00
Protein total body fluid $114.00 $114.00 $114.00 $82.80
Protein total serum plasma whole blood $46.50 $46.50 $46.50 $46.50
Prothrombin complex kcentra $7,912.65 $7,912.65 $7,912.65 $8.25
Prothrombin time substitution plasma fractions each $62.25 $62.25 $62.25 $62.25
Prq av fstl crt uxtr sep acs $20,328.00 $20,328.00 $20,328.00 $20,328.00
Prq card revasc mi 1 vsl $31,300.50 $31,300.50 $31,300.50 $31,300.50
Prq card revasc mi 1 vsl drug-eluting $35,208.75 $35,208.75 $35,208.75 $23,282.40
Prq revasc byp graft 1 art and/or branches $29,319.00 $29,319.00 $29,319.00 $29,319.00
Prq tcat plmt ntrac st 1 les $12,034.50 $12,034.50 $12,034.50 $12,034.50
Prq tcat plmt ntrac st 2+les $6,903.00 $6,903.00 $6,903.00 $6,903.00
Prq trl rvs ch occ ant&rtrgr $32,826.75 $32,826.75 $32,826.75 $32,826.75
Prq trlml c athrc st angiop1 $29,319.00 $29,319.00 $29,319.00 $24,920.40
Prq trluml c angiop 1art&/br $9,413.25 $9,413.25 $9,413.25 $9,413.25
Prq trluml c athrc 1 art&/br $9,140.25 $9,140.25 $9,140.25 $10,055.25
Prq trluml revsc ch occ ant $29,319.00 $29,319.00 $29,319.00 $29,319.00
Psy/npsy phys/qhp 2> tst 1st 30 min $316.50 $316.50 $316.50 $316.50
Psy/npsy phys/qhp 2> tst ea l 30 min $153.75 $153.75 $153.75 $153.75
Psy/npsy tst admin tech 2> ea l 30 min $102.00 $102.00 $102.00 $102.00
Psych test eval svc phys/qhp 1st hr $316.50 $316.50 $316.50 $316.50
Psych test eval svc phys/qhp ea addl hr $127.50 $127.50 $127.50 $127.50
Psychotherapy group therapy $271.50 $271.50 $271.50 $271.50
Psychotherapy patient individual therapy 30 minutes $193.50 $193.50 $193.50 $193.50
Psychotherapy patient individual therapy 45 minutes $267.00 $267.00 $267.00 $266.25
Psychotherapy patient individual therapy 60 minutes $328.50 $328.50 $328.50 $302.40
Psycl/nrpsyc tech 1st $210.75 $210.75 $210.75 $210.75
Psytx complex interactive $54.00 $54.00 $54.00 $54.00
Psytx pt w/e&m 16-37 min $290.25 $290.25 $290.25 $290.25
Psytx pt w/e&m 38-52 min $399.00 $399.00 $399.00 $399.00
Psytx pt w/e&m 53+ min $492.00 $492.00 $492.00 $492.00
Pt application of modality >=1 area electrical stimulation each 15 minutes $164.25 $164.25 $164.25 $114.75
Pt application of modality >=1 area hot/cold packs $19.50 $19.50 $19.50 $38.40
Pt application of modality >=1 area iontophoresis each 15 minutes $133.50 $133.50 $133.50 $115.50
Pt application of modality >=1 area ultrasound each 15 minutes $117.00 $117.00 $117.00 $101.40
Pt application of modality traction mechanical $135.75 $135.75 $135.75 $130.20
Pt evaluation high complexity patient/family $297.00 $297.00 $297.00 $297.00
Pt evaluation low complexity patient/family $264.00 $264.00 $264.00 $264.00
Pt evaluation moderate complexity patient/family $264.00 $264.00 $264.00 $264.00
Pt re-evaluation patient/family $177.00 $177.00 $177.00 $139.20
Pt repositioning canalith procedure(s) per day $150.75 $150.75 $150.75 $150.75
Pt therapeutic procedure >=1 area gait training each 15 minutes $138.75 $138.75 $138.75 $121.50
Pt therapeutic procedure >=1 area massage each 15 minutes $115.50 $115.50 $115.50 $115.50
Pt wheelchair management each 15 minutes $123.00 $123.00 $123.00 $88.50
Pul art balloon repr percut $4,406.25 $4,406.25 $4,406.25 $4,406.25
Pul art balloon repr percut $8,869.50 $8,869.50 $8,869.50 $8,869.50
Pulmonary vent imaging $478.50 $478.50 $478.50 $478.50
Pulse ox continuous overnight monitoring $376.50 $376.50 $376.50 $360.60
Pulse ox multiple $309.00 $309.00 $309.00 $309.00
Pulse ox single $151.50 $151.50 $151.50 $141.00
Punc of shunt for asp or inj $801.75 $801.75 $801.75 $801.75
Puncture arterial withdrawal blood for diagnosis $138.00 $138.00 $138.00 $109.20
Puncture aspiration abscess/hematoma/bulla/cyst $382.50 $382.50 $382.50 $399.53
Puncture spinal lumbar diagnostic $1,088.25 $1,088.25 $1,088.25 $1,186.50
Puraply 1 sq cm $18,720.00 $18,720.00 $18,720.00 $18,720.00
Pvb thoracic 2nd+ inj site $680.25 $680.25 $680.25 $680.25
Pvb thoracic single inj site $801.75 $801.75 $801.75 $801.75
Pyridoxine hcl 100 mg $29.11 $29.11 $29.11 $29.11
Pyruvate $108.75 $108.75 $108.75 $108.75
Pyruvate kinase $252.75 $252.75 $252.75 $252.75
Quant diff pulm perf and vent w/imaging $2,580.00 $2,580.00 $2,580.00 $2,580.00
Quant diff pulm perf w/imaging $1,789.50 $1,789.50 $1,789.50 $1,440.00
Quest t3 uptake $108.75 $108.75 $108.75 $108.75
R hrt cath chd nml nt cnj $7,495.50 $7,495.50 $7,495.50 $7,495.50
Rabies ig heat-treated human im/subq 90376 $3,103.43 $3,103.43 $3,103.43 $3,103.43
Rabies ig ht&sol human im/sc $8,111.40 $8,111.40 $8,111.40 $8,111.40
Rabies immune globulin (pf) 300 unit/ml intramuscular solution $11,649.94 $11,649.94 $11,649.94 $11,649.94
Radiation therapy dose plan $949.50 $949.50 $949.50 $790.80
Radphm lcl tmr plnr bdy sgl day img $2,841.00 $2,841.00 $2,841.00 $2,286.00
Radphm lcl tmr plnr bdy two day img $3,232.50 $3,232.50 $3,232.50 $2,988.75
Radphm lcl tomogr sgl area sgl day $2,619.00 $2,619.00 $2,619.00 $2,619.00
Radphm quant measure sgl area add-on $46.50 $46.50 $46.50 $46.50
Rapid Strep Test $100.50 $100.50 $100.50 $74.10
Rasburicase 1.5 mg intravenous solution $20,465.52 $20,465.52 $20,465.52 $11,391.60
Ravulizumab-cwvz 100 mg/ml intravenous solution $88,558.68 $88,558.68 $88,558.68 $88,558.68
Rbc count only automated $37.50 $37.50 $37.50 $24.00
Rbc deglycerolized each unit $1,524.00 $1,524.00 $1,524.00 $1,471.50
Rbc irradiated each unit $1,046.25 $1,046.25 $1,046.25 $1,046.25
Red blood cells each unit $1,275.00 $1,275.00 $1,275.00 $919.20
Red blood cells leukocytes reduced each unit $830.25 $830.25 $830.25 $830.25
Red blood cells leukocytes reduced irradiated each unit $837.00 $837.00 $837.00 $837.00
Red blood cells washed each unit $1,280.25 $1,280.25 $1,280.25 $871.80
Redo endovas vena cava filtr $3,682.50 $3,682.50 $3,682.50 $3,682.50
Reduction of procidentia 45900 $1,067.25 $1,067.25 $1,067.25 $1,067.25
Refill maint impl spine pump $352.50 $352.50 $352.50 $352.50
Refill/maint pump/resvr syst $630.00 $630.00 $630.00 $630.00
Regadenoson 0.4 mg/5 ml intravenous syringe $698.06 $698.06 $698.06 $698.06
Release of eye fluid $2,667.75 $2,667.75 $2,667.75 $2,667.75
Relocation skin pocket aicd $3,869.25 $3,869.25 $3,869.25 $3,869.25
Relocation skin pocket pm $2,939.25 $2,939.25 $2,939.25 $2,939.25
Rem endovas vena cava filter $5,661.75 $5,661.75 $5,661.75 $5,661.75
Rem interrog dev eval icpms $109.50 $109.50 $109.50 $109.50
Rem interrog dev eval scrms $109.50 $109.50 $109.50 $109.50
Rem interrog evl pm/ids $204.00 $204.00 $204.00 $204.00
Rem mntr physiol 1st dev supply ea 30 days $84.00 $84.00 $84.00 $84.00
Rem mntr physiol 1st set up pt educaj eqp $295.50 $295.50 $295.50 $273.00
Rem/biv cast full arm/leg $320.25 $320.25 $320.25 $370.80
Remdesivir 100 mg intravenous powder for solution $2,406.04 $2,406.04 $2,406.04 $16.80
Removal anal seton other marker 46030 $1,368.00 $1,368.00 $1,368.00 $1,368.00
Removal biliary drg cath $2,025.75 $2,025.75 $2,025.75 $1,663.20
Removal central venous catheter tunneled without port/pump $1,899.75 $1,899.75 $1,899.75 $1,899.75
Removal central venous device tunneled w/port/pump central/peripheral insertion $2,838.00 $2,838.00 $2,838.00 $2,838.00
Removal cerclage w/anes $3,577.50 $3,577.50 $3,577.50 $3,577.50
Removal cerclage without anes $778.50 $778.50 $778.50 $778.50
Removal cerumen impacted (both sides) $170.25 $170.25 $170.25 $169.20
Removal clot in graft oth/thn 35875 $5,270.25 $5,270.25 $5,270.25 $5,270.25
Removal clot in graft xcp 35876 $5,270.25 $5,270.25 $5,270.25 $5,270.25
Removal devitalized tissue non-selective debridement without anesthesia per session $343.50 $343.50 $343.50 $343.50
Removal duct glbldr calculi $3,895.50 $3,895.50 $3,895.50 $3,895.50
Removal embedded foreign body vestibule mouth smpl $876.00 $876.00 $876.00 $876.00
Removal foreign body foot cmplx $2,117.25 $2,117.25 $2,117.25 $1,957.50
Removal foreign body foot subcutaneous right $1,181.25 $1,181.25 $1,181.25 $901.80
Removal foreign body gum 41805 $1,692.75 $1,692.75 $1,692.75 $1,692.75
Removal implant superficial separate procedure $3,387.00 $3,387.00 $3,387.00 $3,387.00
Removal of breast lesion $3,704.25 $3,704.25 $3,704.25 $3,704.25
Removal of implant deep $5,565.75 $5,565.75 $5,565.75 $5,565.75
Removal of intranasal lesion $3,732.00 $3,732.00 $3,732.00 $3,732.00
Removal of shunt $6,577.50 $6,577.50 $6,577.50 $6,563.25
Removal of skin tags each add'l 10 $421.50 $421.50 $421.50 $396.00
Removal skin tags fibrocutaneous any area <= 15 lesions $292.50 $292.50 $292.50 $471.00
Removal sutr or stapl no anes $328.50 $328.50 $328.50 $187.20
Removal tunnled intprtnl cath $4,377.00 $4,377.00 $4,377.00 $3,859.50
Removal w/reinsrt nonbiogrdble $3,072.00 $3,072.00 $3,072.00 $2,840.25
Removal/replacement ppm generator dual lead system $9,527.25 $9,527.25 $9,527.25 $9,527.25
Remove anal fist complex $3,371.25 $3,371.25 $3,371.25 $3,371.25
Remove anal fist subq $3,249.75 $3,249.75 $3,249.75 $3,249.75
Remove cva lumen obstruct $2,241.75 $2,241.75 $2,241.75 $1,578.00
Remove ear canal lesion(s) $3,293.25 $3,293.25 $3,293.25 $3,293.25
Remove eyelid lesion $1,133.25 $1,133.25 $1,133.25 $1,133.25
Remove hip foreign body 27086 $417.75 $417.75 $417.75 $417.75
Remove hip/pelvis lesion 27047 $3,348.75 $3,348.75 $3,348.75 $3,348.75
Remove in/ex hem grps w/fist $3,255.75 $3,255.75 $3,255.75 $3,255.75
Remove renal tube w/fluoro $1,281.75 $1,281.75 $1,281.75 $1,281.75
Remove shoulder foreign body subq 23330 $1,879.50 $1,879.50 $1,879.50 $1,879.50
Remove spine eltrd perq aray $2,238.75 $2,238.75 $2,238.75 $2,238.75
Remove stent via transureth $1,638.75 $1,638.75 $1,638.75 $1,638.75
Remove tonsils and adenoids $3,600.75 $3,600.75 $3,600.75 $3,600.75
Remove ureter stent percut $3,552.00 $3,552.00 $3,552.00 $3,552.00
Remove vaginal foreign body 57415 $3,577.50 $3,577.50 $3,577.50 $3,577.50
Renal function panel $188.25 $188.25 $188.25 $188.25
Renal venogram bil s&i $3,386.25 $3,386.25 $3,386.25 $3,386.25
Repair blood vessel dir upper extr $3,682.50 $3,682.50 $3,682.50 $3,682.50
Repair complex wound scalp/arms/legs 2.6 - 7.5 cm $969.00 $969.00 $969.00 $1,664.40
Repair dental ellis ii fx $3,575.25 $3,575.25 $3,575.25 $232.22
Repair detached retina $2,701.50 $2,701.50 $2,701.50 $2,701.50
Repair detached retina pc $666.75 $666.75 $666.75 $666.75
Repair elbow perc $3,752.25 $3,752.25 $3,752.25 $3,752.25
Repair eyelid wound $2,675.25 $2,675.25 $2,675.25 $2,675.25
Repair eyelid wound $2,675.25 $2,675.25 $2,675.25 $2,675.25
Repair finger tendon $3,752.25 $3,752.25 $3,752.25 $3,752.25
Repair lip full thkns =<one-half vert height $579.00 $579.00 $579.00 $579.00
Repair lip full thkns >one-half vert height/cmplx $1,768.50 $1,768.50 $1,768.50 $1,768.50
Repair of toe dislocation $3,752.25 $3,752.25 $3,752.25 $3,752.25
Repair pm/icd lead dual $6,205.50 $6,205.50 $6,205.50 $6,205.50
Repair pm/icd lead sgl $4,257.75 $4,257.75 $4,257.75 $4,257.75
Repair rpr lac tongue floor mouth > 2.6 cm/cmplx $262.50 $262.50 $262.50 $1,497.00
Repair rpr lip full thickness vermilion only $579.00 $579.00 $579.00 $837.75
Repair stomach opening $4,451.25 $4,451.25 $4,451.25 $4,451.25
Repair tendon/muscle forearm/wrist prime sngl ea $3,752.25 $3,752.25 $3,752.25 $3,752.25
Repair tongue lac <2.5cm past 1/3 tongue 41251 $262.50 $262.50 $262.50 $262.50
Repair upper arm/elbow tendon/muscle ea $8,293.50 $8,293.50 $8,293.50 $7,143.73
Replace aortic valve open femoral 33362 $31,283.25 $31,283.25 $31,283.25 $31,283.25
Replace aortic valve open iliac 33364 $44,969.25 $44,969.25 $44,969.25 $44,969.25
Replace aortic valve w/byp prq aprch 33367 $44,969.25 $44,969.25 $44,969.25 $44,969.25
Replace duod/jej tube perc $1,464.75 $1,464.75 $1,464.75 $1,868.40
Replace g-j tube perc $1,479.75 $1,479.75 $1,479.75 $1,479.75
Replace g/c tube perc $1,059.75 $1,059.75 $1,059.75 $2,467.80
Replace tunneled cv cath $4,034.25 $4,034.25 $4,034.25 $4,034.25
Repos lv lead pm/icd $3,322.50 $3,322.50 $3,322.50 $3,322.50
Repos sq defib eltrd $10,506.75 $10,506.75 $10,506.75 $10,506.75
Reposg phrnc nrv stim trnsvn $4,023.75 $4,023.75 $4,023.75 $4,023.75
Reposition pm/icd lead $4,089.00 $4,089.00 $4,089.00 $4,089.00
Reprogram cochlear implt 7/> $382.50 $382.50 $382.50 $382.50
Reprogram cochlear implt <7 $762.75 $762.75 $762.75 $762.75
Reptilase test $138.75 $138.75 $138.75 $105.60
Resect inferior turbinate $3,810.75 $3,810.75 $3,810.75 $3,810.75
Reslizumab 10 mg/ml intravenous solution $4,119.02 $4,119.02 $4,119.02 $4,119.02
Resp virus 6-11 targets $1,559.25 $1,559.25 $1,559.25 $1,237.80
Resuscitation cardiopulmonary $1,155.00 $1,155.00 $1,155.00 $912.60
Resuscitation delivery/birthing room $721.50 $721.50 $721.50 $721.50
Reticulated platelet assay $99.00 $99.00 $99.00 $99.00
Reticulocyte automated $54.75 $54.75 $54.75 $54.75
Rev-rem impl neurostim gen-rec $3,945.00 $3,945.00 $3,945.00 $3,945.00
Revasc evasc fpvt angio cplx 1st $9,528.00 $9,528.00 $9,528.00 $9,528.00
Revasc evasc fpvt angio sf 1st $9,528.00 $9,528.00 $9,528.00 $9,528.00
Revasc evasc fpvt athrec cplx 1st $16,954.50 $16,954.50 $16,954.50 $16,954.50
Revasc evasc fpvt athrec sf 1st $16,954.50 $16,954.50 $16,954.50 $16,954.50
Revasc evasc fpvt st athrec sf 1st $21,221.25 $21,221.25 $21,221.25 $21,221.25
Revasc evasc fpvt stent cplx 1st $16,936.50 $16,936.50 $16,936.50 $16,936.50
Revasc evasc fpvt stent sf 1st $16,936.50 $16,936.50 $16,936.50 $16,936.50
Revasc evasc imvt angio cplx 1st $11,497.50 $11,497.50 $11,497.50 $11,497.50
Revasc evasc imvt angio sf 1st $11,497.50 $11,497.50 $11,497.50 $11,497.50
Revasc evasc ivt angio cplx 1st $9,998.25 $9,998.25 $9,998.25 $9,998.25
Revasc evasc ivt stent cplx 1st $14,052.00 $14,052.00 $14,052.00 $14,052.00
Revasc evasc ivt stent sf 1st $14,052.00 $14,052.00 $14,052.00 $14,052.00
Revasc evasc tpvt angio cplx 1st $9,804.00 $9,804.00 $9,804.00 $9,804.00
Revasc evasc tpvt angio sf 1st $9,804.00 $9,804.00 $9,804.00 $9,804.00
Revasc evasc tpvt athrec cplx 1st $14,665.50 $14,665.50 $14,665.50 $14,665.50
Revasc evasc tpvt athrec sf 1st $14,665.50 $14,665.50 $14,665.50 $14,665.50
Revasc intra lithotrip-ather $20,329.50 $20,329.50 $20,329.50 $20,329.50
Revasc intra lithotrip-stent $20,329.50 $20,329.50 $20,329.50 $20,329.50
Revasc intravasc lithotripsy $12,754.50 $12,754.50 $12,754.50 $12,754.50
Revasc lith-sten-ath tib/per $20,329.50 $20,329.50 $20,329.50 $20,329.50
Revasc lithotr-ather tib/per $20,329.50 $20,329.50 $20,329.50 $20,329.50
Revasc lithotr-stent tib/per $20,329.50 $20,329.50 $20,329.50 $20,329.50
Revasc lithotrip tibi/perone $12,754.50 $12,754.50 $12,754.50 $12,754.50
Revasc lithotrip-stent-ather $20,329.50 $20,329.50 $20,329.50 $20,329.50
Revise abdomen-venous shunt $7,104.75 $7,104.75 $7,104.75 $7,086.00
Revise/remove sling repair $3,720.00 $3,720.00 $3,720.00 $3,720.00
Revision of cervix $5,771.25 $5,771.25 $5,771.25 $5,771.25
Revision of cervix $7,213.50 $7,213.50 $7,213.50 $7,213.50
Revision of iris $2,392.50 $2,392.50 $2,392.50 $2,392.50
Revision of penis $4,040.25 $4,040.25 $4,040.25 $4,040.25
Revision tips $7,994.25 $7,994.25 $7,994.25 $7,994.25
Rf abltj nrv nrvtg si jt $1,746.75 $1,746.75 $1,746.75 $1,952.77
Rheumatoid factor quantitative $98.25 $98.25 $98.25 $98.25
Rho d immune globulin inj $194.25 $194.25 $194.25 $336.75
Rho(d) immune globulin h, sd $5,242.06 $5,242.06 $5,242.06 $5,242.06
Rifampin in ns IV syringe 3 mg/ml (neo/ped) - cnr $300.54 $300.54 $300.54 $4.20
Right ventric recording $3,039.75 $3,039.75 $3,039.75 $3,039.75
Ring fx reform 11-13x17mm $1,509.75 $1,509.75 $1,509.75 $1,509.75
Risperidone microspheres 12.5 mg/2 ml inj $4,536.51 $4,536.51 $4,536.51 $4,536.51
Rituximab 1,400 mg/11.7 ml (120 mg/ml)-hyaluronidase subcutaneous soln $27,790.74 $27,790.74 $27,790.74 $27,790.74
Rituximab-abbs 10 mg/ml intravenous solution $9,097.89 $9,097.89 $9,097.89 $372.60
Rituximab-pvvr 10 mg/ml intravenous solution $8,464.14 $8,464.14 $8,464.14 $8,464.14
Rmv implant contraceptive capsule 11976 $1,478.25 $1,478.25 $1,478.25 $1,478.25
Rmv&rplcmt phrnc nrv stim ld $15,792.75 $15,792.75 $15,792.75 $15,792.75
Rmv&rplcmt phrnc nrv stim pg $36,000.00 $36,000.00 $36,000.00 $36,000.00
Rmvl foreign body upper arm/elbow subcutaneous $1,897.50 $1,897.50 $1,897.50 $1,778.40
Rmvl icd by tv extr $4,848.75 $4,848.75 $4,848.75 $4,589.40
Rmvl icd gen w/rplc icd gen dual lead sys $22,197.75 $22,197.75 $22,197.75 $22,197.75
Rmvl icd gen w/rplc icd gen mlt lead sys $26,801.25 $26,801.25 $26,801.25 $26,801.25
Rmvl icd gen w/rplc icd gen sgl lead sys $21,319.50 $21,319.50 $21,319.50 $21,319.50
Rmvl icd pulse gen only $4,307.25 $4,307.25 $4,307.25 $4,307.25
Rmvl ndwellg tun pleural cath $2,230.50 $2,230.50 $2,230.50 $2,133.75
Rmvl perm pm pulse gen $6,820.50 $6,820.50 $6,820.50 $4,983.00
Rmvl phrnc nrv stim pg only $4,023.75 $4,023.75 $4,023.75 $4,023.75
Rmvl phrnc nrv stim sys $4,023.75 $4,023.75 $4,023.75 $4,023.75
Rmvl phrnc nrv stim transvns $3,945.00 $3,945.00 $3,945.00 $3,945.00
Rmvl pm gen w/rplc pm gen mlt lead sys $18,045.00 $18,045.00 $18,045.00 $18,045.00
Rmvl pm gen w/rplc pm gen sgl lead sys $8,797.50 $8,797.50 $8,797.50 $8,797.50
Rmvl pq iabp $84.00 $84.00 $84.00 $84.00
Rmvl pq vad left hrt vein sep session $6,116.25 $6,116.25 $6,116.25 $6,116.25
Rmvl sq defib electrode $4,551.75 $4,551.75 $4,551.75 $4,551.75
Rmvl subq card rhythm mntr $7,037.25 $7,037.25 $7,037.25 $2,560.20
Rmvl tv pm lead dual $3,988.50 $3,988.50 $3,988.50 $3,988.50
Rmvl tv pm lead sgl $3,303.75 $3,303.75 $3,303.75 $3,303.75
Romidepsin 10 mg/2 ml intravenous powder for solution $11,827.02 $11,827.02 $11,827.02 $11,827.02
Romiplostim 125 mcg subcutaneous solution $20,356.48 $20,356.48 $20,356.48 $34.60
Romosozumab-aqqg 105 mg/1.17 ml subcutaneous syringe (wrapper) $8,372.44 $8,372.44 $8,372.44 $8,372.44
Ropivacaine 0.2 % epidural pca - 1 hour dose limit $184.88 $184.88 $184.88 $184.88
Rp loclzj tum spect w/ct 1 $2,531.25 $2,531.25 $2,531.25 $2,531.25
Rpl non-tun cvc wo sbq prt/pmp $2,703.00 $2,703.00 $2,703.00 $2,703.00
Rpl picc wo subq port/pump incl image guidnc w/s&i $2,534.25 $2,534.25 $2,534.25 $2,534.25
Rpl tun cvc wo subq port $2,957.25 $2,957.25 $2,957.25 $2,957.25
Rpl tun-cvad w subq port $3,880.50 $3,880.50 $3,880.50 $3,880.50
Rubella antibody igg $84.00 $84.00 $84.00 $84.00
Rubeola antibody igg $171.00 $171.00 $171.00 $171.00
Russell viper venom diluted $108.00 $108.00 $108.00 $108.00
S bowel endoscope w/stent $4,379.25 $4,379.25 $4,379.25 $4,379.25
Sacituzumab govitecan-hziy 180 mg intravenous solution $9,478.55 $9,478.55 $9,478.55 $6,723.60
Salivary gland imaging $585.00 $585.00 $585.00 $585.00
Salmonella antibody $29.25 $29.25 $29.25 $29.25
Sargramostim injection $1,092.15 $1,092.15 $1,092.15 $1,092.15
Sarscov coronavirus ag ia $59.25 $59.25 $59.25 $39.00
Scan duplex abd/pelvis/retroperitoneal complete $1,225.50 $1,225.50 $1,225.50 $1,225.50
Scan duplex abd/pelvis/retroperitoneal limited $977.25 $977.25 $977.25 $929.25
Scan duplex aorta/ivc/iliac or bypass grafts complete $994.50 $994.50 $994.50 $994.50
Scan duplex aorta/ivc/iliac unilateral/limited $724.50 $724.50 $724.50 $724.50
Scan duplex extracranial arteries unilateral/limited study $127.50 $127.50 $127.50 $379.80
Scan duplex extremity veins unilateral/limited study $999.75 $999.75 $999.75 $847.80
Scan duplex lower extremity arteries complete bilateral $1,207.50 $1,207.50 $1,207.50 $1,207.50
Scan duplex lower extremity arteries unilateral/limited study left $830.25 $830.25 $830.25 $830.25
Scan duplex upper extremity arteries unilateral/limited study left $779.25 $779.25 $779.25 $779.25
Sclerotherapy fluid collection pq w/img $1,810.50 $1,810.50 $1,810.50 $1,810.50
Scope uretscp lithovue dig disp $7,863.75 $7,863.75 $7,863.75 $7,863.75
Screen/visual acuity/bilat/quant 99173 $26.25 $26.25 $26.25 $26.25
Screening Colonoscopy (average risk) $2,602.50 $2,602.50 $2,602.50 $1,440.00
Screening Colonoscopy (high risk) $2,602.50 $2,602.50 $2,602.50 $2,000.00
Screening Mammogram $509.25 $509.25 $509.25 $331.50
Screw cortex 2.0 x 10mm $28,563.75 $28,563.75 $28,563.75 $28,563.75
Sec art mech thrmbc non-intracranial add-on $8,255.25 $8,255.25 $8,255.25 $8,255.25
Sedation moderate same physician performing a gastrointestinal endoscopic service >= 5 years initial 15 minutes intra-service time $667.50 $667.50 $667.50 $667.50
Sedimentation rate erythrocyte automated $75.00 $75.00 $75.00 $69.60
Select picture audiometry $67.50 $67.50 $67.50 $67.50
Self-mgmt educ/train 2-4 pt 30min $135.00 $135.00 $135.00 $135.00
Sensorimotor examination $109.50 $109.50 $109.50 $109.50
Sertraline (zoloft) - sendout $101.25 $101.25 $101.25 $101.25
Sevelamer carbonate pdr 20mg $638.94 $638.94 $638.94 $638.94
Sgmdsc w/band ligation $1,380.00 $1,380.00 $1,380.00 $2,563.80
Shave sgl skin lsn f/e/e/n/l/m 0.5cm/< $987.75 $987.75 $987.75 $722.40
Shave sgl skin lsn f/e/e/n/l/m 0.6-1.0cm $935.25 $935.25 $935.25 $935.25
Shave sgl skin lsn f/e/e/n/l/m 1.1-2cm $935.25 $935.25 $935.25 $935.25
Shave sgl skin lsn f/e/e/n/l/m >2cm $582.75 $582.75 $582.75 $582.75
Shave sgl skin lsn s/n/h/f/g 0.5cm/< $219.00 $219.00 $219.00 $219.00
Shave sgl skin lsn s/n/h/f/g 0.6-1.0 cm $231.75 $231.75 $231.75 $231.75
Shave sgl skin lsn s/n/h/f/g 1.1-2cm $252.00 $252.00 $252.00 $252.00
Shave sgl skin lsn s/n/h/f/g >2cm $367.50 $367.50 $367.50 $367.50
Shave sgl skin lsn t/a/l 0.5cm/< $311.25 $311.25 $311.25 $311.25
Shave sgl skin lsn t/a/l 0.6-1.0cm $206.25 $206.25 $206.25 $206.25
Shave sgl skin lsn t/a/l 1.1-2.0cm $304.50 $304.50 $304.50 $304.50
Sheath gldlight lasr 12fx50cm $7,076.25 $7,076.25 $7,076.25 $7,076.25
Sheath laser cavaclear 14f $11,238.75 $11,238.75 $11,238.75 $11,238.75
Shoe post-op mens m $29.76 $29.76 $29.76 $29.76
Shoulder MRI (with and without contrast) $2,628.75 $2,628.75 $2,628.75 $2,650.10
Shoulder MRI (with contrast) $2,259.00 $2,259.00 $2,259.00 $2,713.80
Shoulder MRI (without contrast) $2,127.00 $2,127.00 $2,127.00 $1,938.28
Shoulder X-ray $461.25 $461.25 $461.25 $307.20
Shunt glaucoma baerveldt 350mm $4,050.00 $4,050.00 $4,050.00 $4,050.00
Shuntogram nonvascular supervision & interpretation $539.25 $539.25 $539.25 $382.20
Sialolithotomy 42330 $3,732.75 $3,732.75 $3,732.75 $3,732.75
Sickling rbc $90.75 $90.75 $90.75 $81.00
Sig w/tndsc balloon dilation $2,738.25 $2,738.25 $2,738.25 $2,738.25
Sigmoid/rmv tumor/polyp/hot bx for 45333 $2,535.00 $2,535.00 $2,535.00 $2,535.00
Sigmoidoscopy and biopsy $1,942.50 $1,942.50 $1,942.50 $1,942.50
Sigmoidoscopy flex decompression 45337 $1,058.25 $1,058.25 $1,058.25 $1,058.25
Sigmoidoscopy for bleeding $2,765.25 $2,765.25 $2,765.25 $2,765.25
Sigmoidoscopy w/ablation $2,604.00 $2,604.00 $2,604.00 $2,604.00
Sigmoidoscopy w/fb removal 45332 $1,370.25 $1,370.25 $1,370.25 $1,370.25
Sigmoidoscopy w/plcmt stent $4,379.25 $4,379.25 $4,379.25 $4,379.25
Sigmoidoscopy w/resection $3,254.25 $3,254.25 $3,254.25 $3,254.25
Sigmoidoscopy w/tumr remove $2,502.75 $2,502.75 $2,502.75 $2,502.75
Sigmoidoscopy w/ultrasound $3,027.00 $3,027.00 $3,027.00 $2,237.25
Sigmoidoscopy w/us guide bx $4,014.75 $4,014.75 $4,014.75 $2,967.75
Sigmoidoscopy/submucosal injection 45335 $2,389.50 $2,389.50 $2,389.50 $2,235.60
Simple cystometrogram 51725 $759.00 $759.00 $759.00 $759.00
Sincalide 5 mcg solution for injection $456.17 $456.17 $456.17 $456.17
Sinus CT scan (with and without contrast) $1,576.50 $1,576.50 $1,576.50 $1,823.88
Sinus CT scan (with contrast) $1,519.50 $1,519.50 $1,519.50 $1,519.50
Sinus CT scan (without contrast) $1,303.50 $1,303.50 $1,303.50 $1,279.50
Sinus/juglr venogram s&i $2,489.25 $2,489.25 $2,489.25 $2,489.25
Sipuleucel-t - su $95,750.46 $95,750.46 $95,750.46 $95,750.46
Sirolimus, oral $12,667.27 $12,667.27 $12,667.27 $180.00
Skin Biopsy $300.00 $300.00 $300.00 $362.40
Skyla, 13.5 mg $3,739.59 $3,739.59 $3,739.59 $3,739.59
Sleep Study (Polysomnography) $6,070.50 $6,070.50 $6,070.50 $4,141.16
Sleep study attended $404.25 $404.25 $404.25 $404.25
Sleep study unattended $594.00 $594.00 $594.00 $594.00
Sleeve fing rolyan med $32.25 $32.25 $32.25 $32.25
Sling arm deluxe w/pad xs $30.35 $30.35 $30.35 $91.80
Sling suprapubic suburetheral $21,217.50 $21,217.50 $21,217.50 $21,217.50
Slp pure tone screening $64.50 $64.50 $64.50 $64.50
Small bowel endoscopy $3,970.50 $3,970.50 $3,970.50 $3,970.50
Small bowel endoscopy $3,175.50 $3,175.50 $3,175.50 $3,175.50
Small bowel endoscopy $4,077.00 $4,077.00 $4,077.00 $4,077.00
Small bowel endoscopy $3,048.00 $3,048.00 $3,048.00 $3,048.00
Small bowel endoscopy $3,657.00 $3,657.00 $3,657.00 $3,657.00
Small bowel endoscopy $2,467.50 $2,467.50 $2,467.50 $2,467.50
Small bowel endoscopy $2,597.25 $2,597.25 $2,597.25 $2,597.25
Small bowel endoscopy 44365 $3,540.00 $3,540.00 $3,540.00 $3,540.00
Small bowel endoscopy >2nd w/remove 44363 $3,096.75 $3,096.75 $3,096.75 $3,096.75
Small bowel endoscopy br/wa $2,218.50 $2,218.50 $2,218.50 $2,218.50
Small bowel endoscopy br/wa $2,166.75 $2,166.75 $2,166.75 $2,166.75
Small bowel endoscopy/biopsy $4,161.00 $4,161.00 $4,161.00 $4,047.00
Small bowel endoscopy/biopsy $2,205.75 $2,205.75 $2,205.75 $2,205.75
Small bowel endoscopy/stent 44370 $6,607.50 $6,607.50 $6,607.50 $6,607.50
Smallpox&monkeypox vac 0.5ml $2.43 $2.43 $2.43 $2.43
Smear fluorescent and/or acid fast stain $81.00 $81.00 $81.00 $81.00
Smear gram stain $66.00 $66.00 $66.00 $60.75
Smear nasal eosinophil $46.50 $46.50 $46.50 $46.50
Smear special stain inclusion bodies/parasites $52.50 $52.50 $52.50 $52.50
Smear wet mount $88.50 $88.50 $88.50 $78.75
Snrpn/ube3a gene $376.50 $376.50 $376.50 $376.50
So gsap cll fr dna/dna&rna $2,242.50 $2,242.50 $2,242.50 $2,242.50
So gsap dna cpy nmbr&mcrstl $1,580.25 $1,580.25 $1,580.25 $1,580.25
Sodium 24 hour urine $60.00 $60.00 $60.00 $60.00
Sodium chloride 0.9 % IV bolus $19.42 $19.42 $19.42 $32.40
Sodium chloride 0.9 % IV bolus $20.34 $20.34 $20.34 $22.20
Sodium chloride 0.9 % intravenous solution $33.28 $33.28 $33.28 $33.28
Sodium chloride 3 % ivpb $11.10 $11.10 $11.10 $13.20
Sodium ferric gluconate complex in sucrose 62.5 mg/5 ml intravenous $28.46 $28.46 $28.46 $28.46
Sodium hyaluronate 20 mg/2 ml syringe $651.32 $651.32 $651.32 $651.32
Sodium serum/plasma/whole blood $57.00 $57.00 $57.00 $47.80
Somatosensory testing $1,404.00 $1,404.00 $1,404.00 $1,130.25
Somatropin injection $2,600.83 $2,600.83 $2,600.83 $2,600.83
Sotalol hydrochloride IV $13,396.05 $13,396.05 $13,396.05 $13,396.05
Specimen fat stain $60.75 $60.75 $60.75 $60.75
Speech audiometry complete $104.25 $104.25 $104.25 $104.25
Speech evaluation complex $1,077.00 $1,077.00 $1,077.00 $1,068.75
Speech recep thresh $104.25 $104.25 $104.25 $104.25
Spinal puncture lumbar diagnostic w/fluoroscopic or CT guidance $1,416.00 $1,416.00 $1,416.00 $1,416.00
Spirometry bronchodilation responsiveness pre/post bronchodilator administration $672.00 $672.00 $672.00 $577.50
Spirometry up to 2 yrs old $1,005.75 $1,005.75 $1,005.75 $1,005.75
Spleen imaging $469.50 $469.50 $469.50 $469.50
Splint dorsal bloc wh med perf 3.2mm lf polyflex ii $48.75 $48.75 $48.75 $48.75
Splint extn xsm w sof-stretch rolyan $93.00 $93.00 $93.00 $93.00
Splint finger frog med $73.50 $73.50 $73.50 $73.50
Splint rstrc wrst/cmc right med $35.25 $35.25 $35.25 $97.20
Split blood or products $606.00 $606.00 $606.00 $384.00
Sputum specimen collection $337.50 $337.50 $337.50 $337.50
St analysis behavior qualitative voice/resonance $393.00 $393.00 $393.00 $326.25
St cognitve performance testing healthcare professional each hour $330.75 $330.75 $330.75 $330.75
St evaluate speech sound production $341.25 $341.25 $341.25 $310.20
St evaluate speech sound production comprehensive/expressive $387.00 $387.00 $387.00 $369.75
St evaluation motion fluoroscopic swallow function cine/video $551.25 $551.25 $551.25 $480.00
St evaluation swallow function $442.50 $442.50 $442.50 $416.40
St treatment speech individual $332.25 $332.25 $332.25 $225.60
St treatment swallow dysfunction/oral $415.50 $415.50 $415.50 $318.00
Staggered spondaic word test $474.75 $474.75 $474.75 $474.75
Staph a dna amp probe $129.00 $129.00 $129.00 $129.00
Stem cells total count $96.00 $96.00 $96.00 $96.00
Stenger test pure tone $162.00 $162.00 $162.00 $162.00
Stenger test speech $404.25 $404.25 $404.25 $404.25
Stent axios caut enh 15x10mm electrocaut $47,137.50 $47,137.50 $47,137.50 $44,044.80
Stent bili dbl pgtl 10fx5cm $5,076.00 $5,076.00 $5,076.00 $1,894.80
Stent bili rx wallflx 10x80 uncvr $38,815.81 $38,815.81 $38,815.81 $35,011.80
Str markers specimen anal $1,678.50 $1,678.50 $1,678.50 $1,678.50
Strapping of ankle and/or ft 29540 $183.75 $183.75 $183.75 $183.75
Strapping of elbow or wrist 29260 $230.25 $230.25 $230.25 $230.25
Strapping of hand or finger $315.00 $315.00 $315.00 $315.00
Strapping of hip $147.00 $147.00 $147.00 $147.00
Strapping of knee $204.75 $204.75 $204.75 $204.75
Strapping of toes 29550 $151.50 $151.50 $151.50 $151.50
Streptozocin injection $1,286.99 $1,286.99 $1,286.99 $1,286.99
Stress test pulmonary $654.00 $654.00 $654.00 $452.25
Stress tte complete $2,007.00 $2,007.00 $2,007.00 $2,007.00
Subq njx filling matrl 1cc/< $1,392.00 $1,392.00 $1,392.00 $1,392.00
Succinylcholine chloride 20 mg/ml injection solution (wrapper) $22.19 $22.19 $22.19 $22.19
Sulfonylurea screen qn-sendout $270.00 $270.00 $270.00 $270.00
Sumatriptan 6 mg/0.5 ml subcutaneous solution $167.98 $167.98 $167.98 $167.98
Support clav 29.6-40.5in med $105.75 $105.75 $105.75 $105.75
Supprelin la implant $185,546.55 $185,546.55 $185,546.55 $185,546.55
Surgical pathology level 1 gross examination only $117.00 $117.00 $117.00 $67.80
Surgical pathology level 2 gross & microscopic examination $193.50 $193.50 $193.50 $189.00
Surgical pathology level 3 gross & microscopic examination $240.00 $240.00 $240.00 $240.00
Surgical pathology level 4 gross & microscopic examination $330.75 $330.75 $330.75 $330.75
Surgical pathology level 5 gross & microscopic examination $507.00 $507.00 $507.00 $505.20
Surgical pathology level 6 gross & microscopic examination $720.75 $720.75 $720.75 $713.25
Susceptibility agar dilution per agent $130.50 $130.50 $130.50 $91.80
Susceptibility enzyme detection per enzyme $31.50 $31.50 $31.50 $25.80
Susceptibility mic per plate $96.00 $96.00 $96.00 $96.00
Svc venogram s&i $4,438.50 $4,438.50 $4,438.50 $2,816.25
Synvisc or synvisc-one $1,696.83 $1,696.83 $1,696.83 $1,696.83
Syphilis test non-treponemal antibody quantitative rpr $67.50 $67.50 $67.50 $67.50
System cardiomems hosp electronics $53,437.50 $53,437.50 $53,437.50 $53,437.50
System pacing micra av $33,750.00 $33,750.00 $33,750.00 $33,750.00
System pcmkr dual chamber leadless micra av2 intrdcr cath $11,441.25 $11,441.25 $11,441.25 $11,441.25
System sealant biosentry tract $900.00 $900.00 $900.00 $900.00
T cells total count $108.00 $108.00 $108.00 $108.00
T3 (triiodothyronine) free $62.25 $62.25 $62.25 $65.25
T3 (triiodothyronine) total $52.50 $52.50 $52.50 $60.75
T4 (thyroxine) free $45.75 $45.75 $45.75 $45.75
T4 (thyroxine) total $99.75 $99.75 $99.75 $91.80
Tacrol astagraf ex rel oral $2,970.47 $2,970.47 $2,970.47 $2,970.47
Tacrol envarsus ex rel oral $8,369.30 $8,369.30 $8,369.30 $3.40
Tacrolimus 1 mg capsule, immediate-release $12,682.80 $12,682.80 $12,682.80 $29.40
Tacrolimus 5 mg/ml intravenous solution $874.23 $874.23 $874.23 $874.23
Tacrolimus therapeutic drug level $174.75 $174.75 $174.75 $174.75
Tafasitamab-cxix 200 mg intravenous solution $5,161.23 $5,161.23 $5,161.23 $5,161.23
Talimogene laherparepvec 10exp6 (1 million) pfu/ml susp for injection $25,827.38 $25,827.38 $25,827.38 $25,827.38
Target gsa panel hmtlmph neop $1,708.50 $1,708.50 $1,708.50 $1,708.50
Target gsa panel organ neop $1,643.25 $1,643.25 $1,643.25 $1,643.25
Tattooing/intraderm 6.1-20.0 sq cm 11921 $1,148.25 $1,148.25 $1,148.25 $1,148.25
Tavr perq femoral $25,185.75 $25,185.75 $25,185.75 $25,185.75
Tb test cell mediated immunity antigen response enumeration gamma interferon t-cells $460.50 $460.50 $460.50 $556.80
Tbo-filgrastim 300 mcg/0.5 ml subcutaneous syringe $959.55 $959.55 $959.55 $959.55
Tc-99m mebrofenin $1,248.75 $1,248.75 $1,248.75 $353.60
Tc-99m mertiatide $4,717.50 $4,717.50 $4,717.50 $2,142.00
Tc-99m pentetate dtpa $975.00 $975.00 $975.00 $975.00
Tc-99m sestamibi p study dose $6,044.97 $6,044.97 $6,044.97 $1,276.20
Tc-99m sulfur colloid $3,734.48 $3,734.48 $3,734.48 $542.40
Tcd emboli detect w/inj $1,061.25 $1,061.25 $1,061.25 $1,061.25
Tcd emboli detect without inj $1,269.00 $1,269.00 $1,269.00 $1,269.00
Tcran magn stim redetemine $354.00 $354.00 $354.00 $354.00
Tcranial magn stim tx deli $354.00 $354.00 $354.00 $354.00
Tcranial magn stim tx plan $354.00 $354.00 $354.00 $354.00
Tee w or without fol w/cont, mon $1,165.50 $1,165.50 $1,165.50 $1,165.50
Tee w or without fol w/cont,cong $1,826.25 $1,826.25 $1,826.25 $1,826.25
Telavancin injection $2,428.05 $2,428.05 $2,428.05 $2,428.05
Telehealth original site facility fee $151.50 $151.50 $151.50 $151.50
Temozolomide $1,918.68 $1,918.68 $1,918.68 $1,918.68
Temozolomide 100 mg intravenous solution $3,438.61 $3,438.61 $3,438.61 $3,438.61
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial) $29,758.74 $29,758.74 $29,758.74 $27,148.20
Terbutaline 1 mg/ml subcutaneous solution $68.57 $68.57 $68.57 $68.57
Tert gene targeted seq alys $347.25 $347.25 $347.25 $347.25
Test for chlorohydrocarbons $225.00 $225.00 $225.00 $225.00
Test stress cardiovascular tracing only $1,012.50 $1,012.50 $1,012.50 $1,012.50
Testicular imaging w/vasc flow $1,209.75 $1,209.75 $1,209.75 $1,209.75
Tetanus immune globulin inj $1,939.05 $1,939.05 $1,939.05 $1,524.00
Theophylline therapeutic drug level $111.00 $111.00 $111.00 $111.00
Ther nma rdctj intus/obstrcj $208.50 $208.50 $208.50 $208.50
Ther/proph/diag inj ia $380.25 $380.25 $380.25 $378.00
Therapy activation ipnss $108.00 $108.00 $108.00 $108.00
Therapy nutrition individual initial f2f w/patient each 15 minutes $65.25 $65.25 $65.25 $50.40
Therapy nutrition individual reassessment/intervention f2f w/patient each 15 minutes $65.25 $65.25 $65.25 $48.00
Thiamine hcl (vitamin b1) 100 mg/ml injection solution $23.67 $23.67 $23.67 $23.67
Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides) $1,687.50 $1,687.50 $1,687.50 $1,687.50
Thoracotomy with cardiac massage $4,610.25 $4,610.25 $4,610.25 $4,610.25
Thrombectmy crnry perq mechanical $4,489.50 $4,489.50 $4,489.50 $4,489.50
Thrombectomy/inf pq dialysis circuit $6,205.50 $6,205.50 $6,205.50 $6,205.50
Thrombectomy/inf pq dialysis circuit w/pta $10,103.25 $10,103.25 $10,103.25 $10,103.25
Thrombectomy/inf pq dialysis circuit w/stent plcmnt $15,313.50 $15,313.50 $15,313.50 $15,313.50
Thrombin time $87.00 $87.00 $87.00 $87.00
Thromboplastin time partial (ptt) substitution fractions each $99.75 $99.75 $99.75 $99.75
Thyroglobulin antibody $47.25 $47.25 $47.25 $95.25
Thyroid (TSH) Test $136.50 $136.50 $136.50 $110.00
Thyroid Ultrasound $885.75 $885.75 $885.75 $615.00
Thyroid mets imag whole body $2,506.50 $2,506.50 $2,506.50 $2,506.50
Thyroid uptake measurement $856.50 $856.50 $856.50 $856.50
Thyrotropin alfa 0.9 mg intramuscular solution $7,476.81 $7,476.81 $7,476.81 $7,476.81
Thyroxine binding globulin (tbg) $58.50 $58.50 $58.50 $75.00
Tib/per revasc stent & ather 37231 $21,900.00 $21,900.00 $21,900.00 $21,900.00
Tigecycline injection $534.77 $534.77 $534.77 $534.77
Tilt table study $1,428.00 $1,428.00 $1,428.00 $1,428.00
Tisagenlecleucel car-pos t $2,194,589.53 $2,194,589.53 $2,194,589.53 $2,194,589.53
Tisotumab vedotin-tftv 40 mg intravenous solution $27,364.47 $27,364.47 $27,364.47 $27,364.47
Tissue culture placenta $6,844.50 $6,844.50 $6,844.50 $6,844.50
Tissue culture skin/biopsy $1,468.50 $1,468.50 $1,468.50 $1,441.80
Tissue culture tumor $945.00 $945.00 $945.00 $945.00
Tissue exam koh skin/hair/nails $66.00 $66.00 $66.00 $66.00
Tissue matrix 1.8x1.8cm collagen dermacell porous 4sq cm cost per sq cm $2,516.07 $2,516.07 $2,516.07 $2,516.07
Tissue matrix xcm thk 20x30cm -cost per sq cm $1,679.65 $1,679.65 $1,679.65 $1,679.65
Tissue surgimend prs meshed 20 cm x 10 cm - cost per 0.5cm $6,114.24 $6,114.24 $6,114.24 $6,114.24
Tissue transglutaminase iga $42.75 $42.75 $42.75 $42.75
Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr $286.24 $286.24 $286.24 $286.24
Tobramycin non-comp unit $124.14 $124.14 $124.14 $124.14
Tobramycin peak therapeutic drug level $93.00 $93.00 $93.00 $94.50
Tomosynthesis breast screen bilateral $81.75 $81.75 $81.75 $74.25
Tongue biopsy; posterior one-third 41105 $2,845.50 $2,845.50 $2,845.50 $2,845.50
Topotecan 4 mg/4 ml (1 mg/ml) intravenous solution $517.65 $517.65 $517.65 $141.00
Total tau $504.00 $504.00 $504.00 $504.00
Toxoplasma antibody igg $60.00 $60.00 $60.00 $80.40
Toxoplasma antibody igm $93.00 $93.00 $93.00 $97.20
Tpmt gene com vrnts $1,022.25 $1,022.25 $1,022.25 $477.00
Trabectedin 1 mg intravenous solution $13,641.34 $13,641.34 $13,641.34 $13,269.60
Trabeculoplasty laser surg $671.25 $671.25 $671.25 $671.25
Tracheobrnchsc thru est trachs incisn $2,597.25 $2,597.25 $2,597.25 $2,597.25
Training self management diabetes individual outpatient department per 30 minutes $101.25 $101.25 $101.25 $101.25
Tranexamic acid 1,000 mg/10 ml (100 mg/ml) intravenous solution $77.65 $77.65 $77.65 $77.65
Transabdom amnioinfus w/us $1,177.50 $1,177.50 $1,177.50 $1,034.40
Transcath biopsy $4,294.50 $4,294.50 $4,294.50 $4,294.50
Transcath closure of asd $16,096.50 $16,096.50 $16,096.50 $16,096.50
Transcath closure of vsd $15,782.25 $15,782.25 $15,782.25 $15,782.25
Transcath mv repair init prosthesis $19,213.50 $19,213.50 $19,213.50 $19,213.50
Transcath occlusion cns $19,546.50 $19,546.50 $19,546.50 $19,546.50
Transcath occlusion non-cns $16,788.75 $16,788.75 $16,788.75 $16,788.75
Transcath rmvl perm ldss pmkr rv $3,696.00 $3,696.00 $3,696.00 $3,696.00
Transcatheter bx s&i $3,122.25 $3,122.25 $3,122.25 $3,122.25
Transferrin $136.50 $136.50 $136.50 $108.60
Transfusion blood/blood component(s) $1,166.25 $1,166.25 $1,166.25 $1,166.25
Transorl lwr esophgl myotomy $6,978.00 $6,978.00 $6,978.00 $6,978.00
Trastuzumab 150 mg intravenous solution $5,762.28 $5,762.28 $5,762.28 $5,762.28
Trastuzumab-anns 150 mg intravenous solution $12,199.65 $12,199.65 $12,199.65 $12,199.65
Trauma partial team response w/critical care services level 4 $3,822.00 $3,822.00 $3,822.00 $6,141.60
Tray bonemarrw oncontrol 102mm $1,094.25 $1,094.25 $1,094.25 $1,094.25
Treat ankle dislocation $1,872.00 $1,872.00 $1,872.00 $1,872.00
Treat clavicle dislocation 23545 $261.75 $261.75 $261.75 $261.75
Treat elbow dislocation $1,815.75 $1,815.75 $1,815.75 $1,815.75
Treat elbow fracture $1,815.75 $1,815.75 $1,815.75 $1,815.75
Treat finger fracture each $1,815.75 $1,815.75 $1,815.75 $2,053.80
Treat foot dislocation $261.75 $261.75 $261.75 $261.75
Treat fracture of radius $1,514.25 $1,514.25 $1,514.25 $1,514.25
Treat fracture of radius $1,815.75 $1,815.75 $1,815.75 $1,815.75
Treat fracture of ulna $2,169.75 $2,169.75 $2,169.75 $2,169.75
Treat hip dislocation $1,815.75 $1,815.75 $1,815.75 $1,980.60
Treat humerus fracture $1,815.75 $1,815.75 $1,815.75 $1,815.75
Treat humerus fracture $1,815.75 $1,815.75 $1,815.75 $2,055.00
Treat knee dislocation $1,815.75 $1,815.75 $1,815.75 $1,815.75
Treat knee fracture 27530 $344.25 $344.25 $344.25 $344.25
Treat knee fracture(s) $642.00 $642.00 $642.00 $642.00
Treat metacarpal fracture $3,767.25 $3,767.25 $3,767.25 $3,767.25
Treat sternum fracture $423.00 $423.00 $423.00 $423.00
Treat thigh fracture $261.75 $261.75 $261.75 $261.75
Treat thigh fx growth plate $1,815.75 $1,815.75 $1,815.75 $1,815.75
Treat ulnar fracture $1,198.50 $1,198.50 $1,198.50 $2,055.00
Treat vaginal bleeding $235.50 $235.50 $235.50 $235.50
Treat wrist bone fracture $1,815.75 $1,815.75 $1,815.75 $1,815.75
Treat wrist dislocation $656.25 $656.25 $656.25 $656.25
Treatment fx radial distal open w/internal fixation 2 frag left (restricted method ii cah) $8,370.75 $8,370.75 $8,370.75 $8,370.75
Treatment fx radial distal open w/internal fixation 3+ frag left (restricted method ii cah) $8,370.75 $8,370.75 $8,370.75 $8,370.75
Treatment fx radial distal open w/internal fixation left (restricted method ii cah) $8,370.75 $8,370.75 $8,370.75 $8,370.75
Treatment incomplete abortion completed surgically any trimester $3,996.00 $3,996.00 $3,996.00 $3,996.00
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour $333.75 $333.75 $333.75 $254.25
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour $320.25 $320.25 $320.25 $234.75
Treatment inhalation pressurized/nonpressurized acute airway obstruction $198.75 $198.75 $198.75 $203.39
Treatment missed abortion completed surgically 1st trimester $7,085.25 $7,085.25 $7,085.25 $7,085.25
Treatment of ankle fracture 27786 $358.50 $358.50 $358.50 $358.50
Treatment of fibula fracture 27780 $558.75 $558.75 $558.75 $558.75
Treatment of foot infection $1,872.75 $1,872.75 $1,872.75 $1,872.75
Treatment of heel fracture 28400 $352.50 $352.50 $352.50 $352.50
Treatment of miscarriage $9,051.75 $9,051.75 $9,051.75 $9,051.75
Treatment of thigh fracture $2,093.25 $2,093.25 $2,093.25 $2,093.25
Treatment of thigh fracture $732.75 $732.75 $732.75 $732.75
Treatment of thigh fracture $525.75 $525.75 $525.75 $525.75
Treatment of thigh fracture $2,068.50 $2,068.50 $2,068.50 $2,068.50
Treatment of toe fracture 28510 $315.00 $315.00 $315.00 $315.00
Treatment x10sv retinopathy $674.25 $674.25 $674.25 $674.25
Treponema pallidum antibody $169.50 $169.50 $169.50 $169.50
Treprostinil injection $21,186.46 $21,186.46 $21,186.46 $21,186.46
Trg gene rearrangement anal $732.00 $732.00 $732.00 $732.00
Triamcinolone a inj prs-free $3,235.98 $3,235.98 $3,235.98 $843.00
Triamcinolone acetonide 40 mg/ml suspension for injection $162.88 $162.88 $162.88 $70.80
Trichinella antibody $140.25 $140.25 $140.25 $140.25
Triglycerides $78.75 $78.75 $78.75 $78.75
Trim nail(s) $69.75 $69.75 $69.75 $69.75
Trim nondyst nails $318.75 $318.75 $318.75 $157.60
Trimethobenzamide hcl inj $191.20 $191.20 $191.20 $162.60
Triptorelin pamoate $16,454.18 $16,454.18 $16,454.18 $16,454.18
Trml dstrj ios bvn 1st 2 l/s $15,258.00 $15,258.00 $15,258.00 $15,258.00
Trml dstrj ios bvn ea addl $10,173.00 $10,173.00 $10,173.00 $10,173.00
Trnscath plc stent crv crtd w/prtct $9,767.25 $9,767.25 $9,767.25 $9,767.25
Trnscath plc stent crv crtd without prtct $7,944.75 $7,944.75 $7,944.75 $7,944.75
Trnscath plc vas stent w/s&i ea addl artery $7,463.25 $7,463.25 $7,463.25 $7,463.25
Trnscath plc vas stent w/s&i ea addl vein $7,374.00 $7,374.00 $7,374.00 $8,640.60
Trnscath plc vas stent w/s&i ini vein $10,059.75 $10,059.75 $10,059.75 $12,780.00
Trnscath retrv pq vasc fb w/guide $3,869.25 $3,869.25 $3,869.25 $3,869.25
Trnscath tx thromblytc art/ven sbsq day $4,505.25 $4,505.25 $4,505.25 $4,505.25
Trnscath tx thromblytc artery non-intracrn ini day $8,034.75 $8,034.75 $8,034.75 $8,034.75
Trnscath tx thromblytc cath rmv sbsq day $15,764.25 $15,764.25 $15,764.25 $5,623.50
Trnscath tx thromblytc vein ini day $2,489.25 $2,489.25 $2,489.25 $3,299.25
Troponin quantitative $180.00 $180.00 $180.00 $147.00
Tte w or without fol w/con,stres $1,949.25 $1,949.25 $1,949.25 $1,949.25
Tte w or without fol w/cont, com $1,922.25 $1,922.25 $1,922.25 $1,475.25
Tte w or without fol w/cont, f/u $1,341.75 $1,341.75 $1,341.75 $1,250.25
Tx atrial fib pulm vein isol $29,199.75 $29,199.75 $29,199.75 $29,199.75
Tx closed distal humerus fx $3,632.25 $3,632.25 $3,632.25 $153.60
Tx closed hip disl traumatic without anes $261.75 $261.75 $261.75 $825.60
Tx closed tib fx proximal w/w/o manip w/skel trac $3,767.25 $3,767.25 $3,767.25 $3,767.25
Tx closed tib shaft fx without manip $362.25 $362.25 $362.25 $362.25
Tx contour defects 1.1-5.0cc 11951 $2,245.50 $2,245.50 $2,245.50 $2,245.50
Tx l/r atrial fib addl $10,523.25 $10,523.25 $10,523.25 $10,523.25
Tx tarsal bone fx without manip 28450 $365.25 $365.25 $365.25 $365.25
Tympanometry & reflex thresh $141.75 $141.75 $141.75 $141.75
Tympanostomy/ven tube/loc/top anes 69433 $2,048.25 $2,048.25 $2,048.25 $2,048.25
Ua w/micro/comp poc $100.50 $100.50 $100.50 $33.60
Ugt1a1 gene analy common variants $438.75 $438.75 $438.75 $438.75
Ultrasound abdomen aorta screening study aaa $473.25 $473.25 $473.25 $339.60
Ultrasound breast complete $510.00 $510.00 $510.00 $546.60
Ultrasound breast unilateral limited (both sides) $478.50 $478.50 $478.50 $478.50
Ultrasound chest $695.25 $695.25 $695.25 $557.60
Ultrasound doppler velocimetry fetal umbilical artery $561.00 $561.00 $561.00 $561.00
Ultrasound dx ophth b-scan $404.25 $404.25 $404.25 $404.25
Ultrasound elastography ea l target les $177.00 $177.00 $177.00 $177.00
Ultrasound elastography parenchyma $284.25 $284.25 $284.25 $284.25
Ultrasound encephalogram $463.50 $463.50 $463.50 $463.50
Ultrasound exam k transpl w/doppler $967.50 $967.50 $967.50 $804.00
Ultrasound fetal biophysical profile without non-stress testing $535.50 $535.50 $535.50 $535.50
Ultrasound guidance for vascular access $511.50 $511.50 $511.50 $446.25
Ultrasound guide intraoperative $822.00 $822.00 $822.00 $822.00
Ultrasound guide tissue ablation $1,032.75 $1,032.75 $1,032.75 $1,032.75
Ultrasound guided needle placement supervision & interpretation $1,074.75 $1,074.75 $1,074.75 $1,009.80
Ultrasound hips infant dynamic $382.50 $382.50 $382.50 $382.50
Ultrasound infant hips ltd without stress $311.25 $311.25 $311.25 $311.25
Ultrasound joint complete left $808.50 $808.50 $808.50 $808.50
Ultrasound joint/nonvascular extremity limited left $542.25 $542.25 $542.25 $557.40
Ultrasound ob >=14wks ea addl gest $849.75 $849.75 $849.75 $849.75
Ultrasound pregnant uterus < 14 weeks each additional gestation $602.25 $602.25 $602.25 $602.25
Ultrasound pregnant uterus detailed fetal exam single/1st gestation $915.75 $915.75 $915.75 $915.75
Ultrasound pregnant uterus follow up per fetus $450.75 $450.75 $450.75 $450.75
Ultrasound pregnant uterus limited >= 1 fetuses $548.25 $548.25 $548.25 $548.25
Ultrasound pregnant uterus transvaginal $765.75 $765.75 $765.75 $754.50
Ultrasound prostate/transrectal $954.75 $954.75 $954.75 $829.20
Ultrasound retroperitoneal limited $718.50 $718.50 $718.50 $606.00
Ultrasound scrotum and contents $735.75 $735.75 $735.75 $735.75
Ultrasound spinal canal and contents $352.50 $352.50 $352.50 $394.20
Ultrasound transabd ea addl gest $701.25 $701.25 $701.25 $701.25
Ultrasound transvaginal non obstetric $877.50 $877.50 $877.50 $873.75
Ultrasound trgt dyn mbubb 1st les $303.00 $303.00 $303.00 $303.00
Unit mobile power mpu $18,857.25 $18,857.25 $18,857.25 $18,857.25
Unlisted CT procedure $1,578.75 $1,578.75 $1,578.75 $1,518.00
Unlisted dx gi procedure $2,470.50 $2,470.50 $2,470.50 $2,463.00
Unlisted hystsc px uterus $3,720.00 $3,720.00 $3,720.00 $3,720.00
Unlisted misc path test $1,014.00 $1,014.00 $1,014.00 $1,014.00
Unlisted mr procedure $1,616.25 $1,616.25 $1,616.25 $1,596.75
Unlisted orl service/px $121.50 $121.50 $121.50 $121.50
Unlisted procedure colon $6,297.75 $6,297.75 $6,297.75 $4,911.75
Unlisted procedure esophagus $6,297.75 $6,297.75 $6,297.75 $6,297.75
Unlisted procedure larynx $4,960.50 $4,960.50 $4,960.50 $4,960.50
Unlisted procedure liver $2,802.00 $2,802.00 $2,802.00 $2,802.00
Unlisted procedure microbiology $277.50 $277.50 $277.50 $277.50
Unlisted procedure pancreas $2,967.75 $2,967.75 $2,967.75 $2,967.75
Unlisted procedure rectum $1,058.25 $1,058.25 $1,058.25 $1,058.25
Unlisted px abdomen muscskel $1,824.75 $1,824.75 $1,824.75 $1,824.75
Unlisted px casting/strpg $316.50 $316.50 $316.50 $157.79
Unlisted px foot/toes $3,846.75 $3,846.75 $3,846.75 $3,846.75
Unlisted px neck/thorax $2,340.75 $2,340.75 $2,340.75 $2,340.75
Unlisted px small intestine $2,493.00 $2,493.00 $2,493.00 $2,493.00
Unlisted px tongue flr mouth $1,627.50 $1,627.50 $1,627.50 $1,565.25
Unlisted ultrasound procedure $532.50 $532.50 $532.50 $462.00
Upgrade pm system $13,140.75 $13,140.75 $13,140.75 $13,140.75
Upper Back (Thoracic Spine) MRI (with and without contrast) $2,590.50 $2,590.50 $2,590.50 $2,713.80
Upper Back (Thoracic Spine) MRI (with contrast) $2,441.25 $2,441.25 $2,441.25 $2,039.85
Upper Back (Thoracic Spine) MRI (without contrast) $2,265.75 $2,265.75 $2,265.75 $2,013.08
Upper Endoscopy (EGD, diagnostic) $2,514.75 $2,514.75 $2,514.75 $1,760.00
Upper Endoscopy (EGD, with biopsy) $2,464.50 $2,464.50 $2,464.50 $1,760.00
Uppr gi scope w/submuc inj $2,262.00 $2,262.00 $2,262.00 $2,262.00
Urea nitrogen $54.00 $54.00 $54.00 $42.00
Urea nitrogen 24 hour urine $49.50 $49.50 $49.50 $49.50
Urea nitrogen clearance $57.00 $57.00 $57.00 $57.00
Ureteral reflux study $1,353.75 $1,353.75 $1,353.75 $1,353.75
Urethrcystgrphy rtrgrde s&i $810.75 $810.75 $810.75 $776.80
Urethrocystography void s&i $880.50 $880.50 $880.50 $880.50
Uric acid blood $58.50 $58.50 $58.50 $58.50
Uric acid urine $55.50 $55.50 $55.50 $52.20
Urinalysis (with microscopy) $123.00 $123.00 $123.00 $36.66
Urinalysis (without microscopy) $62.25 $62.25 $62.25 $32.50
Urine Culture Test $126.00 $126.00 $126.00 $67.55
Urine flow measurement 51736 $148.50 $148.50 $148.50 $148.50
Urine pregnancy test $69.75 $69.75 $69.75 $69.75
Urography, antegrade $808.50 $808.50 $808.50 $896.40
Use 1st target lesion $252.00 $252.00 $252.00 $252.00
Ustekinumab 130 mg/26 ml intravenous solution $8,225.22 $8,225.22 $8,225.22 $55.80
Ustekinumab 45 mg/0.5 ml subcutaneous solution $109,781.59 $109,781.59 $109,781.59 $109,781.59
Vaccine covid-19 moderna 6mos-11yrs 25mcg/0.25ml $368.25 $368.25 $368.25 $368.25
Vaccine covid-19 moderna >=12yrs 50mcg/0.5ml $368.25 $368.25 $368.25 $340.00
Vaccine covid-19 pfizer tris-sucrose 5yrs-11yrs 10mcg/0.3ml im $222.00 $222.00 $222.00 $222.00
Vaccine covid-19 pfizer tris-sucrose 6mos-4yrs 3mcg/0.3ml im $165.00 $165.00 $165.00 $165.00
Vaccine covid-19 pfizer tris-sucrose >=12yrs 30mcg/0.3ml im $331.50 $331.50 $331.50 $331.50
Vaccine dtap < 7 years im $60.00 $60.00 $60.00 $60.00
Vaccine dtap-hep b-ipv im $233.91 $233.91 $233.91 $233.91
Vaccine dtap-ipv 4-6 years im $129.00 $129.00 $129.00 $129.00
Vaccine dtap-ipv/hib im $25.50 $25.50 $25.50 $25.50
Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im $111.00 $111.00 $111.00 $99.92
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im $45.33 $45.33 $45.33 $32.40
Vaccine hepatitis a (hepa) adult im $241.96 $241.96 $241.96 $108.00
Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im $354.74 $354.74 $354.74 $354.74
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im $135.00 $135.00 $135.00 $100.79
Vaccine hepatitis b (hepb) adolescent 2 dose im $54.75 $54.75 $54.75 $54.75
Vaccine hepatitis b (hepb) adult 3 dose im $162.07 $162.07 $162.07 $86.40
Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im $118.50 $118.50 $118.50 $126.60
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im $75.39 $75.39 $75.39 $75.39
Vaccine hpv types 6/11/16/18 quadrivalent (4vhpv) 3 dose im $599.25 $599.25 $599.25 $248.00
Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im $1,044.16 $1,044.16 $1,044.16 $1,044.16
Vaccine influenza (iiv) preservative free antigen content im $67.50 $67.50 $67.50 $67.50
Vaccine influenza inactivated adjuvant im $50.25 $50.25 $50.25 $50.25
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im $45.75 $45.75 $45.75 $45.75
Vaccine influenza quadrivalent (iiv4) preservative free 0.25ml dose im $25.50 $25.50 $25.50 $25.50
Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im $25.50 $25.50 $25.50 $14.40
Vaccine influenza quadrivalent (riv4) rdna antibiotic/preservative free im $50.25 $50.25 $50.25 $50.25
Vaccine influenza quadrivalent live (laiv4) intranasal $102.00 $102.00 $102.00 $102.00
Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im $89.25 $89.25 $89.25 $24.00
Vaccine mengingoccocal serogroup b 2 dose im $569.67 $569.67 $569.67 $111.60
Vaccine mengingoccocal serogroup b 2 or 3 dose im $747.00 $747.00 $747.00 $747.00
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im $545.45 $545.45 $545.45 $108.80
Vaccine mmr live subcutaneous $311.03 $311.03 $311.03 $64.80
Vaccine mmrv live subcutaneous $957.30 $957.30 $957.30 $957.30
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im $401.34 $401.34 $401.34 $75.00
Vaccine pneumococcal conjugate 13 valent (pcv13) im $793.01 $793.01 $793.01 $144.00
Vaccine pneumonococcal conjugate 15 valent (pcv15) im $239.25 $239.25 $239.25 $239.25
Vaccine pneumonococcal conjugate 20 valent (pcv20) im $913.50 $913.50 $913.50 $192.00
Vaccine polio (ipv) subcutaneous/im $1,529.59 $1,529.59 $1,529.59 $1,529.59
Vaccine rabies im $1,514.28 $1,514.28 $1,514.28 $800.00
Vaccine respiratory syncytial virus bivalent subunit/preservative free im $907.50 $907.50 $907.50 $672.00
Vaccine respiratory syncytial virus recombinant subunit adjuvanted/preservative free im $998.25 $998.25 $998.25 $998.25
Vaccine rotavirus attenuated (rv1) live 2 dose oral $504.00 $504.00 $504.00 $504.00
Vaccine rotavirus pentavalent (rv5) live 3 dose oral $344.25 $344.25 $344.25 $344.25
Vaccine td preservative free >= 7 years im $145.19 $145.19 $145.19 $74.40
Vaccine tdap >=7 years im $140.25 $140.25 $140.25 $42.40
Vaccine typhoid vicps im $333.00 $333.00 $333.00 $333.00
Vaccine varicella live subcutaneous $642.96 $642.96 $642.96 $642.96
Vaccine yellow fever live subcutaneous $714.00 $714.00 $714.00 $714.00
Vad battery clip set hmii 14-v li-ion $2,592.00 $2,592.00 $2,592.00 $2,592.00
Vad univ batt charger hm 1440 $16,971.75 $16,971.75 $16,971.75 $16,971.75
Vaginal bx $231.00 $231.00 $231.00 $201.17
Vaginal hysterectomy $5,766.00 $5,766.00 $5,766.00 $5,766.00
Valproate in ns IV syringe 10 mg/ml (pediatric) - cnr $22.29 $22.29 $22.29 $22.29
Valproic acid total therapeutic drug level $153.75 $153.75 $153.75 $153.75
Valrubicin injection $6,841.31 $6,841.31 $6,841.31 $6,841.31
Valvuloplasty aortic $6,749.25 $6,749.25 $6,749.25 $6,749.25
Valvuloplasty mitral $9,472.50 $9,472.50 $9,472.50 $9,472.50
Valvuloplasty pulmonary $14,701.50 $14,701.50 $14,701.50 $14,701.50
Vancomycin 1,000 mg intravenous injection $366.03 $366.03 $366.03 $366.03
Vancomycin 750 mg intravenous solution $303.13 $303.13 $303.13 $303.13
Vancomycin peak therapeutic drug level $147.00 $147.00 $147.00 $147.00
Varicella zoster antibody igg $99.75 $99.75 $99.75 $99.75
Varicella-zoster immue globin im $8,070.06 $8,070.06 $8,070.06 $8,070.06
Vasc emb/occ w/prs cath $21,009.00 $21,009.00 $21,009.00 $21,009.00
Vasectomy $2,361.00 $2,361.00 $2,361.00 $2,361.00
Vasopressin 20 unit/ml intravenous solution $103.53 $103.53 $103.53 $42.00
Vedolizumab 300 mg intravenous solution $34,608.27 $34,608.27 $34,608.27 $27,154.80
Veeg cont 2-12 hrs $2,361.75 $2,361.75 $2,361.75 $2,361.75
Veeg ea 12-26hr cont mntr $4,640.25 $4,640.25 $4,640.25 $4,640.25
Veeg intrmnt 2-12 hrs $1,329.00 $1,329.00 $1,329.00 $1,329.00
Veeg unmon 12-26 hrs $422.25 $422.25 $422.25 $422.25
Veeg unmon 2-12 hrs $422.25 $422.25 $422.25 $422.25
Vein x-ray adrenal gland $2,489.25 $2,489.25 $2,489.25 $2,489.25
Vein x-ray eye socket $2,040.00 $2,040.00 $2,040.00 $1,475.25
Vein x-ray kidney $2,750.25 $2,750.25 $2,750.25 $2,750.25
Vein x-ray liver $3,135.75 $3,135.75 $3,135.75 $3,135.75
Vein x-ray liver w/hemodynam $3,413.25 $3,413.25 $3,413.25 $3,413.25
Vein x-ray liver w/hemodynam $3,859.50 $3,859.50 $3,859.50 $3,298.20
Vein x-ray liver without hemodyn $2,489.25 $2,489.25 $2,489.25 $2,489.25
Vein x-ray skull $2,489.25 $2,489.25 $2,489.25 $2,489.25
Vein x-ray skull epidural $1,424.25 $1,424.25 $1,424.25 $1,424.25
Vein x-ray spleen/liver $3,682.50 $3,682.50 $3,682.50 $3,682.50
Velaglucerase alfa 400 unit intravenous solution $5,564.78 $5,564.78 $5,564.78 $5,564.78
Vemp test i&r cervical $867.00 $867.00 $867.00 $867.00
Vemp test i&r ocular $632.25 $632.25 $632.25 $632.25
Vemp tst i&r cervical&ocular $1,181.25 $1,181.25 $1,181.25 $1,181.25
Ven thrombosis images bilat $1,103.25 $1,103.25 $1,103.25 $1,103.25
Venipuncture >= 3 years diagnostic/therapeutic (not to be used for routine venipuncture) $144.00 $144.00 $144.00 $133.50
Venogram ext bil s&i $2,472.00 $2,472.00 $2,472.00 $2,472.00
Venogram extremity supervision & interpretation unilateral $1,653.75 $1,653.75 $1,653.75 $1,653.75
Venous m-thrombectomy add-on $6,159.75 $6,159.75 $6,159.75 $6,159.75
Venous mech thrombectomy $8,869.50 $8,869.50 $8,869.50 $8,869.50
Venous sampling s&i $4,294.50 $4,294.50 $4,294.50 $4,294.50
Ventilator each subsequent day $1,138.50 $1,138.50 $1,138.50 $1,138.50
Ventilator initial day $1,387.50 $1,387.50 $1,387.50 $1,387.50
Ventricular puncture prev burr hole without inj 61020 $832.50 $832.50 $832.50 $832.50
Version cephalic external $2,361.75 $2,361.75 $2,361.75 $2,361.75
Very long chain fatty acids $465.00 $465.00 $465.00 $465.00
Vest large holster $1,012.50 $1,012.50 $1,012.50 $1,012.50
Vinblastine 1 mg/ml intravenous solution $177.38 $177.38 $177.38 $177.38
Vincristine 1 mg/ml intravenous solution $111.30 $111.30 $111.30 $111.30
Vinorelbine 10 mg/ml intravenous solution (wrapper) $177.04 $177.04 $177.04 $177.04
Visual audiometry (vra) $202.50 $202.50 $202.50 $202.50
Vital capacity test $256.50 $256.50 $256.50 $216.00
Vitamin D Test $265.50 $265.50 $265.50 $147.00
Vitamin b-12 $111.00 $111.00 $111.00 $111.00
Voiding pressure study/intra-abd 51797 $810.00 $810.00 $810.00 $700.50
Vol reduction of blood/prod $131.25 $131.25 $131.25 $131.25
Volume measurement urine timed $43.50 $43.50 $43.50 $35.25
Voriconazole in ns IV syringe 5 mg/ml (pediatric) - cnr $221.85 $221.85 $221.85 $221.85
Warde 1003990 aldosterone $189.00 $189.00 $189.00 $205.80
Warde 1005020 citrate 24 hour urine $182.25 $182.25 $182.25 $182.25
Warde 1005055 5-hiaa 24 hour urine $176.25 $176.25 $176.25 $176.25
Warde 1006955 catecholamines fractionated 24 hour urine $127.50 $127.50 $127.50 $135.75
Warde 1007138 vanillymandelic acid 24 hour urine $133.50 $133.50 $133.50 $133.50
Warde 1015200 kappa light chain free $139.50 $139.50 $139.50 $133.20
Warde 3004000 immunoglobulin subclass 1 $157.50 $157.50 $157.50 $142.20
Warde 3008005 oligoclonal bands $94.50 $94.50 $94.50 $135.75
Warde 3016000 west nile virus antibody $174.75 $174.75 $174.75 $150.00
Warde 3016000 west nile virus antibody igg $173.25 $173.25 $173.25 $150.00
Warde 3016300 saccharomyces cerevisiae iga antibody $44.25 $44.25 $44.25 $44.25
Warde 3400652 ova & parasites direct smear concentration and id $36.00 $36.00 $36.00 $41.40
Warde 3400652 smear complex special stain ova/parasites $36.00 $36.00 $36.00 $88.80
Warde 3400683 amplification rna markers infectious disease bacterial vaginosis $400.50 $400.50 $400.50 $400.50
Warde 3400852 arsenic $232.50 $232.50 $232.50 $198.75
Warde 3708165 mercury urine $150.00 $150.00 $150.00 $135.00
Warde acetylcholine receptor blocking antibody $357.75 $357.75 $357.75 $357.75
Warde actin (smooth muscle) antibody each $135.00 $135.00 $135.00 $135.00
Warde adenosine deaminase pleural fluid $347.25 $347.25 $347.25 $142.20
Warde adrenocorticotropic hormone (acth) $141.75 $141.75 $141.75 $141.75
Warde aldolase $72.75 $72.75 $72.75 $72.75
Warde amino acids 6 or more quantitative each specimen $480.00 $480.00 $480.00 $480.00
Warde amiodarone therapeutic drug level $96.00 $96.00 $96.00 $129.60
Warde analysis gene hfe common variants $153.75 $153.75 $153.75 $153.75
Warde analysis translocation bcr/abl1 major breakpoint qualitative/quantitative $318.75 $318.75 $318.75 $332.25
Warde anti-mullerian hormone $198.75 $198.75 $198.75 $198.75
Warde antiepileptics nos definitive assay 1-3 clobazam w metabolites $128.25 $128.25 $128.25 $128.25
Warde apolipoprotein b $141.00 $141.00 $141.00 $139.20
Warde bile acids $124.50 $124.50 $124.50 $124.50
Warde cadmium blood $84.75 $84.75 $84.75 $90.75
Warde calcitonin $111.00 $111.00 $111.00 $133.20
Warde calculus (stone) infrared $92.25 $92.25 $92.25 $97.20
Warde clozapine therapeutic drug level $94.50 $94.50 $94.50 $94.50
Warde cobalt heavy metal quantitative each nes $248.25 $248.25 $248.25 $248.25
Warde collagen cross links c-telopeptide $207.00 $207.00 $207.00 $207.00
Warde complement total hemolytic $171.75 $171.75 $171.75 $171.75
Warde copper $243.00 $243.00 $243.00 $243.00
Warde cryoglobulin $164.25 $164.25 $164.25 $96.00
Warde erythropoietin $127.50 $127.50 $127.50 $127.50
Warde fluorescent antibody screen endomysial iga $222.75 $222.75 $222.75 $159.00
Warde folic acid rbc $52.50 $52.50 $52.50 $52.50
Warde g6pd (glucose 6 phosphate dehydrogenase) quantitative $252.75 $252.75 $252.75 $252.75
Warde gastrin $121.50 $121.50 $121.50 $121.50
Warde growth hormone (hgh) $110.25 $110.25 $110.25 $110.25
Warde haloperidol therapeutic drug level $81.00 $81.00 $81.00 $81.00
Warde helminth antibody strongyloides igg $205.50 $205.50 $205.50 $171.75
Warde hemoglobin fractionation/quantitation electrophoresis $506.25 $506.25 $506.25 $133.80
Warde hepatitis a antibody $87.00 $87.00 $87.00 $87.00
Warde hepatitis be antibody $77.25 $77.25 $77.25 $78.75
Warde hepatitis delta agent antibody $198.00 $198.00 $198.00 $177.00
Warde immunofixation electrophoresis urine $349.50 $349.50 $349.50 $345.00
Warde infectious agent antigen immunoassay ql/sq multi step hepatitis be agn $70.50 $70.50 $70.50 $72.00
Warde infectious agent nucleic acid genotype hepatitis c $1,140.00 $1,140.00 $1,140.00 $1,425.00
Warde islet cell antibody zinc transporter 8 $615.75 $615.75 $615.75 $250.20
Warde lipoprotein (a) $168.00 $168.00 $168.00 $112.80
Warde mitochondrial antibody each $123.00 $123.00 $123.00 $123.00
Warde neutralization rabies $183.00 $183.00 $183.00 $169.50
Warde oxcarbazepine therapeutic drug level $60.00 $60.00 $60.00 $69.75
Warde pancreatic elastase fecal quantitative $144.75 $144.75 $144.75 $144.75
Warde protein c antigen $141.75 $141.75 $141.75 $141.75
Warde sex hormone binding globulin $141.00 $141.00 $141.00 $141.00
Warde somatomedin $93.75 $93.75 $93.75 $112.80
Warde sugars single qualitative each specimen stool $54.75 $54.75 $54.75 $54.75
Warde t3 (triiodothyronine) reverse $77.25 $77.25 $77.25 $85.50
Warde thyroid stimulating immunoglobulins $403.50 $403.50 $403.50 $403.50
Warde topiramate therapeutic drug level $384.75 $384.75 $384.75 $201.60
Warde virus isolation tissue culture innoculation presumptive id herpes simplex $113.25 $113.25 $113.25 $129.60
Warde viscosity $153.00 $153.00 $153.00 $153.00
Warde vitamin a $90.00 $90.00 $90.00 $90.00
Warde vitamin b-1 (thiamine) $109.50 $109.50 $109.50 $109.50
Warde vitamin b6 (pyridoxine) $114.00 $114.00 $114.00 $145.50
Warde vitamin c (ascorbic acid) $36.75 $36.75 $36.75 $40.20
Warde vitamin d (1 25 dihydroxy) $193.50 $193.50 $193.50 $195.00
Warde vitamin e (alpha-tocopherol) $52.50 $52.50 $52.50 $63.75
Warde zinc $90.00 $90.00 $90.00 $90.00
Wbc automated $63.00 $63.00 $63.00 $42.80
Western blot test $603.00 $603.00 $603.00 $219.20
Wnd prep f/n/hf/g addl cm $1,496.25 $1,496.25 $1,496.25 $1,496.25
Wound therapy negative pressure per session <= 50 sq cm $729.00 $729.00 $729.00 $471.75
Wound therapy negative pressure per session <= 50 sq cm dme $318.75 $318.75 $318.75 $230.40
Wound therapy negative pressure per session > 50 sq cm $822.75 $822.75 $822.75 $509.25
Wound therapy negative pressure per session > 50 sq cm dme $414.75 $414.75 $414.75 $399.53
Wrist X-ray $461.25 $461.25 $461.25 $313.60
X-ray abdomen 1 view $284.25 $284.25 $284.25 $284.25
X-ray abdomen 2 views $489.00 $489.00 $489.00 $395.20
X-ray abdomen >=3 views $502.50 $502.50 $502.50 $405.00
X-ray abdomen complete acute series including spine erect and/or decubitus single view chest $471.75 $471.75 $471.75 $471.75
X-ray acromioclavicular joints without or w/weighted distraction bilateral $525.75 $525.75 $525.75 $405.00
X-ray ankle 2 views (both sides) $361.50 $361.50 $361.50 $361.50
X-ray arthrogram shoulder supervision & interpretation (both sides) $1,134.00 $1,134.00 $1,134.00 $895.50
X-ray bone age studies $367.50 $367.50 $367.50 $350.40
X-ray bone length studies $287.25 $287.25 $287.25 $302.40
X-ray bone survey complete $963.75 $963.75 $963.75 $765.60
X-ray bone survey infant $403.50 $403.50 $403.50 $322.20
X-ray cervical spine 2-3 views $432.75 $432.75 $432.75 $419.40
X-ray cervical spine 4-5 views $663.75 $663.75 $663.75 $590.25
X-ray cervical spine >= 6 views $781.50 $781.50 $781.50 $679.20
X-ray clavicle complete (both sides) $364.50 $364.50 $364.50 $312.00
X-ray colon abdominal radiograph(s) & delayed images single contrast study $814.50 $814.50 $814.50 $779.40
X-ray colon abdominal radiograph(s) & delayed images with glucagon double contrast study $966.00 $966.00 $966.00 $966.00
X-ray elbow 2 views (both sides) $379.50 $379.50 $379.50 $379.50
X-ray elbow >= 3 views (both sides) $462.00 $462.00 $462.00 $405.00
X-ray esophogram chest radiograph(s) & delayed images single contrast study $792.75 $792.75 $792.75 $713.40
X-ray exam entire spi 4/5 vw $381.75 $381.75 $381.75 $381.75
X-ray exam entire spi 6/> vw $341.25 $341.25 $341.25 $341.25
X-ray exam of arm infant $299.25 $299.25 $299.25 $299.25
X-ray exam of eye sockets $674.25 $674.25 $674.25 $419.40
X-ray exam of femur 1 $295.50 $295.50 $295.50 $295.50
X-ray exam of jaw joint $429.00 $429.00 $429.00 $405.00
X-ray exam of mastoids $374.25 $374.25 $374.25 $374.25
X-ray exam of perineum $284.25 $284.25 $284.25 $284.25
X-ray exam of sinuses $444.75 $444.75 $444.75 $385.60
X-ray exam thorac spine4/>vw $616.50 $616.50 $616.50 $480.00
X-ray facial bones complete > 3 views $663.00 $663.00 $663.00 $456.60
X-ray fallopian tube $940.50 $940.50 $940.50 $940.50
X-ray femur >=2 views (both sides) $300.75 $300.75 $300.75 $300.75
X-ray finger(s) >= 2 views (both sides) $387.00 $387.00 $387.00 $310.50
X-ray foot 2 views (both sides) $333.00 $333.00 $333.00 $333.00
X-ray forearm 2 views (both sides) $394.50 $394.50 $394.50 $394.50
X-ray hand 2 views (both sides) $426.75 $426.75 $426.75 $419.40
X-ray heel/calcaneus > 2 views (both sides) $385.50 $385.50 $385.50 $354.40
X-ray hip uni w/wo pelvis min 4 views $531.00 $531.00 $531.00 $419.40
X-ray hip with pelvis when performed bilateral 2 views $342.75 $342.75 $342.75 $374.40
X-ray hip with pelvis when performed bilateral 3-4 views $475.50 $475.50 $475.50 $449.25
X-ray hip with pelvis when performed bilateral >= 5 views $683.25 $683.25 $683.25 $564.75
X-ray hip with pelvis when performed unilateral 1 view left $265.50 $265.50 $265.50 $270.00
X-ray humerus >= 2 views left $363.75 $363.75 $363.75 $363.75
X-ray joint survey 1 view $393.75 $393.75 $393.75 $345.00
X-ray knee 1-2 views (both sides) $283.50 $283.50 $283.50 $283.50
X-ray knee 3 views (both sides) $420.75 $420.75 $420.75 $399.00
X-ray knee ap standing bilateral $388.50 $388.50 $388.50 $287.20
X-ray l/s-spine bend vw only 2-3 vw $408.00 $408.00 $408.00 $408.00
X-ray lower extremities infant > 2 views (both sides) $375.75 $375.75 $375.75 $375.75
X-ray lumbosacral spine >= 4 views $548.25 $548.25 $548.25 $548.25
X-ray lumbosacral spine complete including bending views >= 6 views $702.75 $702.75 $702.75 $682.20
X-ray mandible complete > 4 views $421.50 $421.50 $421.50 $419.40
X-ray mandible ltd <4 views $319.50 $319.50 $319.50 $319.50
X-ray nasal bones complete > 3 views $367.50 $367.50 $367.50 $367.50
X-ray neck soft tissue $350.25 $350.25 $350.25 $344.80
X-ray nose to rectum for foreign body child $367.50 $367.50 $367.50 $319.50
X-ray of mammary ducts $634.50 $634.50 $634.50 $634.50
X-ray optic foramina $426.75 $426.75 $426.75 $353.25
X-ray pelvis 1-2 views $300.00 $300.00 $300.00 $300.00
X-ray pelvis complete > 3 views $355.50 $355.50 $355.50 $355.50
X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation $810.75 $810.75 $810.75 $810.75
X-ray ribs 2 views left $448.50 $448.50 $448.50 $368.80
X-ray ribs 3 views bilateral $492.75 $492.75 $492.75 $464.40
X-ray ribs w/posterior anterior chest 3 views left $471.75 $471.75 $471.75 $419.40
X-ray ribs w/posterior anterior chest > 4 views bilateral $524.25 $524.25 $524.25 $524.25
X-ray sacroiliac joints >= 3 views $542.25 $542.25 $542.25 $419.40
X-ray sacrum/coccyx >= 2 views $297.00 $297.00 $297.00 $297.00
X-ray scapula complete (both sides) $255.00 $255.00 $255.00 $262.80
X-ray shoulder 1 view (both sides) $244.50 $244.50 $244.50 $244.50
X-ray sinus tract/fistula/abscess $944.25 $944.25 $944.25 $944.25
X-ray sinuses paranasal complete > 3 views $629.25 $629.25 $629.25 $448.80
X-ray skull < 4 views $377.25 $377.25 $377.25 $377.25
X-ray skull > 4 views complete $749.25 $749.25 $749.25 $640.50
X-ray slg plne bdy sect without urogr $1,032.75 $1,032.75 $1,032.75 $1,032.75
X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study $709.50 $709.50 $709.50 $669.60
X-ray small intestine follow-through study $422.25 $422.25 $422.25 $422.25
X-ray spine single view $360.00 $360.00 $360.00 $327.00
X-ray sternoclavicular joint(s) > 3 views $527.25 $527.25 $527.25 $405.00
X-ray sternum > 2 views $521.25 $521.25 $521.25 $398.25
X-ray surgical specimen $432.75 $432.75 $432.75 $432.75
X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study $719.25 $719.25 $719.25 $719.25
X-ray temporomandibular joint open/closed mouth bilateral $636.00 $636.00 $636.00 $546.00
X-ray thoracic spine 2 views $388.50 $388.50 $388.50 $388.50
X-ray thoracic spine 3 views $606.00 $606.00 $606.00 $468.00
X-ray thoracolumbar spine >=2 views $408.00 $408.00 $408.00 $396.00
X-ray thoracolumbar spine including skull cervical & sacral spine 1 view $367.50 $367.50 $367.50 $367.50
X-ray thoracolumbar spine including skull cervical & sacral spine 2-3 views $378.00 $378.00 $378.00 $378.00
X-ray tibia/fibula 2 views (both sides) $372.75 $372.75 $372.75 $372.75
X-ray toe(s) > 2 views (both sides) $375.75 $375.75 $375.75 $364.80
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images double contrast $813.00 $813.00 $813.00 $690.00
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images single contrast study $709.50 $709.50 $709.50 $580.20
X-ray wrist 2 views (both sides) $355.50 $355.50 $355.50 $355.50
Xm archive tissue molec anal $51.75 $51.75 $51.75 $51.75
Ziconotide injection $4,530.00 $4,530.00 $4,530.00 $4,530.00
Zidovudine in d5w IV syringe 4 mg/ml (neo/peds) - cnr $100.06 $100.06 $100.06 $100.06
Zika virus dna/rna amp probe $219.00 $219.00 $219.00 $219.00
Zika virus igm antibody $128.25 $128.25 $128.25 $128.25
Ziprasidone 20 mg/ml (final concentration) intramuscular solution $32.46 $32.46 $32.46 $146.40
Zoledronic acid 4 mg/5 ml intravenous solution $146.06 $146.06 $146.06 $146.06
Zoster vaccine-live inj $436.50 $436.50 $436.50 $436.50
_afb id by dna probe rflx ast $150.00 $150.00 $150.00 $150.00
_propoxygc/msur $240.00 $240.00 $240.00 $240.00