|
#_benzodiazconfur
|
$180.00 |
$180.00 |
$180.00 |
$161.25
|
|
#_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 |
$133.20
|
|
#acylcarnitineprfl
|
$110.25 |
$110.25 |
$110.25 |
$169.20
|
|
#cbg+cort-cbg
|
$156.75 |
$156.75 |
$156.75 |
$156.75
|
|
#celiac hla-dq8
|
$175.50 |
$175.50 |
$175.50 |
$1,607.40
|
|
#cf-97variants
|
$1,191.75 |
$1,191.75 |
$1,191.75 |
$3,108.00
|
|
#cms hgb-sulfhemoglobin
|
$132.75 |
$132.75 |
$132.75 |
$132.75
|
|
#cmvcul-virus inoculation shell
|
$72.75 |
$72.75 |
$72.75 |
$55.20
|
|
#covid19rsv-rsv
|
$75.75 |
$75.75 |
$75.75 |
$75.75
|
|
#coxa-coxsackie a serotype a16
|
$171.75 |
$171.75 |
$171.75 |
$110.40
|
|
#creutz-prot.,western blot
|
$939.00 |
$939.00 |
$939.00 |
$176.80
|
|
#fecal-sodium
|
$97.50 |
$97.50 |
$97.50 |
$86.25
|
|
#mec-opiates
|
$27.75 |
$27.75 |
$27.75 |
$27.75
|
|
#pnh-flow cytometry interp
|
$181.50 |
$181.50 |
$181.50 |
$281.40
|
|
(both sides) smear without diff wbc count
|
$127.50 |
$127.50 |
$127.50 |
$121.80
|
|
11-desoxycortisol - sendout
|
$141.00 |
$141.00 |
$141.00 |
$148.20
|
|
17-hydroxypregnenolone
|
$125.25 |
$125.25 |
$125.25 |
$168.60
|
|
24 hr ambulatory b/p monitor
|
$359.25 |
$359.25 |
$359.25 |
$162.60
|
|
2d tee w or without fol w/con,in
|
$2,282.25 |
$2,282.25 |
$2,282.25 |
$1,641.60
|
|
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 |
$5,583.60
|
|
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 |
$697.20
|
|
5' nucleotidase - sendout
|
$252.75 |
$252.75 |
$252.75 |
$243.00
|
|
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 |
$134.40
|
|
99382 initial comp preventive med 1 to 4 years new
|
$135.00 |
$135.00 |
$135.00 |
$117.00
|
|
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 |
$102.75
|
|
99392 periodic comp preventive med 1 to 4 years est
|
$135.00 |
$135.00 |
$135.00 |
$100.50
|
|
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 |
$121.50
|
|
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 |
$213.00
|
|
Abd aorta w/runoff s&i
|
$5,568.75 |
$5,568.75 |
$5,568.75 |
$4,245.00
|
|
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 |
$4,321.20
|
|
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 |
$1,045.50
|
|
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 |
$2,077.14
|
|
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 |
$755.00
|
|
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 |
$1,689.00
|
|
Abl1 gene
|
$430.50 |
$430.50 |
$430.50 |
$1,282.20
|
|
Ablate arrhythmia add on
|
$10,523.25 |
$10,523.25 |
$10,523.25 |
$6,913.20
|
|
Ablate bone tumor(s) cryo perq 20983
|
$4,898.25 |
$4,898.25 |
$4,898.25 |
$5,246.25
|
|
Ablate bone tumor(s) perq
|
$3,543.75 |
$3,543.75 |
$3,543.75 |
$5,092.50
|
|
Ablate heart dysrhythm focus
|
$12,842.25 |
$12,842.25 |
$12,842.25 |
$7,588.10
|
|
Ablate inf turbinate superf 30801
|
$2,706.00 |
$2,706.00 |
$2,706.00 |
$1,849.50
|
|
Ablate pulm tumor perq crybl
|
$10,443.00 |
$10,443.00 |
$10,443.00 |
$10,411.22
|
|
Ablation cardiac vagal inputs atrium
|
$8,025.00 |
$8,025.00 |
$8,025.00 |
$377.40
|
|
Ablation cryo abd perit om
|
$8,358.00 |
$8,358.00 |
$8,358.00 |
$6,311.40
|
|
Ablation cryo adrenal tumor
|
$6,948.75 |
$6,948.75 |
$6,948.75 |
$5,790.75
|
|
Ablation cryo pq chest wall tumor(s) w/guid
|
$280.50 |
$280.50 |
$280.50 |
$234.00
|
|
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 |
$437.18
|
|
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 |
$2,242.80
|
|
Abobotulinumtoxina
|
$3,255.66 |
$3,255.66 |
$3,255.66 |
$61.20
|
|
Abscess drain retroperitoneal surg code
|
$3,121.50 |
$3,121.50 |
$3,121.50 |
$5,568.60
|
|
Access & clsr pq fem art endogft dlvry w/img uni
|
$7,299.75 |
$7,299.75 |
$7,299.75 |
$5,737.80
|
|
Acetaminophen 10 mg/ml soln 100 ml glass cont
|
$147.54 |
$147.54 |
$147.54 |
$47.40
|
|
Acetaminophen level
|
$246.75 |
$246.75 |
$246.75 |
$159.60
|
|
Acetazolamide 500 mg solution for injection
|
$137.07 |
$137.07 |
$137.07 |
$256.80
|
|
Acetylcholine receptor modulating antibody
|
$489.00 |
$489.00 |
$489.00 |
$300.00
|
|
Acetylcysteine 200 mg/ml (20 %) intravenous solution
|
$406.77 |
$406.77 |
$406.77 |
$648.00
|
|
Acetylcysteine non-comp unit
|
$87.97 |
$87.97 |
$87.97 |
$87.97
|
|
Acne surgery 10040
|
$295.50 |
$295.50 |
$295.50 |
$265.20
|
|
Aco annual medicare visit (awv), initial g0438aco
|
$243.00 |
$243.00 |
$243.00 |
$225.00
|
|
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 |
$30.00
|
|
Acoustic immitance testing
|
$141.75 |
$141.75 |
$141.75 |
$141.75
|
|
Acoustic refl threshold tst
|
$120.75 |
$120.75 |
$120.75 |
$39.25
|
|
Actinotherapy uv light
|
$138.75 |
$138.75 |
$138.75 |
$138.75
|
|
Acup 1/> w/estim 1st 15 min
|
$45.75 |
$45.75 |
$45.75 |
$42.75
|
|
Acup 1/> wo estim 1st 15 min
|
$45.75 |
$45.75 |
$45.75 |
$42.75
|
|
Acute hepatitis panel
|
$480.00 |
$480.00 |
$480.00 |
$490.20
|
|
Acute venous thrombus image
|
$873.75 |
$873.75 |
$873.75 |
$632.25
|
|
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 |
$3,454.80
|
|
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 |
$84.60
|
|
Adh-sendout
|
$663.75 |
$663.75 |
$663.75 |
$360.00
|
|
Adj gastric band via subq port
|
$4,266.00 |
$4,266.00 |
$4,266.00 |
$2,977.20
|
|
Admelog u-100 insulin lispro 100 unit/ml subcutaneous solution
|
$5,046.43 |
$5,046.43 |
$5,046.43 |
$450.00
|
|
Administration chemotherapy IV infusion each additional hour
|
$472.50 |
$472.50 |
$472.50 |
$269.60
|
|
Administration chemotherapy IV infusion each addl sequential infusion diff substance/drug >1 hr
|
$971.25 |
$971.25 |
$971.25 |
$322.20
|
|
Administration chemotherapy IV infusion up to 1 hour single/initial substance/drug
|
$857.25 |
$857.25 |
$857.25 |
$771.00
|
|
Administration chemotherapy IV push single/initial substance/drug
|
$736.50 |
$736.50 |
$736.50 |
$508.20
|
|
Administration chemotherapy subcutaneous/im anti neoplastic hormonal
|
$629.25 |
$629.25 |
$629.25 |
$254.40
|
|
Administration chemotherapy subcutaneous/im anti neoplastic non hormonal
|
$645.75 |
$645.75 |
$645.75 |
$254.40
|
|
Administration immunization 1 vaccine
|
$33.75 |
$33.75 |
$33.75 |
$12.60
|
|
Administration immunization each additional component
|
$63.00 |
$63.00 |
$63.00 |
$48.60
|
|
Administration immunization each additional vaccine
|
$33.75 |
$33.75 |
$33.75 |
$12.00
|
|
Administration immunization first component each vaccine
|
$63.00 |
$63.00 |
$63.00 |
$115.20
|
|
Administration immunization intranasal/oral route 1 vaccine
|
$56.25 |
$56.25 |
$56.25 |
$40.50
|
|
Administration immunization intranasal/oral route each additional vaccine
|
$43.50 |
$43.50 |
$43.50 |
$39.00
|
|
Administration vaccine hepatitis b
|
$38.25 |
$38.25 |
$38.25 |
$12.60
|
|
Administration vaccine influenza virus
|
$38.25 |
$38.25 |
$38.25 |
$12.00
|
|
Administration vaccine pneumococcal
|
$38.25 |
$38.25 |
$38.25 |
$12.00
|
|
Ado-trastuzumab emtansine 100 mg intravenous solution
|
$23,602.63 |
$23,602.63 |
$23,602.63 |
$106.80
|
|
Aep hearing status deter i&r
|
$568.50 |
$568.50 |
$568.50 |
$336.60
|
|
Aep neurodiagnostic i&r
|
$1,471.50 |
$1,471.50 |
$1,471.50 |
$519.60
|
|
Aep thrshld est mlt freq i&r
|
$1,308.00 |
$1,308.00 |
$1,308.00 |
$867.00
|
|
After cataract laser surgery
|
$1,499.25 |
$1,499.25 |
$1,499.25 |
$1,380.00
|
|
Agalsidase beta 35 mg intravenous solution
|
$28,942.08 |
$28,942.08 |
$28,942.08 |
$27,295.80
|
|
Air conduction bilat
|
$106.50 |
$106.50 |
$106.50 |
$106.50
|
|
Airway resistance by impulse oscillometry 94728
|
$425.25 |
$425.25 |
$425.25 |
$393.00
|
|
Albumin (human), 25%, 50ml
|
$295.80 |
$295.80 |
$295.80 |
$304.00
|
|
Albumin (human), 5%, 250 ml
|
$295.80 |
$295.80 |
$295.80 |
$609.00
|
|
Albumin (microalbumin) 24 hour urine quantitative
|
$85.50 |
$85.50 |
$85.50 |
$63.75
|
|
Albumin body fluid quantitative each specimen
|
$43.50 |
$43.50 |
$43.50 |
$37.20
|
|
Albumin serum plasma or whole blood
|
$43.50 |
$43.50 |
$43.50 |
$43.50
|
|
Albuterol ipratrop non-comp
|
$2.43 |
$2.43 |
$2.43 |
$13.80
|
|
Albuterol non-comp con
|
$44.56 |
$44.56 |
$44.56 |
$5.00
|
|
Albuterol non-comp unit
|
$2.43 |
$2.43 |
$2.43 |
$7.20
|
|
Alcohol (ethanol) any specimen except urine/breath
|
$60.75 |
$60.75 |
$60.75 |
$56.25
|
|
Alemtuzumab 12 mg/1.2 ml intravenous solution
|
$112,036.08 |
$112,036.08 |
$112,036.08 |
$8,173.80
|
|
Alkaline phosphatase
|
$51.75 |
$51.75 |
$51.75 |
$45.75
|
|
All tstg perq&iq drugs/biol
|
$70.50 |
$70.50 |
$70.50 |
$70.50
|
|
Allergen alpha lactalbumin ige
|
$110.25 |
$110.25 |
$110.25 |
$57.60
|
|
Allergen egg white ige
|
$81.00 |
$81.00 |
$81.00 |
$57.60
|
|
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 |
$46.14
|
|
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 |
$2,929.80
|
|
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 |
$4,885.20
|
|
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 |
$138.60
|
|
Alpha-fetoprotein tumor marker
|
$168.75 |
$168.75 |
$168.75 |
$139.20
|
|
Alprostadil for injection
|
$800.48 |
$800.48 |
$800.48 |
$550.20
|
|
Alt/sgpt
|
$63.75 |
$63.75 |
$63.75 |
$77.25
|
|
Alteplase 100 mg infusion from pyxis vial
|
$31,563.16 |
$31,563.16 |
$31,563.16 |
$9,848.40
|
|
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 |
$1,074.00
|
|
Amantadine (symmetrel)-sendout
|
$240.00 |
$240.00 |
$240.00 |
$240.00
|
|
Ambl bp mntr w/sw a/r
|
$368.25 |
$368.25 |
$368.25 |
$199.50
|
|
Amikacin 4 mg/ml intravitreal injection - cnr
|
$79.87 |
$79.87 |
$79.87 |
$27.00
|
|
Amino acids quant 2-5
|
$239.25 |
$239.25 |
$239.25 |
$220.80
|
|
Aminocaproic acid 5 g/250 ml 0.9% nacl IV - cnr
|
$35.21 |
$35.21 |
$35.21 |
$9.15
|
|
Aminolevulinic acid delta
|
$570.00 |
$570.00 |
$570.00 |
$178.80
|
|
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 |
$96.80
|
|
Amitriptyline (elavil) -sendout
|
$260.25 |
$260.25 |
$260.25 |
$234.75
|
|
Amivantamab-vmjw 50 mg/ml intravenous solution
|
$14,075.19 |
$14,075.19 |
$14,075.19 |
$298.20
|
|
Ammonia
|
$151.50 |
$151.50 |
$151.50 |
$126.00
|
|
Amniocentesis therapeutic
|
$850.50 |
$850.50 |
$850.50 |
$747.75
|
|
Amniocentesisdiagnostic 59000
|
$1,104.00 |
$1,104.00 |
$1,104.00 |
$870.74
|
|
Amphetamine confirm urine -sendout
|
$94.50 |
$94.50 |
$94.50 |
$79.50
|
|
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 |
$146.40
|
|
Amphotericin b lipid complex
|
$360.00 |
$360.00 |
$360.00 |
$272.40
|
|
Amphotericin b liposomal in d5w IV syringe 1 mg/ml (neo/ped) - cnr
|
$434.39 |
$434.39 |
$434.39 |
$592.80
|
|
Ampicillin 1 gram solution for injection
|
$114.78 |
$114.78 |
$114.78 |
$110.40
|
|
Ampicillin-sulbactam 1.5 gram solution for injection
|
$18.87 |
$18.87 |
$18.87 |
$61.20
|
|
Amylase
|
$168.00 |
$168.00 |
$168.00 |
$113.40
|
|
An cholangiogram percutaneous compl
|
$2,959.50 |
$2,959.50 |
$2,959.50 |
$3,342.00
|
|
An fluoro guide for cvp
|
$888.75 |
$888.75 |
$888.75 |
$789.75
|
|
Anal/urinary muscle study
|
$940.50 |
$940.50 |
$940.50 |
$981.00
|
|
Anal/urinary muscle study
|
$730.50 |
$730.50 |
$730.50 |
$580.20
|
|
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 |
$2,361.60
|
|
Analysis gene f5 leiden variant
|
$577.50 |
$577.50 |
$577.50 |
$1,021.80
|
|
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 |
$670.80
|
|
Anaplsma phgcytophlm amp prb
|
$105.00 |
$105.00 |
$105.00 |
$290.40
|
|
Anca screen with reflex to titer -quest
|
$280.50 |
$280.50 |
$280.50 |
$103.20
|
|
Angio balloon ctrl dialysis seg add-on
|
$2,028.00 |
$2,028.00 |
$2,028.00 |
$7,522.20
|
|
Angio trnslmnl balloon same artery ea addl
|
$2,886.75 |
$2,886.75 |
$2,886.75 |
$4,126.80
|
|
Angio trnslmnl balloon same artery ini
|
$7,883.25 |
$7,883.25 |
$7,883.25 |
$7,740.60
|
|
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 |
$22,037.40
|
|
Anidulafungin injection
|
$116.22 |
$116.22 |
$116.22 |
$116.22
|
|
Ankle X-ray
|
$396.75 |
$396.75 |
$396.75 |
$311.92
|
|
Anl sp inf pmp w/mdreprg&fil
|
$693.75 |
$693.75 |
$693.75 |
$639.00
|
|
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 |
$229.20
|
|
Anodyne therapy charges pt
|
$92.25 |
$92.25 |
$92.25 |
$49.50
|
|
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 |
$1,982.25
|
|
Anoscopy remove fb 46608
|
$2,797.50 |
$2,797.50 |
$2,797.50 |
$1,950.00
|
|
Anoscopy remove lesion 46610
|
$3,723.75 |
$3,723.75 |
$3,723.75 |
$2,770.50
|
|
Ans parasymp & symp w/tilt
|
$1,380.75 |
$1,380.75 |
$1,380.75 |
$312.00
|
|
Anti mog serum - sendout
|
$355.50 |
$355.50 |
$355.50 |
$159.00
|
|
Anti-inhibitor
|
$18,764.82 |
$18,764.82 |
$18,764.82 |
$8.70
|
|
Anti-thymocyte glob (equine)(1:1000) intradermal test dose
|
$17,349.88 |
$17,349.88 |
$17,349.88 |
$5,013.11
|
|
Antibody bacterium, not elsewhere specified
|
$164.25 |
$164.25 |
$164.25 |
$76.80
|
|
Antibody elution rbc reference
|
$175.50 |
$175.50 |
$175.50 |
$147.75
|
|
Antibody htlv-i
|
$210.75 |
$210.75 |
$210.75 |
$85.20
|
|
Antibody htlv-ii
|
$210.75 |
$210.75 |
$210.75 |
$195.00
|
|
Antibody htlv/hiv confirm test
|
$325.50 |
$325.50 |
$325.50 |
$246.60
|
|
Antibody id rbc panel
|
$291.75 |
$291.75 |
$291.75 |
$235.80
|
|
Antibody identification platelet antibodies heparin-pf4 igg
|
$1,320.00 |
$1,320.00 |
$1,320.00 |
$621.00
|
|
Antibody lymphocytic choriomeningitis
|
$222.00 |
$222.00 |
$222.00 |
$111.20
|
|
Antibody screen rbc
|
$136.50 |
$136.50 |
$136.50 |
$102.75
|
|
Antidepressant not specified
|
$276.75 |
$276.75 |
$276.75 |
$276.75
|
|
Antigen therapy services
|
$60.75 |
$60.75 |
$60.75 |
$46.14
|
|
Antihemophilic factor-vwf 250 unit-600 unit intravenous solution
|
$5,102.55 |
$5,102.55 |
$5,102.55 |
$11.40
|
|
Antineutrophil cytoplasmic antibody screen each antibody
|
$147.75 |
$147.75 |
$147.75 |
$117.00
|
|
Antinuclear antibodies
|
$98.25 |
$98.25 |
$98.25 |
$97.50
|
|
Antinuclear antibodies titer
|
$80.25 |
$80.25 |
$80.25 |
$91.20
|
|
Antiphosphatidylserine antibody
|
$90.00 |
$90.00 |
$90.00 |
$204.00
|
|
Antistreptolysin o titer
|
$83.25 |
$83.25 |
$83.25 |
$83.40
|
|
Antithrombin iii activity
|
$216.00 |
$216.00 |
$216.00 |
$157.80
|
|
Antithrombin iii injection
|
$6,858.87 |
$6,858.87 |
$6,858.87 |
$70.20
|
|
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 |
$4,685.17
|
|
Apl(pml-rara) quant - sendout
|
$1,187.25 |
$1,187.25 |
$1,187.25 |
$765.00
|
|
App high cost ss f/n/g/h/f <100sq cm addl <25sq cm
|
$552.00 |
$552.00 |
$552.00 |
$433.20
|
|
App high cost ss f/n/g/h/f >100sq cm 1st 100sq cm
|
$2,589.00 |
$2,589.00 |
$2,589.00 |
$1,990.50
|
|
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 |
$384.00
|
|
App high cost ss t/a/l >100sq cm 1st 100sq cm
|
$2,978.25 |
$2,978.25 |
$2,978.25 |
$3,154.80
|
|
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 |
$1,600.41
|
|
Appl modality 1/> areas paraffin bath 97018
|
$102.00 |
$102.00 |
$102.00 |
$80.40
|
|
Appl modality 1/> areas vasopneumatic devices 97016
|
$123.75 |
$123.75 |
$123.75 |
$92.25
|
|
Appl multlay comprs arm/hand
|
$409.50 |
$409.50 |
$409.50 |
$378.75
|
|
Appl patllr tdn bearing cast
|
$429.00 |
$429.00 |
$429.00 |
$396.75
|
|
Application clubfoot cast
|
$254.25 |
$254.25 |
$254.25 |
$157.79
|
|
Application finger splntstatic 29130
|
$208.50 |
$208.50 |
$208.50 |
$192.75
|
|
Application long leg splint 29505
|
$338.25 |
$338.25 |
$338.25 |
$569.60
|
|
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 |
$370.80
|
|
Application of long arm cast 29065
|
$321.00 |
$321.00 |
$321.00 |
$440.40
|
|
Application of long leg cast
|
$480.75 |
$480.75 |
$480.75 |
$444.00
|
|
Application of long leg cast 29345
|
$390.75 |
$390.75 |
$390.75 |
$388.50
|
|
Application of paste boot 29580
|
$390.75 |
$390.75 |
$390.75 |
$366.60
|
|
Application short leg cast 29405
|
$265.50 |
$265.50 |
$265.50 |
$359.25
|
|
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 |
$366.60
|
|
Apply hand/wrist cast 29085
|
$249.00 |
$249.00 |
$249.00 |
$520.80
|
|
Apply rem fixation device
|
$5,230.50 |
$5,230.50 |
$5,230.50 |
$1,600.41
|
|
Apply rigid leg cast 29445
|
$555.00 |
$555.00 |
$555.00 |
$631.20
|
|
Apply short leg castambul type 29425
|
$333.00 |
$333.00 |
$333.00 |
$323.25
|
|
Aqaprn-4 antb flo cytmtry ea
|
$564.75 |
$564.75 |
$564.75 |
$281.40
|
|
Aqua therapy w/exercise/ea 15 min 97113
|
$140.25 |
$140.25 |
$140.25 |
$129.75
|
|
Aquatic exercise - group charge
|
$111.00 |
$111.00 |
$111.00 |
$95.40
|
|
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 |
$579.60
|
|
Arsenic trioxide 2 mg/ml intravenous solution
|
$4,375.05 |
$4,375.05 |
$4,375.05 |
$292.80
|
|
Arterial blood draw/perc 36620
|
$978.00 |
$978.00 |
$978.00 |
$622.20
|
|
Artery x-rays adrenal gland
|
$4,035.00 |
$4,035.00 |
$4,035.00 |
$3,147.50
|
|
Artery x-rays adrenals
|
$5,043.00 |
$5,043.00 |
$5,043.00 |
$3,147.50
|
|
Artery x-rays arm/leg 75710-26
|
$3,650.25 |
$3,650.25 |
$3,650.25 |
$3,147.50
|
|
Artery x-rays arms/legs 75716-26
|
$4,206.00 |
$4,206.00 |
$4,206.00 |
$3,147.50
|
|
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 |
$2,919.00
|
|
Artery x-rays lung
|
$4,931.25 |
$4,931.25 |
$4,931.25 |
$3,147.50
|
|
Artery x-rays lungs
|
$5,836.50 |
$5,836.50 |
$5,836.50 |
$3,831.60
|
|
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 |
$2,463.60
|
|
Artery xray of abdomen 75726-26
|
$4,294.50 |
$4,294.50 |
$4,294.50 |
$4,130.40
|
|
Artery xrays of pelvis 75736 26
|
$4,725.75 |
$4,725.75 |
$4,725.75 |
$4,369.50
|
|
Artery-vein nonautograft
|
$6,325.50 |
$6,325.50 |
$6,325.50 |
$5,405.70
|
|
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 |
$498.00
|
|
Arthrocentesis/aspiration/injection intermediate joint/bursa w/ultrasound guidance (both sides)
|
$619.50 |
$619.50 |
$619.50 |
$625.80
|
|
Arthrocentesis/aspiration/injection intermediate joint/bursa without ultrasound guidance right
|
$609.00 |
$609.00 |
$609.00 |
$453.60
|
|
Arthrocentesis/aspiration/injection major joint/bursa w/ultrasound guidance (both sides)
|
$803.25 |
$803.25 |
$803.25 |
$723.60
|
|
Arthrocentesis/aspiration/injection small joint/bursa without ultrasound guidance
|
$493.50 |
$493.50 |
$493.50 |
$453.60
|
|
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 |
$3,244.61
|
|
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 |
$28,797.60
|
|
Asp & inj bone cyst
|
$756.75 |
$756.75 |
$756.75 |
$703.59
|
|
Asp & inj w/heparin pleurx cath
|
$1,135.50 |
$1,135.50 |
$1,135.50 |
$1,092.00
|
|
Asp core fat pad
|
$1,123.50 |
$1,123.50 |
$1,123.50 |
$174.00
|
|
Aspir/inj thyroid cyst 60300
|
$815.25 |
$815.25 |
$815.25 |
$873.00
|
|
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 |
$1,212.00
|
|
Aspirate/inj ganglion cyst 20612
|
$552.00 |
$552.00 |
$552.00 |
$491.25
|
|
Aspiration fine needle (fna) biopsy w/ultrasound guidance 1st lesion
|
$1,219.50 |
$1,219.50 |
$1,219.50 |
$971.40
|
|
Aspiration peritonsillar abscess
|
$283.50 |
$283.50 |
$283.50 |
$236.25
|
|
Assay acid phosphatase
|
$81.00 |
$81.00 |
$81.00 |
$62.25
|
|
Assay alkaline phosphatase
|
$87.00 |
$87.00 |
$87.00 |
$63.00
|
|
Assay dir meas fr estradiol
|
$391.50 |
$391.50 |
$391.50 |
$103.20
|
|
Assay duodenal fluid trypsin
|
$271.50 |
$271.50 |
$271.50 |
$195.00
|
|
Assay of adp & amp
|
$293.25 |
$293.25 |
$293.25 |
$246.75
|
|
Assay of breath ethanol
|
$64.50 |
$64.50 |
$64.50 |
$105.00
|
|
Assay of digoxin free
|
$27.00 |
$27.00 |
$27.00 |
$25.50
|
|
Assay of fluoride
|
$270.00 |
$270.00 |
$270.00 |
$227.40
|
|
Assay of galactose
|
$426.75 |
$426.75 |
$426.75 |
$307.50
|
|
Assay of glucosidase
|
$1,008.00 |
$1,008.00 |
$1,008.00 |
$342.00
|
|
Assay of glutathione
|
$252.75 |
$252.75 |
$252.75 |
$77.40
|
|
Assay of interleukin-6 (il-6)
|
$45.00 |
$45.00 |
$45.00 |
$67.20
|
|
Assay of leflunomide
|
$153.00 |
$153.00 |
$153.00 |
$147.00
|
|
Assay of lrh hormone
|
$669.75 |
$669.75 |
$669.75 |
$299.20
|
|
Assay of osteocalcin
|
$144.75 |
$144.75 |
$144.75 |
$150.60
|
|
Assay of procainamide w/metab
|
$70.50 |
$70.50 |
$70.50 |
$129.75
|
|
Assay of prostaglandin
|
$93.75 |
$93.75 |
$93.75 |
$192.00
|
|
Assay of salicylate
|
$164.25 |
$164.25 |
$164.25 |
$159.60
|
|
Assay of sialic acid
|
$342.00 |
$342.00 |
$342.00 |
$188.40
|
|
Assay of somatostatin
|
$501.00 |
$501.00 |
$501.00 |
$235.20
|
|
Assay of thiocyanate
|
$333.00 |
$333.00 |
$333.00 |
$72.60
|
|
Assay of urine sulfate
|
$59.25 |
$59.25 |
$59.25 |
$52.20
|
|
Assay phosphohexose enzymes
|
$252.75 |
$252.75 |
$252.75 |
$130.20
|
|
Assay toxin or antitoxin
|
$72.75 |
$72.75 |
$72.75 |
$110.40
|
|
Assess aphasia/interp/rpt/per hr 96105
|
$466.50 |
$466.50 |
$466.50 |
$449.40
|
|
Assess cyst contrast inject
|
$425.25 |
$425.25 |
$425.25 |
$845.40
|
|
Ast/sgot
|
$57.00 |
$57.00 |
$57.00 |
$41.25
|
|
Atezolizumab 60 mg/ml intravenous solution (wrapper)
|
$42,851.67 |
$42,851.67 |
$42,851.67 |
$273.60
|
|
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 |
$95.40
|
|
Aud brainstem implt programg
|
$372.00 |
$372.00 |
$372.00 |
$156.46
|
|
Audiometry air + bone
|
$202.50 |
$202.50 |
$202.50 |
$138.00
|
|
Auditory function 60 min
|
$762.75 |
$762.75 |
$762.75 |
$156.46
|
|
Augment injectable kit 3.0cc
|
$8,645.34 |
$8,645.34 |
$8,645.34 |
$8,418.60
|
|
Augumentation percutaneous vertebral inc cavity creation ea addl thoracic/lumbar vertebral body
|
$9,145.50 |
$9,145.50 |
$9,145.50 |
$8,849.25
|
|
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 |
$604.80
|
|
Avelumab 20 mg/ml intravenous solution
|
$7,742.64 |
$7,742.64 |
$7,742.64 |
$231.00
|
|
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 |
$417.00
|
|
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 |
$186.40
|
|
Aztreonam 1 gram solution for injection
|
$203.80 |
$203.80 |
$203.80 |
$21.60
|
|
B cells total count
|
$84.75 |
$84.75 |
$84.75 |
$112.80
|
|
B-hexosaminidase ea assay
|
$104.25 |
$104.25 |
$104.25 |
$104.25
|
|
Baclofen eval charges
|
$138.75 |
$138.75 |
$138.75 |
$118.20
|
|
Bacterial meningitis antigen
|
$60.75 |
$60.75 |
$60.75 |
$100.80
|
|
Bacterial vaginosis pcr
|
$1,973.25 |
$1,973.25 |
$1,973.25 |
$336.00
|
|
Balloon dilate urtrl strix
|
$2,118.00 |
$2,118.00 |
$2,118.00 |
$6,571.80
|
|
Bartonella dna pcr-sendout
|
$1,113.00 |
$1,113.00 |
$1,113.00 |
$671.40
|
|
Basic vestibular evaluation
|
$998.25 |
$998.25 |
$998.25 |
$462.60
|
|
Basiliximab
|
$15,941.19 |
$15,941.19 |
$15,941.19 |
$7,420.80
|
|
Bausch health Ultrasound surg
|
$2,238.75 |
$2,238.75 |
$2,238.75 |
$800.00
|
|
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 |
$7,881.60
|
|
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 |
$295.50
|
|
Benign lesion paring 4+
|
$276.75 |
$276.75 |
$276.75 |
$368.25
|
|
Benztropine 1 mg/ml injection solution
|
$102.90 |
$102.90 |
$102.90 |
$115.80
|
|
Beta 2 glycoprotein 1 antibody iga
|
$129.00 |
$129.00 |
$129.00 |
$133.50
|
|
Beta-2 microglobulin
|
$84.00 |
$84.00 |
$84.00 |
$91.80
|
|
Beta-amyloid 1-42
|
$504.00 |
$504.00 |
$504.00 |
$1,056.60
|
|
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 |
$3,154.20
|
|
Bilateral n blobk inj pudendal 64430
|
$1,727.25 |
$1,727.25 |
$1,727.25 |
$2,632.20
|
|
Bilateral n block inj occipital 64405
|
$1,218.00 |
$1,218.00 |
$1,218.00 |
$951.00
|
|
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 |
$6,068.25
|
|
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 |
$10,411.22
|
|
Biliary endoscopy thru skin
|
$2,959.50 |
$2,959.50 |
$2,959.50 |
$3,529.06
|
|
Biliary endoscopy thru skin
|
$7,300.50 |
$7,300.50 |
$7,300.50 |
$6,068.25
|
|
Bilicheck
|
$39.00 |
$39.00 |
$39.00 |
$25.20
|
|
Bilirubin direct
|
$55.50 |
$55.50 |
$55.50 |
$58.80
|
|
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 |
$1,704.60
|
|
Biopsy bone trocar/needle superficial
|
$1,534.50 |
$1,534.50 |
$1,534.50 |
$1,629.60
|
|
Biopsy cervixsingle/multiple 57500
|
$1,827.75 |
$1,827.75 |
$1,827.75 |
$7,461.60
|
|
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 |
$1,629.60
|
|
Biopsy needle liver percutaneous
|
$2,136.75 |
$2,136.75 |
$2,136.75 |
$1,642.50
|
|
Biopsy needle lymph node superficial
|
$1,722.00 |
$1,722.00 |
$1,722.00 |
$1,533.00
|
|
Biopsy of heart lining
|
$7,637.25 |
$7,637.25 |
$7,637.25 |
$3,147.50
|
|
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 |
$1,175.20
|
|
Biopsy of salivary glnd;incisional 42405
|
$1,768.50 |
$1,768.50 |
$1,768.50 |
$1,481.28
|
|
Biopsy of upper nose/throat
|
$3,795.00 |
$3,795.00 |
$3,795.00 |
$3,243.07
|
|
Biopsy renal percutaneous trocar/needle (both sides)
|
$2,086.50 |
$2,086.50 |
$2,086.50 |
$1,717.20
|
|
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 |
$639.00
|
|
Biopsy tongue anterior two-thirds
|
$1,865.25 |
$1,865.25 |
$1,865.25 |
$1,829.25
|
|
Biopsy vestibule of mouth 40808
|
$1,356.75 |
$1,356.75 |
$1,356.75 |
$981.00
|
|
Biopsy(ies) & aspiration(s) bone marrow diagnostic (both sides)
|
$2,404.50 |
$2,404.50 |
$2,404.50 |
$1,745.40
|
|
Biopsy/removal lymph nodes
|
$3,913.50 |
$3,913.50 |
$3,913.50 |
$3,913.50
|
|
Biotinidase - quest
|
$331.50 |
$331.50 |
$331.50 |
$221.40
|
|
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 |
$664.20
|
|
Bld prd mix
|
$140.25 |
$140.25 |
$140.25 |
$140.25
|
|
Bleomycin 15 unit solution for injection
|
$172.13 |
$172.13 |
$172.13 |
$306.40
|
|
Blinatumomab 35 mcg intravenous solution
|
$20,544.09 |
$20,544.09 |
$20,544.09 |
$417.00
|
|
Blink reflex test
|
$441.75 |
$441.75 |
$441.75 |
$310.20
|
|
Bln 1.2 mono emrg 15x1.2
|
$10,575.00 |
$10,575.00 |
$10,575.00 |
$6,582.60
|
|
Bln 30frx10mmx12cm renal nephromax
|
$10,800.00 |
$10,800.00 |
$10,800.00 |
$4,790.40
|
|
Bln dil 900ml preperitnl
|
$1,241.51 |
$1,241.51 |
$1,241.51 |
$2,017.80
|
|
Bln inpact admiral 4x150x130cm
|
$38,250.00 |
$38,250.00 |
$38,250.00 |
$4,954.20
|
|
Bln press regulation 71-80cm
|
$17,775.00 |
$17,775.00 |
$17,775.00 |
$16,708.20
|
|
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 |
$1,381.20
|
|
Block paracervical nrv
|
$1,471.50 |
$1,471.50 |
$1,471.50 |
$982.50
|
|
Block plantar digital nerve
|
$572.25 |
$572.25 |
$572.25 |
$491.40
|
|
Block tap inj(s) w/wo img bi
|
$680.25 |
$680.25 |
$680.25 |
$792.80
|
|
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 |
$64.35
|
|
Blood Count (CBC) Test
|
$104.25 |
$104.25 |
$104.25 |
$66.75
|
|
Blood Count (CBC) Test (without differential)
|
$90.75 |
$90.75 |
$90.75 |
$56.55
|
|
Blood Culture Test
|
$150.75 |
$150.75 |
$150.75 |
$112.20
|
|
Blood draw capillary 36416
|
$18.00 |
$18.00 |
$18.00 |
$12.60
|
|
Blood gases o2 saturation direct measurement
|
$226.50 |
$226.50 |
$226.50 |
$225.75
|
|
Blood occult fecal hemoglobin immunoassay qualitative 1-3 simultaneous determinations diagnostic
|
$60.00 |
$60.00 |
$60.00 |
$32.40
|
|
Blood occult feces colorectal neoplasm screening qualitative
|
$34.50 |
$34.50 |
$34.50 |
$20.40
|
|
Blood occult peroxidase activity qualitative gastric
|
$27.75 |
$27.75 |
$27.75 |
$32.40
|
|
Blood smear interpretation
|
$252.75 |
$252.75 |
$252.75 |
$108.00
|
|
Blood smear microscopic w manual differential wbc count
|
$129.75 |
$129.75 |
$129.75 |
$59.40
|
|
Blood split unit
|
$130.50 |
$130.50 |
$130.50 |
$247.80
|
|
Blood typing abo
|
$186.75 |
$186.75 |
$186.75 |
$41.40
|
|
Blood typing ag donor ea ag
|
$270.75 |
$270.75 |
$270.75 |
$102.00
|
|
Blood typing rbc ag non abo/rh ea
|
$270.75 |
$270.75 |
$270.75 |
$84.60
|
|
Blood typing rh (d)
|
$126.00 |
$126.00 |
$126.00 |
$57.00
|
|
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 |
$1,200.00
|
|
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 |
$805.80
|
|
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 |
$94.80
|
|
Bowel imaging
|
$1,699.50 |
$1,699.50 |
$1,699.50 |
$1,365.75
|
|
Br punct aspir ea add, l
|
$507.75 |
$507.75 |
$507.75 |
$497.40
|
|
Brace afo lg left 6607
|
$70.65 |
$70.65 |
$70.65 |
$70.65
|
|
Brace ank air stirrup univ
|
$55.92 |
$55.92 |
$55.92 |
$272.40
|
|
Brace ankle stablizing lg
|
$35.15 |
$35.15 |
$35.15 |
$286.80
|
|
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 |
$351.60
|
|
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 |
$194.40
|
|
Brace wrist classic lft sm
|
$99.75 |
$99.75 |
$99.75 |
$132.60
|
|
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 |
$2,881.20
|
|
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 |
$1,083.00
|
|
Braf gene
|
$214.50 |
$214.50 |
$214.50 |
$349.20
|
|
Brain MRA (blood vessel MRI, with and without contrast)
|
$2,229.00 |
$2,229.00 |
$2,229.00 |
$2,604.00
|
|
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 |
$1,790.00
|
|
Brain MRI (with and without contrast)
|
$2,345.25 |
$2,345.25 |
$2,345.25 |
$2,884.20
|
|
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 |
$1,825.59
|
|
Brain flow imaging only
|
$456.75 |
$456.75 |
$456.75 |
$627.00
|
|
Breast Biopsy (ultrasound-guided, percutaneous)
|
$4,049.25 |
$4,049.25 |
$4,049.25 |
$3,069.25
|
|
Breast punct aspir cyst, bil
|
$542.25 |
$542.25 |
$542.25 |
$845.40
|
|
Breath hydrogen test 91065
|
$577.50 |
$577.50 |
$577.50 |
$333.00
|
|
Brentuximab vedotin 50 mg intravenous solution
|
$46,868.78 |
$46,868.78 |
$46,868.78 |
$25,683.00
|
|
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 |
$2,132.40
|
|
Bronch ebus samplng 1/2 node
|
$5,532.00 |
$5,532.00 |
$5,532.00 |
$3,686.95
|
|
Bronch ebus samplng 3/> node
|
$5,532.00 |
$5,532.00 |
$5,532.00 |
$4,214.40
|
|
Bronch thermoplsty 1 lobe
|
$7,346.25 |
$7,346.25 |
$7,346.25 |
$6,922.47
|
|
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 |
$761.40
|
|
Bronchial valve remov addl
|
$1,968.00 |
$1,968.00 |
$1,968.00 |
$1,639.50
|
|
Bronchial valve remov init
|
$4,341.75 |
$4,341.75 |
$4,341.75 |
$3,618.00
|
|
Bronchoscopy clear airways 31645
|
$3,143.25 |
$3,143.25 |
$3,143.25 |
$2,487.00
|
|
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 |
$2,168.40
|
|
Bronchoscopy w/fb removal 31635
|
$2,919.75 |
$2,919.75 |
$2,919.75 |
$3,279.00
|
|
Bronchoscopy w/markers
|
$11,335.50 |
$11,335.50 |
$11,335.50 |
$6,922.47
|
|
Bronchoscopy w/tumor excise
|
$3,691.50 |
$3,691.50 |
$3,691.50 |
$3,686.95
|
|
Bronchoscopy/lung bx addl 31632
|
$1,872.75 |
$1,872.75 |
$1,872.75 |
$1,305.75
|
|
Bronchoscopy/lung bx each 31628
|
$2,785.50 |
$2,785.50 |
$2,785.50 |
$3,686.95
|
|
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 |
$3,846.60
|
|
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 |
$116.40
|
|
Bundled special stain group 2
|
$134.25 |
$134.25 |
$134.25 |
$131.25
|
|
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 |
$20.25
|
|
Buprenorphine 8 mg-naloxone 2 mg sublingual tablet
|
$621.18 |
$621.18 |
$621.18 |
$36.60
|
|
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 |
$136.50
|
|
Buprenorphine hydrochloride
|
$52.01 |
$52.01 |
$52.01 |
$14.40
|
|
Buprenorphine oral 1mg
|
$715.66 |
$715.66 |
$715.66 |
$715.66
|
|
Bur rotalink 2.15mm
|
$11,463.75 |
$11,463.75 |
$11,463.75 |
$9,807.60
|
|
Busulfan injection
|
$783.10 |
$783.10 |
$783.10 |
$783.10
|
|
Butorphanol tartrate 1 mg
|
$63.62 |
$63.62 |
$63.62 |
$90.60
|
|
Bx bone trocar/ndl deep
|
$2,610.75 |
$2,610.75 |
$2,610.75 |
$2,179.80
|
|
Bx breast 1st lesion mr imag
|
$3,197.25 |
$3,197.25 |
$3,197.25 |
$2,955.75
|
|
Bx breast 1st lesion strtctc
|
$4,984.50 |
$4,984.50 |
$4,984.50 |
$3,438.75
|
|
Bx breast add lesion Ultrasound imag
|
$2,906.25 |
$2,906.25 |
$2,906.25 |
$2,315.20
|
|
Bx breast add lesion mr imag
|
$3,008.25 |
$3,008.25 |
$3,008.25 |
$2,781.75
|
|
Bx breast add lesion strtctc
|
$4,428.00 |
$4,428.00 |
$4,428.00 |
$2,515.20
|
|
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 |
$2,178.00
|
|
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 |
$1,900.50
|
|
Bx perianal mass
|
$1,059.00 |
$1,059.00 |
$1,059.00 |
$911.71
|
|
Bx pleura pq ndl
|
$1,788.75 |
$1,788.75 |
$1,788.75 |
$1,620.24
|
|
Bx prostate trnsrctl u/s guid
|
$4,050.75 |
$4,050.75 |
$4,050.75 |
$3,375.75
|
|
Bx skin incisnl ea sep/add l les
|
$323.25 |
$323.25 |
$323.25 |
$336.00
|
|
Bx skin punch ea sep/ addl les
|
$291.75 |
$291.75 |
$291.75 |
$327.00
|
|
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 |
$1,352.80
|
|
Bx thigh/knee soft tiss supf 27323
|
$1,879.50 |
$1,879.50 |
$1,879.50 |
$1,566.00
|
|
Bx thyroid/percutan core needle 60100
|
$1,148.25 |
$1,148.25 |
$1,148.25 |
$979.50
|
|
Bx vag mucos smpl (sep proc)
|
$2,074.50 |
$2,074.50 |
$2,074.50 |
$966.60
|
|
Bx vulva or perineum/1 lesion 56605
|
$2,212.50 |
$2,212.50 |
$2,212.50 |
$2,765.25
|
|
Bx vulva or perineum/ea add lesion 56606
|
$1,827.75 |
$1,827.75 |
$1,827.75 |
$557.60
|
|
Bx/curett of cervix w/scope 57454
|
$1,140.75 |
$1,140.75 |
$1,140.75 |
$785.40
|
|
Bypass temp external fem-fem
|
$15,243.75 |
$15,243.75 |
$15,243.75 |
$2,349.00
|
|
C motor evoked lwr limbs
|
$413.25 |
$413.25 |
$413.25 |
$457.80
|
|
C motor evoked uppr limbs
|
$780.00 |
$780.00 |
$780.00 |
$429.00
|
|
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 |
$156.00
|
|
C-peptide
|
$128.25 |
$128.25 |
$128.25 |
$156.60
|
|
C-reactive protein
|
$126.00 |
$126.00 |
$126.00 |
$126.00
|
|
C-reactive protein high sensitivity
|
$117.75 |
$117.75 |
$117.75 |
$129.00
|
|
C-reactive protein, quantitative
|
$135.75 |
$135.75 |
$135.75 |
$138.00
|
|
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 |
$3,630.00
|
|
CT Scan of Abdomen and Pelvis (with contrast)
|
$2,493.75 |
$2,493.75 |
$2,493.75 |
$3,180.75
|
|
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 |
$2,494.20
|
|
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 |
$879.75
|
|
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 |
$2,065.20
|
|
CT guidance for percutaneous drain w/catheter placement supervision & interpretation
|
$2,047.50 |
$2,047.50 |
$2,047.50 |
$1,524.60
|
|
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 |
$654.40
|
|
CT lower extremity w/contrast (both sides)
|
$1,553.25 |
$1,553.25 |
$1,553.25 |
$1,619.25
|
|
CT lower extremity without contrast (both sides)
|
$1,372.50 |
$1,372.50 |
$1,372.50 |
$1,471.50
|
|
CT lwr extremity w/o&w/dye
|
$1,618.50 |
$1,618.50 |
$1,618.50 |
$1,983.75
|
|
CT neck soft tissue w/contrast
|
$1,730.25 |
$1,730.25 |
$1,730.25 |
$1,953.00
|
|
CT neck soft tissue without & w/contrast
|
$1,752.75 |
$1,752.75 |
$1,752.75 |
$2,149.50
|
|
CT neck soft tissue without contrast
|
$1,389.75 |
$1,389.75 |
$1,389.75 |
$1,689.75
|
|
CT orbit/sella/ or posterior outer inner or middle ear w/contrast
|
$1,487.25 |
$1,487.25 |
$1,487.25 |
$1,834.50
|
|
CT orbit/sella/ or posterior outer inner or middle ear without contrast
|
$1,400.25 |
$1,400.25 |
$1,400.25 |
$1,623.00
|
|
CT orbit/sella/fossa w/wo contrast
|
$1,661.25 |
$1,661.25 |
$1,661.25 |
$1,923.00
|
|
CT t-spine w /wo contrast
|
$1,817.25 |
$1,817.25 |
$1,817.25 |
$2,228.25
|
|
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 |
$1,473.75
|
|
CT thorax low dose for lung screening without contrast
|
$187.50 |
$187.50 |
$187.50 |
$253.20
|
|
CT upper extremity w/contrast (both sides)
|
$1,614.75 |
$1,614.75 |
$1,614.75 |
$1,764.00
|
|
CT upper extremity without contrast (both sides)
|
$1,473.75 |
$1,473.75 |
$1,473.75 |
$1,518.75
|
|
CT uppr extremity w/o&w/dye
|
$2,224.50 |
$2,224.50 |
$2,224.50 |
$2,785.80
|
|
Ca screen;flexi sigmoidscope
|
$1,296.00 |
$1,296.00 |
$1,296.00 |
$911.71
|
|
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 |
$4,353.60
|
|
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 |
$9,437.60
|
|
Calcium 24 hour urine
|
$78.75 |
$78.75 |
$78.75 |
$78.60
|
|
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 |
$107.40
|
|
Calcium total
|
$52.50 |
$52.50 |
$52.50 |
$39.60
|
|
Caloric vstblr test w/rec
|
$465.75 |
$465.75 |
$465.75 |
$465.75
|
|
Calprotectin fecal
|
$351.00 |
$351.00 |
$351.00 |
$250.20
|
|
Canakinumab injection
|
$79,068.64 |
$79,068.64 |
$79,068.64 |
$10,902.60
|
|
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 |
$4,846.80
|
|
Cap trach decann 15mm
|
$5,400.00 |
$5,400.00 |
$5,400.00 |
$1,737.00
|
|
Capecitabine, oral, 50 mg
|
$20,888.96 |
$20,888.96 |
$20,888.96 |
$8.40
|
|
Carbamazepine free
|
$131.25 |
$131.25 |
$131.25 |
$117.00
|
|
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 |
$111.60
|
|
Carbohydrate urine - sendout
|
$936.00 |
$936.00 |
$936.00 |
$30.60
|
|
Carbon dioxide
|
$155.25 |
$155.25 |
$155.25 |
$39.60
|
|
Carboplatin 10 mg/ml desensitization
|
$45.78 |
$45.78 |
$45.78 |
$500.40
|
|
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 |
$144.75
|
|
Card MRI veloc flow mapping
|
$1,470.75 |
$1,470.75 |
$1,470.75 |
$1,137.60
|
|
Cardiac MRI w/stress img
|
$4,247.25 |
$4,247.25 |
$4,247.25 |
$3,213.60
|
|
Cardiac perf planar mult/ef/wm
|
$5,794.50 |
$5,794.50 |
$5,794.50 |
$2,607.75
|
|
Cardiac perf planar sgl/ef/wm
|
$3,952.50 |
$3,952.50 |
$3,952.50 |
$3,198.60
|
|
Cardiac perf spect sgl/ef/wm rst/strs
|
$4,367.25 |
$4,367.25 |
$4,367.25 |
$3,772.20
|
|
Cardiac rehabilitation op phase 2 w/continous ecg monitoring
|
$268.50 |
$268.50 |
$268.50 |
$218.40
|
|
Cardiac rehabilitation op phase 2 without continous ecg monitoring
|
$216.00 |
$216.00 |
$216.00 |
$106.20
|
|
Cardiolipin antibody iga
|
$213.75 |
$213.75 |
$213.75 |
$186.60
|
|
Cardioversion elective electrical conversion arrhythmia external
|
$2,301.75 |
$2,301.75 |
$2,301.75 |
$1,461.75
|
|
Cardioversion/elective/internal 92961
|
$1,707.00 |
$1,707.00 |
$1,707.00 |
$865.20
|
|
Carfilzomib 10 mg intravenous solution
|
$13,992.87 |
$13,992.87 |
$13,992.87 |
$149.40
|
|
Carmustine 100 mg intravenous powder for solution
|
$9,719.27 |
$9,719.27 |
$9,719.27 |
$2,713.80
|
|
Carotene
|
$75.00 |
$75.00 |
$75.00 |
$85.50
|
|
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 |
$1,752.00
|
|
Cath 2lum 14.5frx43cm maxid kt mahurkar
|
$1,115.83 |
$1,115.83 |
$1,115.83 |
$973.80
|
|
Cath ablat bi-d d-d 8fr 115cm
|
$27,000.00 |
$27,000.00 |
$27,000.00 |
$10,349.40
|
|
Cath ablt clsfast 7fx100cmx
|
$1,687.50 |
$1,687.50 |
$1,687.50 |
$3,024.00
|
|
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 |
$5,926.20
|
|
Cath acuity innr ic130 6f 63cm
|
$64,496.25 |
$64,496.25 |
$64,496.25 |
$8,586.00
|
|
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 |
$21,679.20
|
|
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 |
$8,708.40
|
|
Cath cv dl inj 7fx16cm
|
$6,738.75 |
$6,738.75 |
$6,738.75 |
$2,185.20
|
|
Cath del ampltz 12f 45d 80cm
|
$2,463.75 |
$2,463.75 |
$2,463.75 |
$2,232.00
|
|
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 |
$2,449.80
|
|
Cath hawkone s directional
|
$7,076.25 |
$7,076.25 |
$7,076.25 |
$7,639.20
|
|
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 |
$7,291.50
|
|
Cath left heart/lv gram
|
$12,170.25 |
$12,170.25 |
$12,170.25 |
$7,483.80
|
|
Cath lt/rt pulm art
|
$3,098.25 |
$3,098.25 |
$3,098.25 |
$1,527.00
|
|
Cath malecot 28fr 4-wing ltx
|
$6,845.92 |
$6,845.92 |
$6,845.92 |
$2,099.40
|
|
Cath occl flo-rester 2.25x12mm cor internal vessel occluder
|
$38,250.00 |
$38,250.00 |
$38,250.00 |
$25,520.40
|
|
Cath place 1st order venous 36011
|
$2,613.00 |
$2,613.00 |
$2,613.00 |
$3,910.20
|
|
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 |
$11,503.20
|
|
Cath plc art/angio/rt hrt cath
|
$18,666.75 |
$18,666.75 |
$18,666.75 |
$8,979.00
|
|
Cath plc art/grft/angio right hrt
|
$20,196.00 |
$20,196.00 |
$20,196.00 |
$8,859.00
|
|
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 |
$4,762.80
|
|
Cath right hrt mnpul art
|
$2,094.75 |
$2,094.75 |
$2,094.75 |
$1,847.40
|
|
Cath segmntl pulm art
|
$2,868.00 |
$2,868.00 |
$2,868.00 |
$2,311.80
|
|
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 |
$712.20
|
|
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 |
$411.60
|
|
Catheter declot mechanical
|
$2,209.50 |
$2,209.50 |
$2,209.50 |
$1,523.25
|
|
Catheter stripping venous
|
$2,902.50 |
$2,902.50 |
$2,902.50 |
$5,745.60
|
|
Catheterization collection of specimen single patient all places of service
|
$58.50 |
$58.50 |
$58.50 |
$42.60
|
|
Cauterization chemical granulation tissue
|
$543.75 |
$543.75 |
$543.75 |
$408.60
|
|
Cdna analysis for variants
|
$1,540.50 |
$1,540.50 |
$1,540.50 |
$1,792.80
|
|
Cebpa gene full sequence
|
$387.00 |
$387.00 |
$387.00 |
$1,686.00
|
|
Cefazolin 10 mg/10 ml (dilution #2) IV desensitization - cnr
|
$7.78 |
$7.78 |
$7.78 |
$16.40
|
|
Cefepime 1 gram solution for injection
|
$39.95 |
$39.95 |
$39.95 |
$51.00
|
|
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 |
$552.60
|
|
Ceftazidime 4.5 mg/0.2 ml intraocular injection - cnr
|
$107.85 |
$107.85 |
$107.85 |
$93.60
|
|
Ceftazidime and avibactam
|
$1,418.10 |
$1,418.10 |
$1,418.10 |
$991.80
|
|
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 |
$30.60
|
|
Cell count body fluid
|
$76.50 |
$76.50 |
$76.50 |
$60.75
|
|
Cell count w differential body fluid
|
$145.50 |
$145.50 |
$145.50 |
$131.40
|
|
Cell function assay w/stim
|
$949.50 |
$949.50 |
$949.50 |
$898.80
|
|
Cell marker study
|
$1,170.00 |
$1,170.00 |
$1,170.00 |
$212.40
|
|
Cemiplimab-rwlc 50 mg/ml intravenous solution
|
$40,395.06 |
$40,395.06 |
$40,395.06 |
$527.40
|
|
Cerclage of uterine cervix nonob 57700
|
$7,213.50 |
$7,213.50 |
$7,213.50 |
$3,179.53
|
|
Cerebrospinal fld flw imag
|
$1,215.75 |
$1,215.75 |
$1,215.75 |
$1,124.25
|
|
Certolizumab pegol 400 mg (200 mg x 2 vials) subcutaneous kit
|
$22,182.90 |
$22,182.90 |
$22,182.90 |
$34.60
|
|
Cervical or vaginal cancer screening g0101
|
$156.75 |
$156.75 |
$156.75 |
$123.75
|
|
Cesarean section delivery only 59514
|
$4,472.25 |
$4,472.25 |
$4,472.25 |
$1,705.50
|
|
Cetuximab 100 mg/50 ml intravenous solution
|
$5,734.83 |
$5,734.83 |
$5,734.83 |
$775.20
|
|
Cftr gene dup/delet variants
|
$918.00 |
$918.00 |
$918.00 |
$918.00
|
|
Cftr gene intron poly t
|
$285.75 |
$285.75 |
$285.75 |
$283.80
|
|
Change cystostomy tube simple
|
$621.75 |
$621.75 |
$621.75 |
$411.00
|
|
Change cystostomy tube; complex 51710
|
$780.75 |
$780.75 |
$780.75 |
$2,813.40
|
|
Change g-tube to g-j perc
|
$1,530.00 |
$1,530.00 |
$1,530.00 |
$3,534.60
|
|
Change nephroureteral cath
|
$2,969.25 |
$2,969.25 |
$2,969.25 |
$3,154.80
|
|
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 |
$472.80
|
|
Change ureter stent percut
|
$4,099.50 |
$4,099.50 |
$4,099.50 |
$4,067.25
|
|
Chemo adm cns w/lmbr punct
|
$1,323.75 |
$1,323.75 |
$1,323.75 |
$1,119.00
|
|
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 |
$668.25
|
|
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 |
$692.52
|
|
Chemodenerv 1 extremity 1-4 64642
|
$988.50 |
$988.50 |
$988.50 |
$692.52
|
|
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 |
$358.50
|
|
Chemodenerv trunk musc 1-5 64646
|
$822.75 |
$822.75 |
$822.75 |
$697.20
|
|
Chemodenerv trunk musc 6/] 64647
|
$801.75 |
$801.75 |
$801.75 |
$772.20
|
|
Chemodenervation/face muscl/unilat 64612
|
$891.75 |
$891.75 |
$891.75 |
$891.75
|
|
Chemotx admn pertl cav impl
|
$852.00 |
$852.00 |
$852.00 |
$642.75
|
|
Chest 2 vws w oblique
|
$507.00 |
$507.00 |
$507.00 |
$419.40
|
|
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 |
$1,697.25
|
|
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 |
$303.24
|
|
Chest X-ray (single view)
|
$292.50 |
$292.50 |
$292.50 |
$225.00
|
|
Chest apical lordotic proj
|
$500.25 |
$500.25 |
$500.25 |
$405.00
|
|
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 |
$713.40
|
|
Chimerism anal no cell selec
|
$1,689.75 |
$1,689.75 |
$1,689.75 |
$1,437.75
|
|
Chimerism anal w/cell select
|
$822.00 |
$822.00 |
$822.00 |
$759.75
|
|
Chlamydia culture
|
$105.00 |
$105.00 |
$105.00 |
$109.80
|
|
Chlnggrphy intraop addl s&i
|
$519.00 |
$519.00 |
$519.00 |
$288.80
|
|
Chloramphenicol sodium injec
|
$143.40 |
$143.40 |
$143.40 |
$143.40
|
|
Chloride
|
$42.75 |
$42.75 |
$42.75 |
$39.60
|
|
Chloride 24 hour urine
|
$60.75 |
$60.75 |
$60.75 |
$60.00
|
|
Chloroprocaine hcl injection
|
$69.08 |
$69.08 |
$69.08 |
$1.20
|
|
Chlorothiazide sodium 500 mg intravenous solution
|
$221.85 |
$221.85 |
$221.85 |
$1,236.80
|
|
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 |
$3,529.06
|
|
Cholangiography and/or pancreatography intraoperative supervision & interpretation
|
$694.50 |
$694.50 |
$694.50 |
$629.25
|
|
Cholecystostomy complete w/supervision & interpretation
|
$3,449.25 |
$3,449.25 |
$3,449.25 |
$3,529.06
|
|
Cholesterol
|
$63.75 |
$63.75 |
$63.75 |
$40.80
|
|
Cholesterol (Lipid) Test
|
$143.25 |
$143.25 |
$143.25 |
$100.00
|
|
Cholinesterase
|
$105.00 |
$105.00 |
$105.00 |
$103.20
|
|
Chorionic gonadotropin/1000u
|
$788.58 |
$788.58 |
$788.58 |
$788.58
|
|
Chrom analysis
|
$459.75 |
$459.75 |
$459.75 |
$309.60
|
|
Chromatography
|
$252.75 |
$252.75 |
$252.75 |
$178.80
|
|
Chromo high res and frag x - sendout
|
$293.25 |
$293.25 |
$293.25 |
$770.40
|
|
Chromogenic substrate assay
|
$382.50 |
$382.50 |
$382.50 |
$158.40
|
|
Chromosome analys placenta
|
$892.50 |
$892.50 |
$892.50 |
$642.00
|
|
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 |
$988.50
|
|
Chromosome analysis 45
|
$1,692.75 |
$1,692.75 |
$1,692.75 |
$1,109.60
|
|
Chromosome analysis 5
|
$1,206.00 |
$1,206.00 |
$1,206.00 |
$1,046.25
|
|
Chromosome analysis 50-100
|
$519.00 |
$519.00 |
$519.00 |
$519.00
|
|
Chromosome count additional
|
$147.75 |
$147.75 |
$147.75 |
$57.00
|
|
Chromosome karyotype study
|
$337.50 |
$337.50 |
$337.50 |
$181.80
|
|
Chromosome study additional
|
$136.50 |
$136.50 |
$136.50 |
$181.50
|
|
Chylomicron screen, bf - sendout
|
$336.75 |
$336.75 |
$336.75 |
$334.80
|
|
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 |
$6,678.60
|
|
Clean out mastoid cavity
|
$579.00 |
$579.00 |
$579.00 |
$509.25
|
|
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 |
$47.40
|
|
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 |
$1,481.28
|
|
Close lac/mouth vest/2.5 cm or < 40830
|
$262.50 |
$262.50 |
$262.50 |
$777.60
|
|
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 |
$1,600.41
|
|
Closed tx humerus fx with manip 23605
|
$2,460.00 |
$2,460.00 |
$2,460.00 |
$2,448.00
|
|
Closed tx humerus fx without manip 23600
|
$402.75 |
$402.75 |
$402.75 |
$447.60
|
|
Closed tx metatarsophalangeal jnt disl without anes
|
$261.75 |
$261.75 |
$261.75 |
$643.20
|
|
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 |
$327.60
|
|
Closure laceration vestibule mouth > 2.5 cm cmplx
|
$637.50 |
$637.50 |
$637.50 |
$1,663.80
|
|
Closure paravalvlr leak pq
|
$31,283.25 |
$31,283.25 |
$31,283.25 |
$5,734.80
|
|
Clot factor fletcher fact
|
$466.50 |
$466.50 |
$466.50 |
$231.00
|
|
Clot factor wght kininogen
|
$393.00 |
$393.00 |
$393.00 |
$320.40
|
|
Clot factor xii hageman
|
$246.75 |
$246.75 |
$246.75 |
$197.60
|
|
Clot factor xiii fibrin scrn
|
$47.25 |
$47.25 |
$47.25 |
$47.25
|
|
Clot factor xiii fibrin stab
|
$292.50 |
$292.50 |
$292.50 |
$97.20
|
|
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 |
$998.40
|
|
Clsd tx carpo/metacarpl disl thmb manip ea without anes
|
$543.00 |
$543.00 |
$543.00 |
$327.60
|
|
Clsd tx clav dislc without manip 23520
|
$3,290.25 |
$3,290.25 |
$3,290.25 |
$2,055.00
|
|
Clsd tx clavicle dislocation without manip 23540
|
$581.25 |
$581.25 |
$581.25 |
$537.00
|
|
Clsd tx clavicle fracture w/manip 23505
|
$2,396.25 |
$2,396.25 |
$2,396.25 |
$1,600.41
|
|
Clsd tx dist fib fx w/manip 27788
|
$451.50 |
$451.50 |
$451.50 |
$868.80
|
|
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 |
$1,600.41
|
|
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 |
$1,912.80
|
|
Clsd tx fx radius/ulna dist without manip 25600
|
$409.50 |
$409.50 |
$409.50 |
$520.80
|
|
Clsd tx fx radius/ulna w/manip 25565
|
$1,198.50 |
$1,198.50 |
$1,198.50 |
$2,055.00
|
|
Clsd tx fx radius/ulna without manip 25560
|
$448.50 |
$448.50 |
$448.50 |
$825.60
|
|
Clsd tx hip disloc without anes 27265
|
$261.75 |
$261.75 |
$261.75 |
$868.80
|
|
Clsd tx humeral fract without manip 24530
|
$374.25 |
$374.25 |
$374.25 |
$759.00
|
|
Clsd tx humerus fract without manip 24500
|
$402.75 |
$402.75 |
$402.75 |
$759.00
|
|
Clsd tx metacarp fx w/manip&ext fix ea bone 26607
|
$3,332.25 |
$3,332.25 |
$3,332.25 |
$3,244.61
|
|
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 |
$998.40
|
|
Clsd tx prox fib/shaft fx w/manip 27781
|
$1,863.75 |
$1,863.75 |
$1,863.75 |
$1,614.60
|
|
Clsd tx radius fracture w/manip 24655
|
$1,815.75 |
$1,815.75 |
$1,815.75 |
$2,712.00
|
|
Clsd tx shoulder dislc/fx 23665
|
$1,815.75 |
$1,815.75 |
$1,815.75 |
$3,135.00
|
|
Clsd tx shoulder disloc w/anatom neck fx w/manip 23675
|
$1,863.75 |
$1,863.75 |
$1,863.75 |
$2,073.00
|
|
Clsd tx temporomandibular dislocat 21480
|
$261.75 |
$261.75 |
$261.75 |
$942.60
|
|
Clsd tx toe dislocation without anes28660
|
$261.75 |
$261.75 |
$261.75 |
$520.80
|
|
Clsd tx trimall ankle fx w/manip 27818
|
$1,362.75 |
$1,362.75 |
$1,362.75 |
$1,600.41
|
|
Clsd tx trimall ankle fx without manip 27816
|
$378.75 |
$378.75 |
$378.75 |
$825.60
|
|
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 |
$370.80
|
|
Clsd tx wrist scaphoid fx without manip 25622
|
$411.75 |
$411.75 |
$411.75 |
$520.80
|
|
Clsd tx wrist ulnar styloid fx 25650
|
$342.75 |
$342.75 |
$342.75 |
$672.00
|
|
Clsd tx/clavicular fx without manip 23500
|
$425.25 |
$425.25 |
$425.25 |
$819.60
|
|
Clsd tx/dis phalan fx without manip/ea 26750
|
$353.25 |
$353.25 |
$353.25 |
$370.80
|
|
Clsd tx/dis tib/wt bear no manip 27824
|
$581.25 |
$581.25 |
$581.25 |
$633.60
|
|
Clsd tx/fem shaft fx/manipulation 27502
|
$1,815.75 |
$1,815.75 |
$1,815.75 |
$2,319.00
|
|
Clsd tx/fx grt toe/phalanx/phalang 28490
|
$322.50 |
$322.50 |
$322.50 |
$370.80
|
|
Clsd tx/fx/phalanx/phalang/manip 28515
|
$378.75 |
$378.75 |
$378.75 |
$429.60
|
|
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 |
$825.60
|
|
Clsd tx/metatarsal fx without manip 28470
|
$363.75 |
$363.75 |
$363.75 |
$520.80
|
|
Clsd tx/nasal bone fx/stabilize 21320
|
$3,600.75 |
$3,600.75 |
$3,600.75 |
$3,243.07
|
|
Clsd tx/patellar fx without manip 27520
|
$373.50 |
$373.50 |
$373.50 |
$759.00
|
|
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 |
$496.20
|
|
Clsd tx/shoulder dislo/manip/anest 23655
|
$1,815.75 |
$1,815.75 |
$1,815.75 |
$2,139.60
|
|
Clsd tx/ulnar shaft fx without manip 25530
|
$344.25 |
$344.25 |
$344.25 |
$370.50
|
|
Clsd/shoulder dislo/manip/no anest 23650
|
$600.00 |
$600.00 |
$600.00 |
$856.20
|
|
Clsd/ulnar fx/prox end without manip 24670
|
$372.00 |
$372.00 |
$372.00 |
$494.40
|
|
Cltx hum epcndylr fx wo mnpj
|
$525.75 |
$525.75 |
$525.75 |
$825.60
|
|
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 |
$759.00
|
|
Cltx mndblr fx ntrdntl fixj
|
$6,789.75 |
$6,789.75 |
$6,789.75 |
$5,915.66
|
|
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 |
$3,243.07
|
|
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 |
$2,450.40
|
|
Cltx strnclav dislc w/mnpj
|
$3,526.50 |
$3,526.50 |
$3,526.50 |
$239.88
|
|
Cmptr ophth img optic nerve
|
$130.50 |
$130.50 |
$130.50 |
$97.50
|
|
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 |
$31.00
|
|
Cochlear implt f/up exam 7/>
|
$857.25 |
$857.25 |
$857.25 |
$156.46
|
|
Cochlear implt f/up exam <7
|
$857.25 |
$857.25 |
$857.25 |
$156.46
|
|
Cold agglutinin titer
|
$114.75 |
$114.75 |
$114.75 |
$85.20
|
|
Colistimethate sodium inj
|
$39.42 |
$39.42 |
$39.42 |
$129.00
|
|
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 |
$131.25
|
|
Collection blood specimen using established central/peripheral catheter venous nos
|
$208.50 |
$208.50 |
$208.50 |
$196.00
|
|
Collection of venous blood by venipuncture
|
$22.50 |
$22.50 |
$22.50 |
$20.25
|
|
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 |
$1,846.40
|
|
Colonoscopy (with polyp removal)
|
$2,472.75 |
$2,472.75 |
$2,472.75 |
$1,875.00
|
|
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 |
$1,946.25
|
|
Colonoscopy for foreign body
|
$3,104.25 |
$3,104.25 |
$3,104.25 |
$1,861.50
|
|
Colonoscopy stoma w/endo mucosal rescj 44403
|
$1,368.00 |
$1,368.00 |
$1,368.00 |
$1,286.40
|
|
Colonoscopy stoma w/snare 44394
|
$1,368.00 |
$1,368.00 |
$1,368.00 |
$2,854.80
|
|
Colonoscopy submucous njx
|
$2,063.25 |
$2,063.25 |
$2,063.25 |
$3,528.00
|
|
Colonoscopy thru stoma spx
|
$1,059.00 |
$1,059.00 |
$1,059.00 |
$1,895.40
|
|
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 |
$1,876.80
|
|
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 |
$2,310.00
|
|
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 |
$2,431.20
|
|
Colonoscopy w/injection
|
$2,495.25 |
$2,495.25 |
$2,495.25 |
$2,449.20
|
|
Colonoscopy w/ndl aspir/bx
|
$2,495.25 |
$2,495.25 |
$2,495.25 |
$1,439.25
|
|
Colonoscopy w/resection
|
$3,254.25 |
$3,254.25 |
$3,254.25 |
$2,712.75
|
|
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 |
$1,439.25
|
|
Colonoscopy with ablation
|
$2,495.25 |
$2,495.25 |
$2,495.25 |
$1,740.00
|
|
Colonoscopy with biopsy
|
$1,368.00 |
$1,368.00 |
$1,368.00 |
$1,788.60
|
|
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 |
$435.00
|
|
Colposcopy w/biopsy of cervix 57455
|
$1,155.75 |
$1,155.75 |
$1,155.75 |
$1,147.50
|
|
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 |
$1,446.00
|
|
Colposcopy/cervix/inc up/adjacent vag 57452
|
$853.50 |
$853.50 |
$853.50 |
$434.40
|
|
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 |
$1,216.50
|
|
Compatibility test each unit antiglobulin technique
|
$165.00 |
$165.00 |
$165.00 |
$179.40
|
|
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 |
$171.36
|
|
Complement antigen each component c3
|
$489.00 |
$489.00 |
$489.00 |
$148.20
|
|
Complex cystometrogram 51726
|
$287.25 |
$287.25 |
$287.25 |
$243.21
|
|
Complex repair trunk 1.1-2.5cm 13120
|
$771.75 |
$771.75 |
$771.75 |
$1,919.40
|
|
Complex repair trunk 2.6-7.5cm 13101
|
$2,143.50 |
$2,143.50 |
$2,143.50 |
$2,172.00
|
|
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 |
$2,929.50
|
|
Complx repair enel 2.6-7.5 cm 13152
|
$3,255.75 |
$3,255.75 |
$3,255.75 |
$2,938.80
|
|
Complx repair enel addl 5cm/< 13153
|
$424.50 |
$424.50 |
$424.50 |
$660.00
|
|
Complx repair fccmnaxghf 13131
|
$942.00 |
$942.00 |
$942.00 |
$2,172.00
|
|
Complx repair fccmnaxghf 13132
|
$1,270.50 |
$1,270.50 |
$1,270.50 |
$2,172.00
|
|
Complx repair fccmnaxghf 13133
|
$942.00 |
$942.00 |
$942.00 |
$1,089.00
|
|
Complx repair sal addl 5 cm/> 13122
|
$2,126.25 |
$2,126.25 |
$2,126.25 |
$828.60
|
|
Complx repair trunk addl 5cm/< 13102
|
$2,185.50 |
$2,185.50 |
$2,185.50 |
$931.20
|
|
Compre oph exam est pt 1/>
|
$214.50 |
$214.50 |
$214.50 |
$128.87
|
|
Compre oph exam new pt 1/>
|
$186.00 |
$186.00 |
$186.00 |
$128.87
|
|
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 |
$1,899.75
|
|
Concentration infection agents any type
|
$41.25 |
$41.25 |
$41.25 |
$42.00
|
|
Conditioning play audiometry 92582
|
$147.75 |
$147.75 |
$147.75 |
$123.00
|
|
Condylomata destruction 56420
|
$786.75 |
$786.75 |
$786.75 |
$831.60
|
|
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 |
$212.80
|
|
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 |
$213.60
|
|
Consultation pathology during surgery frozen section each additional block
|
$129.00 |
$129.00 |
$129.00 |
$211.80
|
|
Consultation pathology during surgery frozen section first tissue block
|
$131.25 |
$131.25 |
$131.25 |
$245.40
|
|
Consultation/report referred material w/preparation of slides
|
$231.75 |
$231.75 |
$231.75 |
$737.40
|
|
Cont intraop neuro monitor
|
$335.25 |
$335.25 |
$335.25 |
$335.25
|
|
Contrast baths charges
|
$93.00 |
$93.00 |
$93.00 |
$96.00
|
|
Contrast exam abdominl aorta 75625-26
|
$4,711.50 |
$4,711.50 |
$4,711.50 |
$4,356.00
|
|
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 |
$814.20
|
|
Contrast x-ray of knee joint
|
$1,143.75 |
$1,143.75 |
$1,143.75 |
$868.80
|
|
Contrast x-ray of wrist
|
$417.75 |
$417.75 |
$417.75 |
$417.75
|
|
Control nosebleed pack+caut 30905
|
$147.00 |
$147.00 |
$147.00 |
$569.60
|
|
Control of nosebleed ant comp 30903
|
$388.50 |
$388.50 |
$388.50 |
$569.60
|
|
Control of nosebleedantersmpl 30901
|
$332.25 |
$332.25 |
$332.25 |
$471.00
|
|
Control oropharyngeal hemorr/simp 42960
|
$638.25 |
$638.25 |
$638.25 |
$1,546.80
|
|
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 |
$4,347.00
|
|
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 |
$3,529.06
|
|
Convert nephrostomy catheter
|
$1,549.50 |
$1,549.50 |
$1,549.50 |
$2,643.00
|
|
Coombs direct
|
$117.00 |
$117.00 |
$117.00 |
$75.00
|
|
Coombs indirect qualitative each reagent red cell reference
|
$215.25 |
$215.25 |
$215.25 |
$171.36
|
|
Coombs indirect titer reference
|
$186.75 |
$186.75 |
$186.75 |
$186.75
|
|
Copper intrauterine device
|
$4,211.46 |
$4,211.46 |
$4,211.46 |
$2,606.40
|
|
Core ndl bx lng/med perq
|
$1,428.00 |
$1,428.00 |
$1,428.00 |
$3,052.80
|
|
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 |
$10,920.00
|
|
Coronary angio/lv gram/lt heart
|
$16,669.50 |
$16,669.50 |
$16,669.50 |
$8,070.00
|
|
Coronary angio/lv gram/rt< heart
|
$18,093.75 |
$18,093.75 |
$18,093.75 |
$10,049.40
|
|
Coronary art/grft angio s&i
|
$13,454.25 |
$13,454.25 |
$13,454.25 |
$8,006.25
|
|
Coronary catheterization w/angiography supervision & interpretation
|
$11,955.75 |
$11,955.75 |
$11,955.75 |
$7,491.00
|
|
Correct skin color 6.0 cm/<
|
$1,137.75 |
$1,137.75 |
$1,137.75 |
$876.00
|
|
Cortisol acth stimulation test - sendout
|
$66.00 |
$66.00 |
$66.00 |
$63.75
|
|
Cortisol total am
|
$197.25 |
$197.25 |
$197.25 |
$162.00
|
|
Cosyntropin 0.25 mg solution for injection
|
$296.55 |
$296.55 |
$296.55 |
$542.40
|
|
Counseling smoke cess interm >10mins
|
$167.25 |
$167.25 |
$167.25 |
$48.00
|
|
Coveredge 32 lead kit 40cm 48
|
$8,100.00 |
$8,100.00 |
$8,100.00 |
$6,339.60
|
|
Covid-19 administration immunization im inj 1st/only component
|
$101.25 |
$101.25 |
$101.25 |
$24.00
|
|
Cptr ophth dx img post segmt
|
$105.00 |
$105.00 |
$105.00 |
$97.50
|
|
Crbrospnl fld flw imag cistern
|
$2,313.75 |
$2,313.75 |
$2,313.75 |
$1,859.25
|
|
Creatine - sendout
|
$81.00 |
$81.00 |
$81.00 |
$45.60
|
|
Creatine kinase
|
$90.00 |
$90.00 |
$90.00 |
$80.25
|
|
Creatine kinase isoenzymes
|
$70.50 |
$70.50 |
$70.50 |
$66.00
|
|
Creatine kinase mb
|
$114.75 |
$114.75 |
$114.75 |
$114.75
|
|
Creatinine
|
$56.25 |
$56.25 |
$56.25 |
$43.80
|
|
Creatinine 24 hour urine
|
$73.50 |
$73.50 |
$73.50 |
$75.00
|
|
Creatinine clearance urine
|
$178.50 |
$178.50 |
$178.50 |
$146.40
|
|
Crisis psychotherapy 90839
|
$567.00 |
$567.00 |
$567.00 |
$263.40
|
|
Crisis psychotherapy additional 30 mins 90840
|
$219.00 |
$219.00 |
$219.00 |
$212.40
|
|
Critical care 30-74 minutes
|
$2,937.75 |
$2,937.75 |
$2,937.75 |
$2,085.75
|
|
Critical care each additional 30 minutes
|
$663.00 |
$663.00 |
$663.00 |
$570.60
|
|
Crizanlizumab-tmca 10 mg/ml intravenous solution
|
$9,069.75 |
$9,069.75 |
$9,069.75 |
$436.20
|
|
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 |
$4,747.50
|
|
Cryofibrinogen qualitative - sendout
|
$69.00 |
$69.00 |
$69.00 |
$56.25
|
|
Cryoprecipitate each unit
|
$219.00 |
$219.00 |
$219.00 |
$235.20
|
|
Cryosurgery penis lesion(s) 54056
|
$231.00 |
$231.00 |
$231.00 |
$198.70
|
|
Cryptococcus abs qn - sendout
|
$206.25 |
$206.25 |
$206.25 |
$138.60
|
|
Crystal identification light microscopy
|
$65.25 |
$65.25 |
$65.25 |
$58.50
|
|
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 |
$2,395.20
|
|
Cta lower extremity without & w/contrast (both sides)
|
$1,807.50 |
$1,807.50 |
$1,807.50 |
$2,212.50
|
|
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 |
$2,025.75
|
|
Ctrl nosebld postir subsq 30906
|
$271.50 |
$271.50 |
$271.50 |
$2,487.00
|
|
Culture aerobic additional method definitive id each
|
$78.75 |
$78.75 |
$78.75 |
$67.80
|
|
Culture afb any source
|
$132.75 |
$132.75 |
$132.75 |
$92.80
|
|
Culture anaerobic except blood
|
$127.50 |
$127.50 |
$127.50 |
$126.00
|
|
Culture body fluid
|
$130.50 |
$130.50 |
$130.50 |
$130.50
|
|
Culture fungi definitive id mold
|
$63.75 |
$63.75 |
$63.75 |
$81.75
|
|
Culture fungi definitive id yeast
|
$66.00 |
$66.00 |
$66.00 |
$70.50
|
|
Culture fungi other (except blood)
|
$126.00 |
$126.00 |
$126.00 |
$130.50
|
|
Culture fungi skin/hair/nail
|
$126.00 |
$126.00 |
$126.00 |
$80.40
|
|
Culture mycobacteria definitive id each isolate
|
$96.00 |
$96.00 |
$96.00 |
$114.60
|
|
Culture mycoplasma any source
|
$145.50 |
$145.50 |
$145.50 |
$145.50
|
|
Culture quantitative aerobic other source
|
$99.75 |
$99.75 |
$99.75 |
$96.75
|
|
Culture screening strep group a
|
$115.50 |
$115.50 |
$115.50 |
$105.75
|
|
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 |
$1,200.60
|
|
Cutter lead
|
$22,020.89 |
$22,020.89 |
$22,020.89 |
$3,284.40
|
|
Cv line/pic reposition
|
$2,100.75 |
$2,100.75 |
$2,100.75 |
$1,629.75
|
|
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution
|
$25.86 |
$25.86 |
$25.86 |
$15.00
|
|
Cyanocobalamin unsat binding capacity
|
$76.50 |
$76.50 |
$76.50 |
$93.60
|
|
Cyclic citrullinated peptide antibody
|
$249.75 |
$249.75 |
$249.75 |
$178.50
|
|
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 |
$10.80
|
|
Cyclosporine oral 100 mg
|
$2,865.39 |
$2,865.39 |
$2,865.39 |
$34.00
|
|
Cylinder pump set 20cm titan zero angl
|
$42,849.57 |
$42,849.57 |
$42,849.57 |
$27,160.20
|
|
Cyp2c19 gene com variants
|
$613.50 |
$613.50 |
$613.50 |
$916.20
|
|
Cyp2c9 gene com variants
|
$368.25 |
$368.25 |
$368.25 |
$1,852.80
|
|
Cyp2d6 gene com variants
|
$949.50 |
$949.50 |
$949.50 |
$269.40
|
|
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 |
$119.40
|
|
Cystic fibrosis cftr
|
$6,969.00 |
$6,969.00 |
$6,969.00 |
$4,054.80
|
|
Cystine urine quantitative
|
$239.25 |
$239.25 |
$239.25 |
$125.40
|
|
Cystogram >= 3 views supervision & interpretation
|
$919.50 |
$919.50 |
$919.50 |
$896.40
|
|
Cystoscopy & ureter catheter
|
$2,397.00 |
$2,397.00 |
$2,397.00 |
$3,417.00
|
|
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 |
$5,083.62
|
|
Cystoscopy and treatment
|
$4,587.75 |
$4,587.75 |
$4,587.75 |
$4,102.20
|
|
Cystoscopy and treatment
|
$4,056.00 |
$4,056.00 |
$4,056.00 |
$3,448.97
|
|
Cystoscopy and treatment
|
$4,056.00 |
$4,056.00 |
$4,056.00 |
$3,448.97
|
|
Cystoscopy and treatment
|
$4,056.00 |
$4,056.00 |
$4,056.00 |
$3,448.97
|
|
Cystoscopy and treatment
|
$4,056.00 |
$4,056.00 |
$4,056.00 |
$3,448.97
|
|
Cystoscopy chemodenervation
|
$975.75 |
$975.75 |
$975.75 |
$975.75
|
|
Cystostomy cystotomy w/drainage 51040
|
$2,396.25 |
$2,396.25 |
$2,396.25 |
$4,228.80
|
|
Cystouretero w/lithotripsy
|
$11,789.25 |
$11,789.25 |
$11,789.25 |
$10,899.75
|
|
Cystourethroscop/calib/dilat stric 52281
|
$2,360.25 |
$2,360.25 |
$2,360.25 |
$3,442.20
|
|
Cytarabine 20 mg/ml injection solution
|
$64.71 |
$64.71 |
$64.71 |
$66.20
|
|
Cytogenetics 25-99
|
$143.25 |
$143.25 |
$143.25 |
$292.80
|
|
Cytomegalovirus (cmv) antibody igg
|
$101.25 |
$101.25 |
$101.25 |
$146.40
|
|
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 |
$5,413.80
|
|
Cytopath smear other source
|
$94.50 |
$94.50 |
$94.50 |
$54.60
|
|
Cytopath tbs c/v manual
|
$168.75 |
$168.75 |
$168.75 |
$36.60
|
|
Cytopathology cellular enhancement technique non-gyn
|
$197.25 |
$197.25 |
$197.25 |
$240.75
|
|
Cytopathology cervical/vaginal thin layer auto screen/manual rescreen/review
|
$198.75 |
$198.75 |
$198.75 |
$78.00
|
|
Cytopathology cervical/vaginal thin layer manual screening
|
$173.25 |
$173.25 |
$173.25 |
$61.20
|
|
Cytopathology concentration technique smears & interpretation
|
$225.00 |
$225.00 |
$225.00 |
$85.80
|
|
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 |
$85.60
|
|
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 |
$363.75
|
|
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 |
$67.40
|
|
Dactinomycin 0.5 mg intravenous solution
|
$10,014.84 |
$10,014.84 |
$10,014.84 |
$1,624.80
|
|
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 |
$681.00
|
|
Daunorubicin 5 mg/ml intravenous solution
|
$300.73 |
$300.73 |
$300.73 |
$300.73
|
|
Dch glucoscan
|
$23.25 |
$23.25 |
$23.25 |
$19.50
|
|
Dch pulmonary stress test
|
$1,811.25 |
$1,811.25 |
$1,811.25 |
$650.40
|
|
Dch validity tests
|
$34.50 |
$34.50 |
$34.50 |
$27.00
|
|
Dcm pq ndl dsk sgl/mlt lv lmbr w/guide
|
$2,238.00 |
$2,238.00 |
$2,238.00 |
$1,809.00
|
|
Deamidated gliadin antibody iga
|
$42.75 |
$42.75 |
$42.75 |
$80.40
|
|
Debr musc/fascia 20sq cm/< 11043
|
$888.00 |
$888.00 |
$888.00 |
$997.50
|
|
Debrid ecz/inf skin up tp 10% body 11000
|
$3,006.00 |
$3,006.00 |
$3,006.00 |
$622.20
|
|
Debrid mastoidectomy cavity simple 69220
|
$292.50 |
$292.50 |
$292.50 |
$198.70
|
|
Debride nail1-5 11720
|
$291.75 |
$291.75 |
$291.75 |
$274.20
|
|
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 |
$811.20
|
|
Debridement (>20 cm) charge pt
|
$363.75 |
$363.75 |
$363.75 |
$321.00
|
|
Debridement bone <= 20 sq cm
|
$4,119.00 |
$4,119.00 |
$4,119.00 |
$2,359.20
|
|
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 |
$817.20
|
|
Debridement/bone/ea add 20 sq cm 11047
|
$2,045.25 |
$2,045.25 |
$2,045.25 |
$2,160.00
|
|
Decalcification
|
$50.25 |
$50.25 |
$50.25 |
$124.80
|
|
Decitabine 50 mg intravenous solution
|
$634.17 |
$634.17 |
$634.17 |
$292.80
|
|
Declotting thrombolytic agent implanted vas access device 36
|
$610.50 |
$610.50 |
$610.50 |
$543.00
|
|
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 |
$2,262.60
|
|
Delivery of placenta 59414
|
$2,570.25 |
$2,570.25 |
$2,570.25 |
$3,179.53
|
|
Delivery transcath fxtn dvc to endogrft w/s&i
|
$10,770.75 |
$10,770.75 |
$10,770.75 |
$8,864.40
|
|
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 |
$712.80
|
|
Dermagraft
|
$129.00 |
$129.00 |
$129.00 |
$100.50
|
|
Des thora aorta rpr without left sub art 33881
|
$15,243.75 |
$15,243.75 |
$15,243.75 |
$6,309.00
|
|
Desmopressin 4 mcg/ml injection solution
|
$172.46 |
$172.46 |
$172.46 |
$172.46
|
|
Desoxycorticosterone
|
$364.50 |
$364.50 |
$364.50 |
$285.60
|
|
Dest mal lesion tal 1.1-2.0cm 17262
|
$332.25 |
$332.25 |
$332.25 |
$860.40
|
|
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 |
$2,841.60
|
|
Destroy cth facet jnt addl 64634
|
$1,879.50 |
$1,879.50 |
$1,879.50 |
$2,099.40
|
|
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 |
$228.00
|
|
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 |
$1,783.50
|
|
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 |
$2,203.50
|
|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral (both sides)
|
$2,325.75 |
$2,325.75 |
$2,325.75 |
$2,908.20
|
|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral additional (both sides)
|
$1,879.50 |
$1,879.50 |
$1,879.50 |
$2,224.80
|
|
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 |
$120.00
|
|
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 |
$337.50
|
|
Developmental screen/score/document 96110
|
$573.75 |
$573.75 |
$573.75 |
$34.20
|
|
Device ablt adv novasure
|
$11,239.88 |
$11,239.88 |
$11,239.88 |
$9,649.20
|
|
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 |
$3,052.80
|
|
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 |
$2,707.20
|
|
Dexa bone density study >=1 sites appendicular skeleton (peripheral)
|
$417.00 |
$417.00 |
$417.00 |
$127.20
|
|
Dexamethasone 4 mg tablet
|
$554.26 |
$554.26 |
$554.26 |
$5.40
|
|
Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr
|
$16.28 |
$16.28 |
$16.28 |
$7.60
|
|
Dexrazoxane hcl 250 mg intravenous solution
|
$465.34 |
$465.34 |
$465.34 |
$1,087.80
|
|
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 |
$37.20
|
|
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 |
$60.40
|
|
Dhea-s (dehydroepiand sulfate)
|
$249.75 |
$249.75 |
$249.75 |
$204.00
|
|
Diab manage trn ind/group
|
$57.75 |
$57.75 |
$57.75 |
$57.75
|
|
Diabetes (HbA1c) Test
|
$114.75 |
$114.75 |
$114.75 |
$69.55
|
|
Diag bronchoscope/catheter
|
$4,125.75 |
$4,125.75 |
$4,125.75 |
$2,379.00
|
|
Diagnostic Mammogram (both breasts)
|
$655.50 |
$655.50 |
$655.50 |
$424.00
|
|
Diagnostic Mammogram (one breast)
|
$502.50 |
$502.50 |
$502.50 |
$297.05
|
|
Diagnostic anoscopy spx 46600
|
$181.50 |
$181.50 |
$181.50 |
$341.40
|
|
Diagnostic digital breast tomosynthesis bil
|
$70.50 |
$70.50 |
$70.50 |
$124.80
|
|
Diagnostic digital breast tomosynthesis unil
|
$57.00 |
$57.00 |
$57.00 |
$124.80
|
|
Diagnostic laryngoscopy 31505
|
$592.50 |
$592.50 |
$592.50 |
$338.40
|
|
Diagnostic laryngoscopy 31575
|
$381.00 |
$381.00 |
$381.00 |
$489.75
|
|
Diagnostic radio unlisted proc
|
$564.75 |
$564.75 |
$564.75 |
$170.40
|
|
Dialysis circuit perm vascular embolization 36909
|
$10,461.00 |
$10,461.00 |
$10,461.00 |
$4,614.60
|
|
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 |
$35.40
|
|
Dicyclomine injection
|
$310.41 |
$310.41 |
$310.41 |
$425.60
|
|
Diffusing capacity
|
$504.00 |
$504.00 |
$504.00 |
$412.20
|
|
Digoxin 250 mcg/ml (0.25 mg/ml) injection solution
|
$472.14 |
$472.14 |
$472.14 |
$29.85
|
|
Digoxin immune fab 40 mg intravenous solution
|
$17,050.66 |
$17,050.66 |
$17,050.66 |
$11,176.20
|
|
Digoxin total therapeutic drug level
|
$138.75 |
$138.75 |
$138.75 |
$126.00
|
|
Dihydroergotamine 0.05 mg/ml IV syringe - cnr
|
$297.86 |
$297.86 |
$297.86 |
$518.40
|
|
Dilate esophagus 1/mult pass
|
$1,548.00 |
$1,548.00 |
$1,548.00 |
$1,547.40
|
|
Dilate urethra stricture
|
$513.00 |
$513.00 |
$513.00 |
$534.00
|
|
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 |
$156.46
|
|
Dilator fascial 10fx20cm
|
$291.87 |
$291.87 |
$291.87 |
$795.60
|
|
Diltiazem 5 mg/ml intravenous solution
|
$107.23 |
$107.23 |
$107.23 |
$107.23
|
|
Dimenhydrinate injection
|
$17.32 |
$17.32 |
$17.32 |
$14.40
|
|
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 |
$9.60
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$5.92 |
$5.92 |
$5.92 |
$13.80
|
|
Disability dlco
|
$340.50 |
$340.50 |
$340.50 |
$234.00
|
|
Disaccharidases
|
$1,265.25 |
$1,265.25 |
$1,265.25 |
$163.80
|
|
Discography cerv/thor spine
|
$2,691.00 |
$2,691.00 |
$2,691.00 |
$2,062.50
|
|
Dlyd plmt xtn prosth ea addl
|
$6,681.75 |
$6,681.75 |
$6,681.75 |
$3,828.75
|
|
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 |
$567.75
|
|
Dna antibody native/double stranded
|
$131.25 |
$131.25 |
$131.25 |
$135.75
|
|
Dobutamine 250 mg/20 ml (12.5 mg/ml) intravenous solution
|
$130.35 |
$130.35 |
$130.35 |
$138.60
|
|
Docetaxel 20 mg/ml intravenous solution (wrapper)
|
$1,164.72 |
$1,164.72 |
$1,164.72 |
$94.40
|
|
Dopamine 40 mg/ml intravenous solution (wrapper)
|
$98.91 |
$98.91 |
$98.91 |
$56.40
|
|
Doppler echo complete
|
$498.00 |
$498.00 |
$498.00 |
$677.40
|
|
Doppler intravascular pressure flow initial vessel
|
$3,066.75 |
$3,066.75 |
$3,066.75 |
$3,046.80
|
|
Doppler upper/lower extremity arteries complete bilateral
|
$946.50 |
$946.50 |
$946.50 |
$901.80
|
|
Doppler upper/lower extremity arteries limited bilateral
|
$885.00 |
$885.00 |
$885.00 |
$547.20
|
|
Dornase alfa non-comp unit
|
$479.80 |
$479.80 |
$479.80 |
$380.80
|
|
Dornhoffer fixed part w/window
|
$77,636.25 |
$77,636.25 |
$77,636.25 |
$53,356.20
|
|
Doxorubicin 2 mg/ml intravenous solution (wrapper)
|
$901.65 |
$901.65 |
$901.65 |
$358.40
|
|
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 |
$2,358.60
|
|
Drain blood from under nail 11740
|
$257.25 |
$257.25 |
$257.25 |
$266.40
|
|
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 |
$4,627.80
|
|
Drain cerebro spinal fluid 62272
|
$1,416.75 |
$1,416.75 |
$1,416.75 |
$1,485.75
|
|
Drain finger abscess;simple 26010
|
$228.75 |
$228.75 |
$228.75 |
$318.00
|
|
Drain lower leg lesion 27603
|
$3,269.25 |
$3,269.25 |
$3,269.25 |
$3,022.50
|
|
Drain neck/chest lesion 21501
|
$3,293.25 |
$3,293.25 |
$3,293.25 |
$2,862.05
|
|
Drain ovarn cyst abd
|
$4,305.75 |
$4,305.75 |
$4,305.75 |
$4,140.00
|
|
Drainage absc/cyst/hmtma/vestibule mouth smpl
|
$820.50 |
$820.50 |
$820.50 |
$824.40
|
|
Drainage ext aud canal abscess 69020
|
$820.50 |
$820.50 |
$820.50 |
$1,440.00
|
|
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 |
$709.50
|
|
Drainage mouth roof lesion
|
$282.00 |
$282.00 |
$282.00 |
$837.00
|
|
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 |
$2,280.73
|
|
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 |
$3,243.07
|
|
Drainage of mouth lesion
|
$3,731.25 |
$3,731.25 |
$3,731.25 |
$3,430.80
|
|
Drainage of nose lesion int 30000
|
$283.50 |
$283.50 |
$283.50 |
$649.80
|
|
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 |
$825.60
|
|
Dress/debride pt-tck burn/5-10% bs 16025
|
$350.25 |
$350.25 |
$350.25 |
$451.20
|
|
Dress/debride pt-thick burn/<5% bs 16020
|
$338.25 |
$338.25 |
$338.25 |
$408.60
|
|
Dressing change not for burn w/anes 15852
|
$716.25 |
$716.25 |
$716.25 |
$612.13
|
|
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 |
$3,479.40
|
|
Drng of finger abscess comp 26011
|
$1,253.25 |
$1,253.25 |
$1,253.25 |
$1,875.00
|
|
Drng of ovarian cyst(s) 58800
|
$3,624.75 |
$3,624.75 |
$3,624.75 |
$3,179.53
|
|
Drng of scrotum abscess 55100
|
$1,897.50 |
$1,897.50 |
$1,897.50 |
$2,630.40
|
|
Drng salivary gland submax/subling 42310
|
$596.25 |
$596.25 |
$596.25 |
$509.25
|
|
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 |
$841.60
|
|
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 |
$687.00
|
|
Drug assay caffeine
|
$59.25 |
$59.25 |
$59.25 |
$55.50
|
|
Drug assay posaconazole
|
$186.00 |
$186.00 |
$186.00 |
$171.75
|
|
Drug assay rufinamide
|
$135.75 |
$135.75 |
$135.75 |
$135.75
|
|
Drug assay vedolizumab
|
$949.50 |
$949.50 |
$949.50 |
$298.80
|
|
Drug assay voriconazole
|
$186.00 |
$186.00 |
$186.00 |
$186.00
|
|
Drug asy hydroxychloroquine
|
$531.75 |
$531.75 |
$531.75 |
$196.20
|
|
Drug of abuse screen urine
|
$63.75 |
$63.75 |
$63.75 |
$48.00
|
|
Drug screen quant tiagabine
|
$260.25 |
$260.25 |
$260.25 |
$188.40
|
|
Drug test(s) presumptive any class instrument chemistry analyzers
|
$732.00 |
$732.00 |
$732.00 |
$383.20
|
|
Drvvt confirm - quest
|
$255.75 |
$255.75 |
$255.75 |
$174.60
|
|
Dstrj nulyt agt gnclr nrv
|
$1,746.75 |
$1,746.75 |
$1,746.75 |
$1,614.75
|
|
Ductogram sgl duct
|
$515.25 |
$515.25 |
$515.25 |
$547.80
|
|
Duodenal motility study
|
$1,729.50 |
$1,729.50 |
$1,729.50 |
$1,347.75
|
|
Dup scan/hemodialysis access 93990
|
$835.50 |
$835.50 |
$835.50 |
$684.60
|
|
Dup scan/lwr xtr vasc stdy bilat 93924
|
$963.75 |
$963.75 |
$963.75 |
$914.40
|
|
Dup scan/ue art/graft/bilat/comp 93930
|
$782.25 |
$782.25 |
$782.25 |
$840.00
|
|
Duplex scan bilateral study 93985
|
$657.75 |
$657.75 |
$657.75 |
$1,144.80
|
|
Duplex scan unilateral study 93986
|
$124.50 |
$124.50 |
$124.50 |
$643.20
|
|
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 |
$153.00
|
|
Dx bronchoscope/brush 31623
|
$2,283.00 |
$2,283.00 |
$2,283.00 |
$2,159.25
|
|
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 |
$2,168.40
|
|
Dxa bone density axl vrt fx
|
$591.75 |
$591.75 |
$591.75 |
$591.75
|
|
E equine encephalitis igg
|
$135.75 |
$135.75 |
$135.75 |
$122.40
|
|
ER Visit (level 1, minor)
|
$312.00 |
$312.00 |
$312.00 |
$286.51
|
|
ER Visit (level 2)
|
$510.00 |
$510.00 |
$510.00 |
$469.39
|
|
ER Visit (level 3)
|
$850.50 |
$850.50 |
$850.50 |
$827.20
|
|
ER Visit (level 4)
|
$1,334.25 |
$1,334.25 |
$1,334.25 |
$1,330.00
|
|
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 |
$509.25
|
|
Ear canal biopsy 69105
|
$1,768.50 |
$1,768.50 |
$1,768.50 |
$1,353.00
|
|
Ear irrigation 69209
|
$216.75 |
$216.75 |
$216.75 |
$128.25
|
|
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 |
$72.60
|
|
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 |
$250.50
|
|
Echo exam of fetal heart
|
$644.25 |
$644.25 |
$644.25 |
$548.30
|
|
Echo exam of fetal heart
|
$480.75 |
$480.75 |
$480.75 |
$398.25
|
|
Echo exam of fetal heart
|
$576.75 |
$576.75 |
$576.75 |
$424.80
|
|
Echo exam uterus 76831-
|
$825.75 |
$825.75 |
$825.75 |
$695.40
|
|
Echo guide for amniocentesis
|
$680.25 |
$680.25 |
$680.25 |
$564.75
|
|
Echo guide for artery repair
|
$1,386.00 |
$1,386.00 |
$1,386.00 |
$1,009.20
|
|
Echo guide for transfusion
|
$317.25 |
$317.25 |
$317.25 |
$317.25
|
|
Echo guide villus sampling
|
$693.75 |
$693.75 |
$693.75 |
$574.50
|
|
Echo stress
|
$1,949.25 |
$1,949.25 |
$1,949.25 |
$1,056.00
|
|
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 |
$1,724.25
|
|
Echo transesophageal
|
$1,826.25 |
$1,826.25 |
$1,826.25 |
$1,626.00
|
|
Echo transesophageal intraop
|
$1,165.50 |
$1,165.50 |
$1,165.50 |
$2,142.60
|
|
Echo transthoracic
|
$1,922.25 |
$1,922.25 |
$1,922.25 |
$1,094.40
|
|
Echo transthoracic
|
$1,341.75 |
$1,341.75 |
$1,341.75 |
$548.30
|
|
Echo tte 2d comp wo ctrst wo clr/dplr
|
$1,278.75 |
$1,278.75 |
$1,278.75 |
$1,026.40
|
|
Echocardiogram (Heart Ultrasound)
|
$2,126.25 |
$2,126.25 |
$2,126.25 |
$2,021.12
|
|
Echocardiography doppler color flow mapping
|
$407.25 |
$407.25 |
$407.25 |
$485.25
|
|
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 |
$691.20
|
|
Echocardiography transthoracic 2d followup/limited w/contrast or without & w/contrast
|
$939.00 |
$939.00 |
$939.00 |
$667.50
|
|
Echocardiograpy doppler follow up/limited study
|
$350.25 |
$350.25 |
$350.25 |
$336.00
|
|
Ecmo/ecls daily mgmt artery 33949
|
$4,409.25 |
$4,409.25 |
$4,409.25 |
$3,998.25
|
|
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 |
$1,554.60
|
|
Ecmo/ecls initiation venous 33946
|
$4,324.50 |
$4,324.50 |
$4,324.50 |
$3,767.25
|
|
Ecmo/ecls insj prph cannula 6yrs&older perq 33952
|
$15,762.00 |
$15,762.00 |
$15,762.00 |
$1,958.40
|
|
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 |
$1,488.75
|
|
Eeg monitor/record/awake/drowsy 95816
|
$1,099.50 |
$1,099.50 |
$1,099.50 |
$855.60
|
|
Eeg monitoring/function test
|
$2,747.25 |
$2,747.25 |
$2,747.25 |
$2,440.50
|
|
Eeg over 1 hour 95813 - 26
|
$1,523.25 |
$1,523.25 |
$1,523.25 |
$907.80
|
|
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 |
$586.20
|
|
Eeg without vid 2-12hr cont mntr
|
$2,025.00 |
$2,025.00 |
$2,025.00 |
$623.40
|
|
Eeg without vid ea 12-26hr cont
|
$4,050.00 |
$4,050.00 |
$4,050.00 |
$1,194.00
|
|
Eeg without vid ea 12-26hr intmt
|
$2,361.75 |
$2,361.75 |
$2,361.75 |
$1,126.20
|
|
Eeg wo vid 2-12hr intmt mntr
|
$1,181.25 |
$1,181.25 |
$1,181.25 |
$602.40
|
|
Eeg wo vid ea 12-26hr unmntr
|
$364.50 |
$364.50 |
$364.50 |
$1,126.20
|
|
Eeg/cerebral death evaluation only 95824 -26
|
$1,116.75 |
$1,116.75 |
$1,116.75 |
$1,177.80
|
|
Eeg/record in coma or sleep only 95822
|
$1,091.25 |
$1,091.25 |
$1,091.25 |
$1,095.60
|
|
Egd Ultrasound exam duodenum/jejunum
|
$3,135.75 |
$3,135.75 |
$3,135.75 |
$3,414.00
|
|
Egd Ultrasound fine needle bx/aspir
|
$4,259.25 |
$4,259.25 |
$4,259.25 |
$3,322.50
|
|
Egd Ultrasound fine needle bx/aspir
|
$3,514.50 |
$3,514.50 |
$3,514.50 |
$3,414.00
|
|
Egd Ultrasound transmural injxn/mark
|
$4,423.50 |
$4,423.50 |
$4,423.50 |
$3,127.50
|
|
Egd balloon dil esoph30 mm/>
|
$2,440.50 |
$2,440.50 |
$2,440.50 |
$1,903.50
|
|
Egd control bleeding any
|
$2,553.75 |
$2,553.75 |
$2,553.75 |
$2,547.00
|
|
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 |
$1,896.99
|
|
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 |
$10,411.22
|
|
Egd flx trnsorl rmvl balo
|
$1,051.50 |
$1,051.50 |
$1,051.50 |
$937.56
|
|
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 |
$3,241.20
|
|
Egd lesion ablation
|
$3,672.75 |
$3,672.75 |
$3,672.75 |
$3,360.75
|
|
Egd remove foreign body
|
$2,295.00 |
$2,295.00 |
$2,295.00 |
$2,501.40
|
|
Egd remove lesion snare
|
$2,597.25 |
$2,597.25 |
$2,597.25 |
$2,501.40
|
|
Egd varices ligation
|
$3,264.00 |
$3,264.00 |
$3,264.00 |
$3,061.20
|
|
Egd w/thrml txmnt gerd
|
$5,043.00 |
$5,043.00 |
$5,043.00 |
$6,529.80
|
|
Egd w/transmural drain cyst
|
$4,379.25 |
$4,379.25 |
$4,379.25 |
$5,952.81
|
|
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 |
$290.40
|
|
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 |
$508.50
|
|
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 |
$85.50
|
|
Electroacous eval hear aid/biaural 92595
|
$97.50 |
$97.50 |
$97.50 |
$97.50
|
|
Electrocochleography
|
$1,054.50 |
$1,054.50 |
$1,054.50 |
$349.80
|
|
Electroconvulsive therapy 90870
|
$1,353.00 |
$1,353.00 |
$1,353.00 |
$1,226.40
|
|
Electrocorticography durng sx
|
$4,220.25 |
$4,220.25 |
$4,220.25 |
$881.40
|
|
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 |
$1,386.00
|
|
Electronic analysis with brain program ea add 15 min 95984
|
$642.00 |
$642.00 |
$642.00 |
$513.00
|
|
Electronic analysis with brain program first 15 min 95983
|
$1,237.50 |
$1,237.50 |
$1,237.50 |
$990.75
|
|
Electrophys map 3d add-on
|
$8,985.00 |
$8,985.00 |
$8,985.00 |
$5,610.00
|
|
Electrophysiologic study
|
$10,470.75 |
$10,470.75 |
$10,470.75 |
$5,773.20
|
|
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 |
$1,735.80
|
|
Electrophysiology evaluation
|
$10,838.25 |
$10,838.25 |
$10,838.25 |
$5,576.40
|
|
Electrophysiology evaluation
|
$13,146.75 |
$13,146.75 |
$13,146.75 |
$7,588.10
|
|
Electrophysiology evaluation
|
$6,516.00 |
$6,516.00 |
$6,516.00 |
$2,100.60
|
|
Electrophysiology evaluation
|
$3,130.50 |
$3,130.50 |
$3,130.50 |
$2,161.80
|
|
Elotuzumab 300 mg intravenous solution
|
$11,443.25 |
$11,443.25 |
$11,443.25 |
$1,749.60
|
|
Emb w/colposcopy 58110
|
$1,077.00 |
$1,077.00 |
$1,077.00 |
$706.40
|
|
Emb without cervical dilation 58100
|
$1,692.75 |
$1,692.75 |
$1,692.75 |
$2,115.00
|
|
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 |
$12,721.80
|
|
Embolization s&i
|
$6,008.25 |
$6,008.25 |
$6,008.25 |
$4,390.50
|
|
Emg 2 ext w-w/o paraspinal area 95861
|
$725.25 |
$725.25 |
$725.25 |
$665.40
|
|
Emg 3 ext w-w/o paraspinal area 95863
|
$869.25 |
$869.25 |
$869.25 |
$447.00
|
|
Emg cranial nerve bilateral
|
$807.00 |
$807.00 |
$807.00 |
$529.80
|
|
Emg needle test 1-extremity
|
$398.25 |
$398.25 |
$398.25 |
$362.25
|
|
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 |
$311.40
|
|
Encephalitis, california igg/igm
|
$135.75 |
$135.75 |
$135.75 |
$122.40
|
|
Encephalitis, st louis igg/igm
|
$135.75 |
$135.75 |
$135.75 |
$122.40
|
|
Encephalitis, western equine igg/igm
|
$135.75 |
$135.75 |
$135.75 |
$122.40
|
|
Endo abl/incom vein/ext/laser/#1 36478
|
$6,948.00 |
$6,948.00 |
$6,948.00 |
$6,423.75
|
|
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 |
$982.20
|
|
Endo cath panc duct s&i
|
$771.75 |
$771.75 |
$771.75 |
$877.20
|
|
Endo cholangiopancreatograph
|
$3,536.25 |
$3,536.25 |
$3,536.25 |
$3,831.00
|
|
Endo cholangiopancreatograph
|
$3,543.00 |
$3,543.00 |
$3,543.00 |
$3,546.00
|
|
Endo outlet restrict w/tube
|
$12,180.75 |
$12,180.75 |
$12,180.75 |
$10,411.22
|
|
Endo sleeve gastro w/tube
|
$12,180.75 |
$12,180.75 |
$12,180.75 |
$10,411.22
|
|
Endocerv curettage w/scope 57456
|
$592.50 |
$592.50 |
$592.50 |
$585.00
|
|
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 |
$1,230.75
|
|
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 |
$3,046.80
|
|
Endoscopic Ultrasound exam esoph
|
$3,226.50 |
$3,226.50 |
$3,226.50 |
$2,517.00
|
|
Endoscopic pancreatoscopy
|
$2,117.25 |
$2,117.25 |
$2,117.25 |
$2,116.20
|
|
Endoscopy bowel pouch/biop
|
$2,199.75 |
$2,199.75 |
$2,199.75 |
$1,896.00
|
|
Endoscopy of bowel pouch 44385
|
$2,187.00 |
$2,187.00 |
$2,187.00 |
$1,696.20
|
|
Endoscopy swallow (fees) vid
|
$551.25 |
$551.25 |
$551.25 |
$510.00
|
|
Endoscpy nsl/sns w/cntrl nsl hmrrgh
|
$2,209.50 |
$2,209.50 |
$2,209.50 |
$2,377.20
|
|
Endovasc rpr a-biiliac endogft 34705
|
$10,604.25 |
$10,604.25 |
$10,604.25 |
$10,363.80
|
|
Endovasc tempory vessel occl
|
$8,869.50 |
$8,869.50 |
$8,869.50 |
$9,294.60
|
|
Endoven ther chem adhes 1st 36482
|
$3,548.25 |
$3,548.25 |
$3,548.25 |
$5,405.70
|
|
Endoven ther chem adhes sbsq 36483
|
$4,050.75 |
$4,050.75 |
$4,050.75 |
$3,375.75
|
|
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 |
$3,603.00
|
|
Enfortumab vedotin-ejfv 20 mg intravenous solution
|
$15,579.42 |
$15,579.42 |
$15,579.42 |
$64.20
|
|
Enoxaparin 30 mg/0.3 ml subcutaneous syringe
|
$109.71 |
$109.71 |
$109.71 |
$69.60
|
|
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 |
$547.20
|
|
Enzyme histochemistry
|
$648.75 |
$648.75 |
$648.75 |
$573.60
|
|
Ep & ablate supravent arrhyt
|
$23,285.25 |
$23,285.25 |
$23,285.25 |
$24,532.30
|
|
Ep & ablate ventric tachy
|
$36,500.25 |
$36,500.25 |
$36,500.25 |
$30,975.00
|
|
Ep induct arrhy by elect pacing
|
$3,894.75 |
$3,894.75 |
$3,894.75 |
$3,663.00
|
|
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 |
$1,711.50
|
|
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 |
$3.00
|
|
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 |
$255.20
|
|
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 |
$253.20
|
|
Epstein barr early antigen antibody
|
$136.50 |
$136.50 |
$136.50 |
$105.00
|
|
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 |
$133.20
|
|
Eptifibatide 0.75 mg/ml intravenous solution
|
$924.38 |
$924.38 |
$924.38 |
$350.40
|
|
Eptinezumab-jjmr 100 mg/ml intravenous solution
|
$7,173.42 |
$7,173.42 |
$7,173.42 |
$3,637.20
|
|
Ercp bil/panc duct; each stent plcmt 43274
|
$4,379.25 |
$4,379.25 |
$4,379.25 |
$4,282.20
|
|
Ercp biliary & pancreas
|
$943.50 |
$943.50 |
$943.50 |
$987.60
|
|
Ercp ea duct/ampulla dilate
|
$4,199.25 |
$4,199.25 |
$4,199.25 |
$3,882.75
|
|
Ercp lesion ablate w/dilate 43278
|
$5,948.25 |
$5,948.25 |
$5,948.25 |
$4,640.25
|
|
Ercp lithotripsy calculi
|
$4,379.25 |
$4,379.25 |
$4,379.25 |
$5,378.40
|
|
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 |
$2,771.25
|
|
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 |
$387.60
|
|
Ertapenem 1000 mg/10 ml IV (dilution #1) desensitization - cnr
|
$107.31 |
$107.31 |
$107.31 |
$227.20
|
|
Erythromycin in ns IV syringe 5 mg/ml (neo/ped) - cnr
|
$209.75 |
$209.75 |
$209.75 |
$120.00
|
|
Esd endoscopy or colonoscopy
|
$4,440.75 |
$4,440.75 |
$4,440.75 |
$4,282.20
|
|
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 |
$530.60
|
|
Esoph egd dilation <30 mm
|
$2,597.25 |
$2,597.25 |
$2,597.25 |
$2,501.40
|
|
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 |
$1,122.00
|
|
Esoph imped function test
|
$1,190.25 |
$1,190.25 |
$1,190.25 |
$603.00
|
|
Esoph scope w/sclerosis inj
|
$1,968.00 |
$1,968.00 |
$1,968.00 |
$1,896.99
|
|
Esoph scope w/submucous inj
|
$3,268.50 |
$3,268.50 |
$3,268.50 |
$3,078.00
|
|
Esophageal dilat s&i
|
$787.50 |
$787.50 |
$787.50 |
$787.50
|
|
Esophageal recording
|
$5,991.75 |
$5,991.75 |
$5,991.75 |
$1,213.99
|
|
Esophagosc dilate balloon 30
|
$2,101.50 |
$2,101.50 |
$2,101.50 |
$1,896.99
|
|
Esophagosc flex trnsn biopsy
|
$2,230.50 |
$2,230.50 |
$2,230.50 |
$2,062.50
|
|
Esophagoscop mucosal resect
|
$3,837.00 |
$3,837.00 |
$3,837.00 |
$2,992.50
|
|
Esophagoscop stent placement
|
$6,977.25 |
$6,977.25 |
$6,977.25 |
$5,952.81
|
|
Esophagoscop ultrasound exam
|
$3,936.00 |
$3,936.00 |
$3,936.00 |
$3,414.00
|
|
Esophagoscopy balloon <30mm
|
$3,333.00 |
$3,333.00 |
$3,333.00 |
$2,794.80
|
|
Esophagoscopy control bleed
|
$3,333.00 |
$3,333.00 |
$3,333.00 |
$2,598.75
|
|
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 |
$2,361.00
|
|
Esophagoscopy lesion ablate
|
$2,951.25 |
$2,951.25 |
$2,951.25 |
$3,804.53
|
|
Esophagoscopy lesion removal
|
$3,778.50 |
$3,778.50 |
$3,778.50 |
$2,946.75
|
|
Esophagoscopy retro balloon
|
$2,101.50 |
$2,101.50 |
$2,101.50 |
$1,896.99
|
|
Esophagoscopy snare les remv
|
$3,438.00 |
$3,438.00 |
$3,438.00 |
$2,680.50
|
|
Esophagoscopy w/us needle bx
|
$4,181.25 |
$4,181.25 |
$4,181.25 |
$3,940.50
|
|
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 |
$1,896.99
|
|
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 |
$1,232.25
|
|
Esophgl motil w/stim/perfus
|
$1,341.75 |
$1,341.75 |
$1,341.75 |
$872.25
|
|
Establish access to aorta
|
$1,294.50 |
$1,294.50 |
$1,294.50 |
$2,670.60
|
|
Establish access to artery
|
$2,063.25 |
$2,063.25 |
$2,063.25 |
$1,155.75
|
|
Established Patient Office Visit (level 1)
|
$109.50 |
$109.50 |
$109.50 |
$115.05
|
|
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 |
$183.60
|
|
Established Patient Office Visit (level 4)
|
$147.75 |
$147.75 |
$147.75 |
$228.60
|
|
Established Patient Office Visit (level 5)
|
$168.75 |
$168.75 |
$168.75 |
$306.40
|
|
Estradiol total
|
$174.00 |
$174.00 |
$174.00 |
$226.50
|
|
Estrogens total-sendout
|
$270.00 |
$270.00 |
$270.00 |
$270.00
|
|
Etanercept injection
|
$7,314.47 |
$7,314.47 |
$7,314.47 |
$1,801.80
|
|
Ethanolamine oleate 100 mg
|
$1,622.73 |
$1,622.73 |
$1,622.73 |
$1,605.00
|
|
Ethylene glycol -sendout
|
$79.50 |
$79.50 |
$79.50 |
$104.40
|
|
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 |
$285.60
|
|
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 |
$156.46
|
|
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 |
$2,001.00
|
|
Evaluation of speech fluency 92521
|
$393.00 |
$393.00 |
$393.00 |
$393.00
|
|
Evaluation psychiatric diagnostic
|
$509.25 |
$509.25 |
$509.25 |
$265.80
|
|
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 |
$1,269.00
|
|
Evasc repair of iliac artery; endograft 34718
|
$15,243.75 |
$15,243.75 |
$15,243.75 |
$14,656.50
|
|
Evasc rpr a-ao ndgft 34701
|
$3,078.00 |
$3,078.00 |
$3,078.00 |
$2,959.50
|
|
Evasc rpr a-ao ndgft rpt 34702
|
$2,142.00 |
$2,142.00 |
$2,142.00 |
$2,059.50
|
|
Evasc rpr a-biiliac ndgft rptr
|
$15,243.75 |
$15,243.75 |
$15,243.75 |
$10,363.80
|
|
Evasc rpr a-iliac ndgft 34717
|
$15,243.75 |
$15,243.75 |
$15,243.75 |
$9,316.20
|
|
Evasc rpr a-unilac ndgft 34703
|
$3,078.00 |
$3,078.00 |
$3,078.00 |
$2,959.50
|
|
Evasc rpr a-unilac ndgft rpt
|
$10,196.25 |
$10,196.25 |
$10,196.25 |
$9,804.00
|
|
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 |
$1,020.00
|
|
Event monitor
|
$330.00 |
$330.00 |
$330.00 |
$330.00
|
|
Evok oa screening qual
|
$286.50 |
$286.50 |
$286.50 |
$263.40
|
|
Evoked auditory tst complete
|
$628.50 |
$628.50 |
$628.50 |
$311.40
|
|
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 |
$572.40
|
|
Evoked potentials auditory screening automated analysis
|
$632.25 |
$632.25 |
$632.25 |
$336.60
|
|
Evoked potentials upper limbs
|
$1,179.00 |
$1,179.00 |
$1,179.00 |
$491.40
|
|
Ex palate/uvula lesion without closure 42104
|
$3,629.25 |
$3,629.25 |
$3,629.25 |
$3,243.07
|
|
Ex sq tumor/face or scalp 2 cm/> 21012
|
$3,845.25 |
$3,845.25 |
$3,845.25 |
$1,620.24
|
|
Ex sq tumor/face or scalp < 2 cm 21011
|
$2,397.75 |
$2,397.75 |
$2,397.75 |
$1,620.24
|
|
Exam of vagina w/scope 57420
|
$1,230.00 |
$1,230.00 |
$1,230.00 |
$615.60
|
|
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 |
$2,184.60
|
|
Exc ben+marg excep skin tag feenlm 2.1-3cm 11443
|
$2,319.75 |
$2,319.75 |
$2,319.75 |
$2,184.60
|
|
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 |
$2,901.00
|
|
Exc ben+marg excep skin tag tal 0.6-1cm 11401
|
$2,131.50 |
$2,131.50 |
$2,131.50 |
$1,501.50
|
|
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 |
$2,910.75
|
|
Exc benign snhfg 3.1-4.0cm 11424
|
$2,306.25 |
$2,306.25 |
$2,306.25 |
$3,417.00
|
|
Exc benign tal 0.5 < cm 11400
|
$2,040.00 |
$2,040.00 |
$2,040.00 |
$1,527.60
|
|
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 |
$1,620.24
|
|
Exc hidradenitis peri/umb int 11470
|
$3,294.00 |
$3,294.00 |
$3,294.00 |
$2,862.05
|
|
Exc im tumor/shoulder area 5cm/> 23073
|
$3,294.00 |
$3,294.00 |
$3,294.00 |
$2,745.00
|
|
Exc les/mucos/sub/ves mouth/no rpr 40810
|
$3,401.25 |
$3,401.25 |
$3,401.25 |
$3,243.07
|
|
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 |
$703.59
|
|
Exc malig snhfg 2.1-3 cm 11623
|
$2,306.25 |
$2,306.25 |
$2,306.25 |
$1,620.24
|
|
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 |
$2,862.05
|
|
Exc prtl bn phlnx toe
|
$3,752.25 |
$3,752.25 |
$3,752.25 |
$3,126.75
|
|
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 |
$3,343.20
|
|
Exc sq tum/neck/ant thorax 3cm/> 21552
|
$5,280.00 |
$5,280.00 |
$5,280.00 |
$2,862.05
|
|
Exc sq tum/vasc malform/hand/fngr 26111
|
$1,897.50 |
$1,897.50 |
$1,897.50 |
$1,620.24
|
|
Exc sq tumor/forearm/wrist/<3cm 25075
|
$1,897.50 |
$1,897.50 |
$1,897.50 |
$3,342.00
|
|
Exc sq tumor/leg/ankle 3cm/> 27632
|
$4,661.25 |
$4,661.25 |
$4,661.25 |
$2,862.05
|
|
Exc sq tumor/thigh/knee area 3cm/> 27337
|
$3,293.25 |
$3,293.25 |
$3,293.25 |
$2,862.05
|
|
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 |
$2,491.20
|
|
Exc tmr sft tiss shldr subq <3cm
|
$1,880.25 |
$1,880.25 |
$1,880.25 |
$1,620.24
|
|
Exc tr-ext mal+marg tal >4 cm 11606
|
$2,732.25 |
$2,732.25 |
$2,732.25 |
$2,577.75
|
|
Exc/pilonidal cyst/sinus/simple 11770
|
$3,163.50 |
$3,163.50 |
$3,163.50 |
$4,284.00
|
|
Exchange biliary drg cath
|
$2,959.50 |
$2,959.50 |
$2,959.50 |
$3,529.06
|
|
Exchange drainage catheter
|
$2,774.25 |
$2,774.25 |
$2,774.25 |
$2,610.75
|
|
Exchange nephrostomy cath
|
$2,515.50 |
$2,515.50 |
$2,515.50 |
$2,572.20
|
|
Excise anal ext tag/papilla
|
$1,380.00 |
$1,380.00 |
$1,380.00 |
$2,813.40
|
|
Excise lip or cheek fold
|
$2,247.75 |
$2,247.75 |
$2,247.75 |
$1,481.28
|
|
Excise/repair mouth lesion
|
$3,501.00 |
$3,501.00 |
$3,501.00 |
$1,481.28
|
|
Excision benign lesion face/ears/eyelids/nose/lips/muc memb 0.6 - 1.0 cm
|
$1,447.50 |
$1,447.50 |
$1,447.50 |
$2,184.60
|
|
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 |
$3,265.20
|
|
Excision lesion mouth roof
|
$3,600.75 |
$3,600.75 |
$3,600.75 |
$3,243.07
|
|
Excision of anal lesion(s)
|
$3,190.50 |
$3,190.50 |
$3,190.50 |
$3,114.00
|
|
Excision of penis lesion(s) 54060
|
$2,371.50 |
$2,371.50 |
$2,371.50 |
$1,976.25
|
|
Excision of tongue lesion
|
$3,732.00 |
$3,732.00 |
$3,732.00 |
$3,243.07
|
|
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 |
$2,715.00
|
|
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 |
$2,967.60
|
|
Expander tiss 133s-mv-12-t 300ml natrelle smth
|
$7,852.50 |
$7,852.50 |
$7,852.50 |
$4,135.20
|
|
Explore penetrating wnd/extremity 20103
|
$1,971.00 |
$1,971.00 |
$1,971.00 |
$3,349.80
|
|
Explore woundchest 20101
|
$2,113.50 |
$2,113.50 |
$2,113.50 |
$1,829.23
|
|
Explore/treat knee joint
|
$4,723.50 |
$4,723.50 |
$4,723.50 |
$3,244.61
|
|
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 |
$128.90
|
|
External chromosome analysis 20-25 cells
|
$457.50 |
$457.50 |
$457.50 |
$869.40
|
|
External tissue culture neoplastic disorders bone marrow/blood cells
|
$943.50 |
$943.50 |
$943.50 |
$903.75
|
|
Extractable nuclear antigen/antibody any method each antibody centromere
|
$234.00 |
$234.00 |
$234.00 |
$159.00
|
|
Eye implant band 40
|
$356.07 |
$356.07 |
$356.07 |
$2,927.40
|
|
F-18 fdg pet diag
|
$2,773.11 |
$2,773.11 |
$2,773.11 |
$1,257.60
|
|
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 |
$320.40
|
|
Factor ix
|
$254.25 |
$254.25 |
$254.25 |
$186.75
|
|
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 |
$7.80
|
|
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 |
$34.65
|
|
Factor viii
|
$274.50 |
$274.50 |
$274.50 |
$213.00
|
|
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 |
$2,904.00
|
|
Family therapy with patient 50 min 90847
|
$297.00 |
$297.00 |
$297.00 |
$160.67
|
|
Family therapy without pt 50min 90846
|
$309.75 |
$309.75 |
$309.75 |
$160.67
|
|
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 |
$911.71
|
|
Felbamate (felbatol(r)) - sendout
|
$97.50 |
$97.50 |
$97.50 |
$133.50
|
|
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 |
$144.00
|
|
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 |
$212.40
|
|
Ferumoxytol 510 mg/17 ml (30 mg/ml) intravenous solution
|
$4,030.11 |
$4,030.11 |
$4,030.11 |
$3,963.60
|
|
Fetal biophys profile w/nst 76818
|
$831.75 |
$831.75 |
$831.75 |
$656.25
|
|
Fetal contract stress test 59020 - 26
|
$267.75 |
$267.75 |
$267.75 |
$201.17
|
|
Fetal hemoglobin rosette
|
$204.00 |
$204.00 |
$204.00 |
$78.60
|
|
Fetal non stress test
|
$478.50 |
$478.50 |
$478.50 |
$391.50
|
|
Fetal shunt placement w/us
|
$355.50 |
$355.50 |
$355.50 |
$304.19
|
|
Fibrin degradation d dimer quantitative
|
$162.00 |
$162.00 |
$162.00 |
$87.60
|
|
Fibrin degradation products
|
$171.00 |
$171.00 |
$171.00 |
$91.80
|
|
Fibrinogen activity
|
$113.25 |
$113.25 |
$113.25 |
$80.40
|
|
Fibrinolysins/coagulopathy screen interpretation/report
|
$72.00 |
$72.00 |
$72.00 |
$72.00
|
|
Fibrinolytic antiplasmin
|
$103.50 |
$103.50 |
$103.50 |
$81.00
|
|
Fibrinolytic plasminogen
|
$650.25 |
$650.25 |
$650.25 |
$159.60
|
|
Fibrinolytic plasminogen xcpt antgnc asa
|
$544.50 |
$544.50 |
$544.50 |
$83.40
|
|
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 |
$5,179.20
|
|
Filtered speech hearing test
|
$237.00 |
$237.00 |
$237.00 |
$39.25
|
|
Fine needle asp without image guide 10021
|
$642.75 |
$642.75 |
$642.75 |
$722.40
|
|
Fine needle aspiration biopsy w/fluor gdn; ea addtl 10008
|
$1,165.50 |
$1,165.50 |
$1,165.50 |
$621.75
|
|
Fine needle aspiration biopsy w/fluor gdn;1st lesion 10007
|
$1,219.50 |
$1,219.50 |
$1,219.50 |
$777.00
|
|
Fine needle aspiration biopsy w/us gdn; ea addtl 10006
|
$1,165.50 |
$1,165.50 |
$1,165.50 |
$738.00
|
|
Fine needle aspiration biopsy without img gdn; ea addtl 10004
|
$226.50 |
$226.50 |
$226.50 |
$168.00
|
|
Fixation of knee joint
|
$1,863.75 |
$1,863.75 |
$1,863.75 |
$1,600.41
|
|
Fl exam g/colon tube w contrast
|
$565.50 |
$565.50 |
$565.50 |
$626.40
|
|
Flebogamma injection
|
$3,562.92 |
$3,562.92 |
$3,562.92 |
$3,562.92
|
|
Flecainide (tambocor)-sendout
|
$96.00 |
$96.00 |
$96.00 |
$129.60
|
|
Flexible Sigmoidoscopy
|
$1,763.25 |
$1,763.25 |
$1,763.25 |
$1,158.00
|
|
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 |
$288.60
|
|
Floxuridine injection
|
$14,923.11 |
$14,923.11 |
$14,923.11 |
$8,522.40
|
|
Flt3 gene
|
$206.25 |
$206.25 |
$206.25 |
$277.80
|
|
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 |
$95.40
|
|
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 |
$186.60
|
|
Fluoroguide for spine inject 77003-26
|
$843.75 |
$843.75 |
$843.75 |
$678.00
|
|
Fluoroguide needle placement
|
$599.25 |
$599.25 |
$599.25 |
$599.25
|
|
Fluoroscopy up to 1 hour
|
$818.25 |
$818.25 |
$818.25 |
$534.60
|
|
Fluorouracil 50 mg/ml intravenous solution (wrapper)
|
$203.74 |
$203.74 |
$203.74 |
$152.80
|
|
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 |
$1,337.25
|
|
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 |
$738.00
|
|
Fna bx w/mr gdn 1st les
|
$900.75 |
$900.75 |
$900.75 |
$738.00
|
|
Fna bx w/mr gdn ea addl
|
$847.50 |
$847.50 |
$847.50 |
$833.25
|
|
Folic acid
|
$85.50 |
$85.50 |
$85.50 |
$117.00
|
|
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 |
$490.80
|
|
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 |
$530.25
|
|
Fragmenting of kidney stone
|
$9,827.25 |
$9,827.25 |
$9,827.25 |
$9,085.50
|
|
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 |
$237.00
|
|
Fresh frozen plasma thawing ea un
|
$131.25 |
$131.25 |
$131.25 |
$121.20
|
|
Fructosamine glycated protein
|
$76.50 |
$76.50 |
$76.50 |
$85.20
|
|
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 |
$1,306.80
|
|
G-tube reposition
|
$631.50 |
$631.50 |
$631.50 |
$865.50
|
|
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 |
$4.80
|
|
Gadoterate meglumine 0.5 mmol/ml (376.9 mg/ml) intravenous solution
|
$119.29 |
$119.29 |
$119.29 |
$65.40
|
|
Gadoxetate 0.25 mmol/ml (181.43 mg/ml) intravenous solution
|
$486.60 |
$486.60 |
$486.60 |
$62.40
|
|
Galac-1-phosphate uridyltran - sendout
|
$85.50 |
$85.50 |
$85.50 |
$41.40
|
|
Galectin-3
|
$280.50 |
$280.50 |
$280.50 |
$78.00
|
|
Gamma glutamyltransferase
|
$77.25 |
$77.25 |
$77.25 |
$88.20
|
|
Gammaglobulin iga
|
$183.00 |
$183.00 |
$183.00 |
$169.50
|
|
Gammaglobulin ige
|
$148.50 |
$148.50 |
$148.50 |
$144.60
|
|
Gamunex-c/gammaked
|
$8,519.04 |
$8,519.04 |
$8,519.04 |
$338.40
|
|
Ganciclovir in ns IV syringe 10 mg/ml (neo/ped) - cnr
|
$94.28 |
$94.28 |
$94.28 |
$415.20
|
|
Gastric motility studies
|
$1,942.50 |
$1,942.50 |
$1,942.50 |
$1,317.00
|
|
Gastrin test
|
$138.00 |
$138.00 |
$138.00 |
$106.50
|
|
Gastroesophageal reflux study
|
$1,232.25 |
$1,232.25 |
$1,232.25 |
$1,139.25
|
|
Gastroesophageal reflux test
|
$1,635.75 |
$1,635.75 |
$1,635.75 |
$1,115.40
|
|
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 |
$365.40
|
|
Gemtuzumab ozogamicin 4.5 mg (1 mg/ml initial concentration) IV soln
|
$37,698.54 |
$37,698.54 |
$37,698.54 |
$236.62
|
|
Generator barostim neo2 2014
|
$83,687.18 |
$83,687.18 |
$83,687.18 |
$52,543.20
|
|
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 |
$4,439.40
|
|
Gentamicin 10 mg/ml liquid compound - enteral use only
|
$85.57 |
$85.57 |
$85.57 |
$49.60
|
|
Gentamicin peak therapeutic drug level
|
$156.75 |
$156.75 |
$156.75 |
$156.75
|
|
Ghs HIV antibody
|
$147.75 |
$147.75 |
$147.75 |
$103.20
|
|
Ghs IV inf sq injection, on-body injector
|
$166.50 |
$166.50 |
$166.50 |
$138.60
|
|
Ghs IV infusion bamlanivimab/etesevimab
|
$784.50 |
$784.50 |
$784.50 |
$1,020.00
|
|
Ghs IV infusion casirivimab/imdevimab
|
$784.50 |
$784.50 |
$784.50 |
$1,020.00
|
|
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 |
$1,829.60
|
|
Ghs abscess postoperative iandd complex
|
$4,318.50 |
$4,318.50 |
$4,318.50 |
$3,993.00
|
|
Ghs acetylcholinesterase, rbc
|
$133.50 |
$133.50 |
$133.50 |
$119.25
|
|
Ghs alcohol, methyl (methanol)-medtox
|
$858.00 |
$858.00 |
$858.00 |
$147.60
|
|
Ghs analysis neurostim without reprogramming
|
$829.50 |
$829.50 |
$829.50 |
$574.80
|
|
Ghs antibodies (torch) igm
|
$131.25 |
$131.25 |
$131.25 |
$131.25
|
|
Ghs bladder cath - complex-foley
|
$277.50 |
$277.50 |
$277.50 |
$492.00
|
|
Ghs block ilioinguinal/gentitofemoral
|
$1,471.50 |
$1,471.50 |
$1,471.50 |
$1,260.60
|
|
Ghs central line insert < age 5, failed
|
$2,676.75 |
$2,676.75 |
$2,676.75 |
$3,145.80
|
|
Ghs change cysto/gastrost
|
$909.00 |
$909.00 |
$909.00 |
$1,265.40
|
|
Ghs chemo >8 hrs
|
$862.50 |
$862.50 |
$862.50 |
$772.50
|
|
Ghs chemo IV push, ea addtl
|
$736.50 |
$736.50 |
$736.50 |
$378.00
|
|
Ghs chlamydia pneumoniae by pcr (arup) (306630)
|
$744.75 |
$744.75 |
$744.75 |
$360.00
|
|
Ghs cl tx knee disl; wo anesth
|
$261.75 |
$261.75 |
$261.75 |
$1,961.40
|
|
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 |
$825.60
|
|
Ghs closed tx bimalleolar fracture w/manip
|
$1,198.50 |
$1,198.50 |
$1,198.50 |
$1,635.60
|
|
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 |
$1,600.41
|
|
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 |
$2,632.20
|
|
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 |
$2,319.00
|
|
Ghs community re-entry 15 minutes
|
$96.75 |
$96.75 |
$96.75 |
$75.60
|
|
Ghs conjunctiva foreign body-embed bil
|
$393.00 |
$393.00 |
$393.00 |
$494.40
|
|
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 |
$408.60
|
|
Ghs corneal fb without slit lamp bilat
|
$422.25 |
$422.25 |
$422.25 |
$422.25
|
|
Ghs cricothyroidotomy
|
$271.50 |
$271.50 |
$271.50 |
$777.60
|
|
Ghs dislocation elbow closed treatment
|
$525.75 |
$525.75 |
$525.75 |
$856.20
|
|
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 |
$370.80
|
|
Ghs eeg cont rec w/video by tec min 8 chnls
|
$843.75 |
$843.75 |
$843.75 |
$586.80
|
|
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 |
$1,341.60
|
|
Ghs excision ingrown nail
|
$311.25 |
$311.25 |
$311.25 |
$484.80
|
|
Ghs eye exam
|
$136.50 |
$136.50 |
$136.50 |
$128.87
|
|
Ghs eyelid foreign body-embedded - bil
|
$349.50 |
$349.50 |
$349.50 |
$718.20
|
|
Ghs fat & muscle
|
$45.75 |
$45.75 |
$45.75 |
$33.00
|
|
Ghs fb removal - incisional
|
$1,253.25 |
$1,253.25 |
$1,253.25 |
$3,182.40
|
|
Ghs fb removal - non-incisional
|
$1,897.50 |
$1,897.50 |
$1,897.50 |
$1,551.00
|
|
Ghs fb removal foot - deep - left
|
$2,538.75 |
$2,538.75 |
$2,538.75 |
$3,771.00
|
|
Ghs fb removal from muscle - complicated
|
$5,736.75 |
$5,736.75 |
$5,736.75 |
$3,737.40
|
|
Ghs febrile agglutinns(mayo)
|
$76.50 |
$76.50 |
$76.50 |
$76.50
|
|
Ghs fish cytogen
|
$1,133.25 |
$1,133.25 |
$1,133.25 |
$186.00
|
|
Ghs fish hybrid in situ 100-300
|
$566.25 |
$566.25 |
$566.25 |
$354.60
|
|
Ghs flow volume loop
|
$364.50 |
$364.50 |
$364.50 |
$223.20
|
|
Ghs gastric intub aspiration lavage
|
$363.75 |
$363.75 |
$363.75 |
$304.80
|
|
Ghs hcv amplificaiton
|
$442.50 |
$442.50 |
$442.50 |
$223.80
|
|
Ghs hepatitis c virus (hcv riba)
|
$828.00 |
$828.00 |
$828.00 |
$162.00
|
|
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 |
$2,637.00
|
|
Ghs i and d pilonidal cyst complex
|
$2,460.00 |
$2,460.00 |
$2,460.00 |
$1,572.00
|
|
Ghs i and d pilonidal cyst simple
|
$825.00 |
$825.00 |
$825.00 |
$703.59
|
|
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 |
$4,051.20
|
|
Ghs inhibitor screen
|
$662.25 |
$662.25 |
$662.25 |
$345.00
|
|
Ghs init tx 1st degree burn
|
$485.25 |
$485.25 |
$485.25 |
$448.50
|
|
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 |
$1,231.20
|
|
Ghs inj tendon origin/insertion
|
$293.25 |
$293.25 |
$293.25 |
$467.40
|
|
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 |
$1,957.50
|
|
Ghs insertion of needle - bone
|
$366.75 |
$366.75 |
$366.75 |
$550.80
|
|
Ghs intermed repair 12.6 - 20.0 cm-12035
|
$2,315.25 |
$2,315.25 |
$2,315.25 |
$1,829.40
|
|
Ghs intermed repair 20.1 - 30.0 cm-12036
|
$735.00 |
$735.00 |
$735.00 |
$2,649.00
|
|
Ghs intermed repair over 30 cm - 12037
|
$2,912.25 |
$2,912.25 |
$2,912.25 |
$3,532.20
|
|
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 |
$2,619.00
|
|
Ghs lac repair mouth.ant tong 2.5cm/less
|
$478.50 |
$478.50 |
$478.50 |
$569.60
|
|
Ghs layer closure 2.5 cm or less - 12031
|
$396.00 |
$396.00 |
$396.00 |
$477.00
|
|
Ghs layer closure 2.5 cm or less - 12041
|
$1,428.75 |
$1,428.75 |
$1,428.75 |
$825.60
|
|
Ghs layer closure 2.5cm or less - 12051
|
$550.50 |
$550.50 |
$550.50 |
$520.80
|
|
Ghs layer closure 2.6 - 5.0 cm - 12052
|
$1,967.25 |
$1,967.25 |
$1,967.25 |
$825.60
|
|
Ghs layer closure 2.6 - 7.5 cm - 12042
|
$2,092.50 |
$2,092.50 |
$2,092.50 |
$825.60
|
|
Ghs layer closure 5.1 - 7.5 cm - 12053
|
$2,133.00 |
$2,133.00 |
$2,133.00 |
$825.60
|
|
Ghs layer closure 7.6 - 12.5 cm - 12034
|
$876.00 |
$876.00 |
$876.00 |
$998.40
|
|
Ghs layer closure 7.6 - 12.5 cm - 12044
|
$735.00 |
$735.00 |
$735.00 |
$1,212.00
|
|
Ghs layer closure 7.6 - 12.5 cm - 12054
|
$471.75 |
$471.75 |
$471.75 |
$825.60
|
|
Ghs layered repair 12.6 - 20.0 cm -12045
|
$979.50 |
$979.50 |
$979.50 |
$1,134.60
|
|
Ghs layered repair 12.6 - 20.0 cm -12055
|
$471.75 |
$471.75 |
$471.75 |
$993.00
|
|
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 |
$143.25
|
|
Ghs moderate sedation < 5 yr, 30 min
|
$738.00 |
$738.00 |
$738.00 |
$429.60
|
|
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 |
$429.60
|
|
Ghs musc test done w/n test comp
|
$392.25 |
$392.25 |
$392.25 |
$322.80
|
|
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 |
$322.80
|
|
Ghs myocardial strain img spckl track
|
$138.00 |
$138.00 |
$138.00 |
$792.60
|
|
Ghs nailbed repair/nail removal
|
$900.00 |
$900.00 |
$900.00 |
$1,236.60
|
|
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 |
$1,541.40
|
|
Ghs nerve block axillary nerve
|
$1,907.25 |
$1,907.25 |
$1,907.25 |
$1,763.25
|
|
Ghs nerve block brachial plexus
|
$1,828.50 |
$1,828.50 |
$1,828.50 |
$1,689.00
|
|
Ghs nerve block celiac plexus
|
$2,300.25 |
$2,300.25 |
$2,300.25 |
$2,512.80
|
|
Ghs nerve block interscaline
|
$1,926.75 |
$1,926.75 |
$1,926.75 |
$1,671.75
|
|
Ghs nerve block lumbar or thoracic symp
|
$1,907.25 |
$1,907.25 |
$1,907.25 |
$1,787.40
|
|
Ghs nerve block sciatic nerve
|
$1,745.25 |
$1,745.25 |
$1,745.25 |
$1,809.60
|
|
Ghs nerve block suprascapular
|
$1,471.50 |
$1,471.50 |
$1,471.50 |
$1,131.00
|
|
Ghs ng placement w fluoro guidance
|
$684.75 |
$684.75 |
$684.75 |
$589.80
|
|
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 |
$4,080.00
|
|
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 |
$260.40
|
|
Ghs osteopathic manipulative tx, 1-2 regions
|
$54.00 |
$54.00 |
$54.00 |
$47.80
|
|
Ghs osteopathic manipulative tx, 3-4 regions
|
$88.50 |
$88.50 |
$88.50 |
$25.30
|
|
Ghs ot dds rom
|
$196.50 |
$196.50 |
$196.50 |
$194.25
|
|
Ghs ot prosthetic training/15 min
|
$138.75 |
$138.75 |
$138.75 |
$121.20
|
|
Ghs ot sensory integrative tech/15min
|
$138.75 |
$138.75 |
$138.75 |
$124.20
|
|
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 |
$1,656.60
|
|
Ghs paravert facet/nerve lumb ea add bil
|
$1,053.00 |
$1,053.00 |
$1,053.00 |
$1,386.00
|
|
Ghs peritonsillar abscess i andd
|
$765.75 |
$765.75 |
$765.75 |
$1,080.75
|
|
Ghs phenylketonurid
|
$148.50 |
$148.50 |
$148.50 |
$128.25
|
|
Ghs picc line insert < 5
|
$6,876.75 |
$6,876.75 |
$6,876.75 |
$3,226.80
|
|
Ghs plngl fx pm cl
|
$418.50 |
$418.50 |
$418.50 |
$685.80
|
|
Ghs pos nystagmus
|
$678.00 |
$678.00 |
$678.00 |
$251.40
|
|
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 |
$83.40
|
|
Ghs protoporphyrins fract
|
$60.75 |
$60.75 |
$60.75 |
$87.60
|
|
Ghs pseudocholinesterase,dibucain-inhibi
|
$138.75 |
$138.75 |
$138.75 |
$108.00
|
|
Ghs refill of implantable pump
|
$870.75 |
$870.75 |
$870.75 |
$774.00
|
|
Ghs removal intranasal foreign body
|
$531.75 |
$531.75 |
$531.75 |
$341.40
|
|
Ghs removal pharyngeal foreign body
|
$478.50 |
$478.50 |
$478.50 |
$397.50
|
|
Ghs sensitivity (per antimicro)
|
$78.75 |
$78.75 |
$78.75 |
$74.40
|
|
Ghs simple repair 12.6 - 20.0 cm - 12005
|
$368.25 |
$368.25 |
$368.25 |
$819.60
|
|
Ghs simple repair 12.6 - 20.0 cm - 12016
|
$368.25 |
$368.25 |
$368.25 |
$1,230.60
|
|
Ghs simple repair 20.1 - 30.0 cm - 12006
|
$374.25 |
$374.25 |
$374.25 |
$965.40
|
|
Ghs simple repair 20.1 - 30.0 cm - 12017
|
$374.25 |
$374.25 |
$374.25 |
$2,079.60
|
|
Ghs simple repair 5.1 - 7.5 cm - 12014
|
$364.50 |
$364.50 |
$364.50 |
$589.80
|
|
Ghs simple repair 7.6 - 12.5 cm - 12004
|
$362.25 |
$362.25 |
$362.25 |
$589.80
|
|
Ghs simple repair 7.6 - 12.5 cm - 12015
|
$364.50 |
$364.50 |
$364.50 |
$589.80
|
|
Ghs simple repair over 30 cm - 12007
|
$381.75 |
$381.75 |
$381.75 |
$660.00
|
|
Ghs simple repair over 30 cm - 12018
|
$381.75 |
$381.75 |
$381.75 |
$198.70
|
|
Ghs somatosensory testing lower extremit
|
$1,464.00 |
$1,464.00 |
$1,464.00 |
$978.60
|
|
Ghs somatosensory testing upper & lower limbs
|
$2,091.75 |
$2,091.75 |
$2,091.75 |
$855.60
|
|
Ghs sp train/fitting sp device - kx
|
$365.25 |
$365.25 |
$365.25 |
$324.75
|
|
Ghs speech-gen aug dev eval iii, st
|
$230.25 |
$230.25 |
$230.25 |
$188.80
|
|
Ghs sphenopalatine ganglion block
|
$2,005.50 |
$2,005.50 |
$2,005.50 |
$901.80
|
|
Ghs spont nystagmus
|
$256.50 |
$256.50 |
$256.50 |
$250.80
|
|
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 |
$410.25
|
|
Ghs strapping shoulder - 29240
|
$257.25 |
$257.25 |
$257.25 |
$346.20
|
|
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 |
$945.60
|
|
Ghs superficial wnd dehiscence simp12020
|
$728.25 |
$728.25 |
$728.25 |
$2,181.60
|
|
Ghs tx distal phalangeal fx with manipulation
|
$405.75 |
$405.75 |
$405.75 |
$660.00
|
|
Ghs urine, porphyrins quant
|
$499.50 |
$499.50 |
$499.50 |
$288.60
|
|
Ghs vaginal delivery only
|
$2,361.75 |
$2,361.75 |
$2,361.75 |
$3,179.53
|
|
Ghs veeg 12-26 hr intmt mont
|
$2,699.25 |
$2,699.25 |
$2,699.25 |
$2,109.60
|
|
Gi inhouse confirmation
|
$79.50 |
$79.50 |
$79.50 |
$84.60
|
|
Gi tract capsule endoscopy (pillcam) 91110
|
$2,745.00 |
$2,745.00 |
$2,745.00 |
$1,582.50
|
|
Giardia lamblia antibody
|
$147.00 |
$147.00 |
$147.00 |
$114.00
|
|
Glassia injection
|
$2,551.28 |
$2,551.28 |
$2,551.28 |
$41.40
|
|
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 |
$131.40
|
|
Glucose 1 hr post dose
|
$168.00 |
$168.00 |
$168.00 |
$45.00
|
|
Glucose blood by monitoring device cleared by fda for home use
|
$39.00 |
$39.00 |
$39.00 |
$30.00
|
|
Glucose blood quantitative
|
$45.00 |
$45.00 |
$45.00 |
$45.00
|
|
Glucose body fluid
|
$72.75 |
$72.75 |
$72.75 |
$59.25
|
|
Glucose tolerance test (gtt) 3 specimens
|
$201.75 |
$201.75 |
$201.75 |
$147.00
|
|
Glucose tolerance test (gtt) >3 specimens each additional
|
$63.00 |
$63.00 |
$63.00 |
$34.80
|
|
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 |
$11.70
|
|
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 |
$171.75
|
|
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 |
$1,831.20
|
|
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 |
$28,358.40
|
|
Graft nerve adv 3-4x70mm
|
$27,652.41 |
$27,652.41 |
$27,652.41 |
$25,992.80
|
|
Graft patch felt ptfe 2x2
|
$78,750.00 |
$78,750.00 |
$78,750.00 |
$7,958.40
|
|
Graft primatrix xcr 6cm x6cm n-q4110-cost per sq cm
|
$29,670.10 |
$29,670.10 |
$29,670.10 |
$3,645.60
|
|
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 |
$3,681.60
|
|
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 |
$6,241.80
|
|
Graft tiss strattice 10x10 frm 10x10cm firm -cost per sq cm
|
$66,548.25 |
$66,548.25 |
$66,548.25 |
$53,576.40
|
|
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 |
$30,786.60
|
|
Graft xenmtrx sft rect 19x28cm
|
$6,187.50 |
$6,187.50 |
$6,187.50 |
$3,076.20
|
|
Great toe with reduction 28495
|
$581.25 |
$581.25 |
$581.25 |
$825.60
|
|
Growth stimulation gene 2
|
$1,637.25 |
$1,637.25 |
$1,637.25 |
$237.60
|
|
Gu dilat ureter/urethra s&i
|
$1,712.25 |
$1,712.25 |
$1,712.25 |
$2,048.51
|
|
Guide endoanchr sg-64 aaa 62cm
|
$2,108.25 |
$2,108.25 |
$2,108.25 |
$9,038.40
|
|
Guide wire threaded 1.4x150mm
|
$20,413.63 |
$20,413.63 |
$20,413.63 |
$2,825.40
|
|
Guide worley csg 9fx50cm std
|
$3,593.25 |
$3,593.25 |
$3,593.25 |
$1,083.60
|
|
Guided cath fluid drainage 10030
|
$542.25 |
$542.25 |
$542.25 |
$1,600.20
|
|
Gw stiffened micro access kit
|
$101,250.00 |
$101,250.00 |
$101,250.00 |
$3,215.40
|
|
H pylori (c-13) breath
|
$342.75 |
$342.75 |
$342.75 |
$346.80
|
|
Haloperidol decanoate 50 mg/ml intramuscular solution
|
$120.02 |
$120.02 |
$120.02 |
$160.00
|
|
Haloperidol lactate 5 mg/ml injection solution
|
$8.58 |
$8.58 |
$8.58 |
$9.00
|
|
Hand X-ray
|
$431.25 |
$431.25 |
$431.25 |
$313.04
|
|
Haptoglobin quantitative
|
$105.00 |
$105.00 |
$105.00 |
$135.00
|
|
Hast w/i&r phys/qhp
|
$351.00 |
$351.00 |
$351.00 |
$275.40
|
|
Hast w/oxygen titrate
|
$422.25 |
$422.25 |
$422.25 |
$226.80
|
|
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 |
$714.75
|
|
Hbot, full body chamber, 30m
|
$738.75 |
$738.75 |
$738.75 |
$756.60
|
|
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 |
$679.20
|
|
Hc nm kidney imaging with flow
|
$1,419.75 |
$1,419.75 |
$1,419.75 |
$1,228.80
|
|
Hc nm myocard infarct avid plnr tomo spect w/wo quant
|
$1,006.50 |
$1,006.50 |
$1,006.50 |
$807.75
|
|
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 |
$85.20
|
|
Hcg quantitative
|
$88.50 |
$88.50 |
$88.50 |
$145.50
|
|
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 |
$1,070.25
|
|
Hematocrit
|
$52.50 |
$52.50 |
$52.50 |
$37.20
|
|
Hematopoietic nuclear tx
|
$2,648.25 |
$2,648.25 |
$2,648.25 |
$746.40
|
|
Hemin 350 mg intravenous powder for solution
|
$41,382.91 |
$41,382.91 |
$41,382.91 |
$6,247.80
|
|
Hemoglobin
|
$52.50 |
$52.50 |
$52.50 |
$36.75
|
|
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 |
$61.20
|
|
Hemorrhoidectomy intrnl lig rbbr band ligations
|
$1,314.00 |
$1,314.00 |
$1,314.00 |
$2,925.00
|
|
Hepagam b im injection
|
$2,543.59 |
$2,543.59 |
$2,543.59 |
$586.80
|
|
Heparin assay
|
$194.25 |
$194.25 |
$194.25 |
$178.20
|
|
Heparin bolus from bag
|
$57.46 |
$57.46 |
$57.46 |
$39.40
|
|
Heparin neutralization
|
$187.50 |
$187.50 |
$187.50 |
$187.50
|
|
Heparin, porcine (pf) 10 unit/ml flush (wrapper)
|
$6.20 |
$6.20 |
$6.20 |
$5.40
|
|
Hepatitis a antibody igm
|
$84.00 |
$84.00 |
$84.00 |
$107.25
|
|
Hepatitis b core antibody igm
|
$127.50 |
$127.50 |
$127.50 |
$127.50
|
|
Hepatitis b core antibody total
|
$84.75 |
$84.75 |
$84.75 |
$111.75
|
|
Hepatitis b immune globulin greater than 1,560 units/5 ml im solution
|
$1,890.21 |
$1,890.21 |
$1,890.21 |
$1,109.60
|
|
Hepatitis b surface antibody
|
$88.50 |
$88.50 |
$88.50 |
$106.20
|
|
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 |
$108.00
|
|
Hepatitis d quantification
|
$1,161.75 |
$1,161.75 |
$1,161.75 |
$627.00
|
|
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 |
$96.00
|
|
Herpes simplex type 2 antibody igg
|
$111.00 |
$111.00 |
$111.00 |
$109.80
|
|
Herpes simplex virus isolation
|
$54.75 |
$54.75 |
$54.75 |
$186.60
|
|
Heterophile antibodies screening
|
$97.50 |
$97.50 |
$97.50 |
$56.40
|
|
Hhv-6 dna quant
|
$652.50 |
$652.50 |
$652.50 |
$457.80
|
|
Hip X-ray
|
$436.50 |
$436.50 |
$436.50 |
$290.00
|
|
Histamine
|
$189.00 |
$189.00 |
$189.00 |
$254.40
|
|
Hizentra injection
|
$4,991.26 |
$4,991.26 |
$4,991.26 |
$181.20
|
|
Hla class i high defin qual
|
$666.75 |
$666.75 |
$666.75 |
$435.60
|
|
Hla class i semiquant panel
|
$697.50 |
$697.50 |
$697.50 |
$645.00
|
|
Hla class i/ii antibody qual
|
$435.00 |
$435.00 |
$435.00 |
$418.50
|
|
Hla class ii high defin qual
|
$568.50 |
$568.50 |
$568.50 |
$471.00
|
|
Hla class ii semiquant panel
|
$620.25 |
$620.25 |
$620.25 |
$573.00
|
|
Hla i & ii type verify lr
|
$342.00 |
$342.00 |
$342.00 |
$365.25
|
|
Hla i low res one antigen equiv ea
|
$197.25 |
$197.25 |
$197.25 |
$791.40
|
|
Hla i typing 1 locus hr
|
$177.00 |
$177.00 |
$177.00 |
$177.25
|
|
Hla i typing complete hr
|
$381.00 |
$381.00 |
$381.00 |
$386.25
|
|
Hla i typing complete lr
|
$488.25 |
$488.25 |
$488.25 |
$1,672.20
|
|
Hla i typing high res 1 allele grp ea
|
$201.75 |
$201.75 |
$201.75 |
$688.80
|
|
Hla ii typing 1 loc hr
|
$867.00 |
$867.00 |
$867.00 |
$1,001.25
|
|
Hla ii typing ag equiv lr
|
$193.50 |
$193.50 |
$193.50 |
$797.40
|
|
Hla x-match noncytotoxc addl
|
$168.00 |
$168.00 |
$168.00 |
$155.25
|
|
Hla x-math non-cytotoxic
|
$429.75 |
$429.75 |
$429.75 |
$397.50
|
|
Hlth bhv assmt/reassessment
|
$117.00 |
$117.00 |
$117.00 |
$144.75
|
|
Hlth bhv ivntj fam 1st 30
|
$115.50 |
$115.50 |
$115.50 |
$111.60
|
|
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 |
$34.80
|
|
Homocysteine
|
$90.75 |
$90.75 |
$90.75 |
$102.75
|
|
Homovanillic acid (hva)
|
$220.50 |
$220.50 |
$220.50 |
$108.00
|
|
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 |
$1,271.40
|
|
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 |
$92.80
|
|
Hydration IV infusion each additional hour
|
$456.75 |
$456.75 |
$456.75 |
$214.80
|
|
Hydration IV infusion initial 31minutes - 1 hour
|
$722.25 |
$722.25 |
$722.25 |
$490.20
|
|
Hydrocortisone in ns IV syringe 1 mg/ml (neo/ped) - cnr
|
$569.91 |
$569.91 |
$569.91 |
$121.20
|
|
Hydromorphone 0.2 mg/ml in 0.9% nacl IV pca opioid naive - 4 hr dose limit (wrapper)
|
$72.63 |
$72.63 |
$72.63 |
$12.75
|
|
Hydromorphone 20-0.9 mg/100ml-% soln 100 ml cartridge
|
$277.32 |
$277.32 |
$277.32 |
$654.40
|
|
Hydroxocobalamin im 10mcg
|
$83.64 |
$83.64 |
$83.64 |
$83.64
|
|
Hydroxyzine hcl 50 mg/ml intramuscular solution
|
$87.60 |
$87.60 |
$87.60 |
$17.55
|
|
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 |
$4,936.45
|
|
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 |
$4,936.45
|
|
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 |
$150.00
|
|
I&d frarm&/wrst deep absc/hematoma
|
$3,761.25 |
$3,761.25 |
$3,761.25 |
$3,350.40
|
|
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 |
$10,866.00
|
|
I-123 ioflupane diag
|
$9,058.88 |
$9,058.88 |
$9,058.88 |
$8,455.20
|
|
IV infusion therapy/prophylaxis/diagnosis addl sequential infusion new drug/substance > 1 hour
|
$456.75 |
$456.75 |
$456.75 |
$285.60
|
|
IV infusion therapy/prophylaxis/diagnosis concurrent infusion
|
$454.50 |
$454.50 |
$454.50 |
$325.20
|
|
IV infusion therapy/prophylaxis/diagnosis each additional 1 hour
|
$456.75 |
$456.75 |
$456.75 |
$298.20
|
|
IV infusion therapy/prophylaxis/diagnosis initial up to 1 hour
|
$722.25 |
$722.25 |
$722.25 |
$586.50
|
|
Ia infect ag ab qual/semiquant sgl step
|
$36.75 |
$36.75 |
$36.75 |
$48.00
|
|
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 |
$14,973.00
|
|
Icut allergy test drug/bug
|
$118.50 |
$118.50 |
$118.50 |
$115.80
|
|
Idarubicin hcl injection
|
$249.51 |
$249.51 |
$249.51 |
$555.60
|
|
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 |
$1,392.00
|
|
Ihc/icc per specimen each additional single antibody stain
|
$309.75 |
$309.75 |
$309.75 |
$286.50
|
|
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 |
$59.40
|
|
Immobilizer shldr cntor adlt
|
$134.01 |
$134.01 |
$134.01 |
$198.00
|
|
Immobilizer shldr dlx str 24-36in med
|
$67.77 |
$67.77 |
$67.77 |
$198.00
|
|
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 |
$623.20
|
|
Immune globulin, gamma (igg) (10 %)-malt-iga over 50 mcg/ml intravenous solution
|
$3,486.01 |
$3,486.01 |
$3,486.01 |
$1,080.00
|
|
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 |
$141.00
|
|
Immunoassay tumor antigen quantitative ca 19-9
|
$130.50 |
$130.50 |
$130.50 |
$159.00
|
|
Immunodiff gel qual ea antigen/ab
|
$108.00 |
$108.00 |
$108.00 |
$123.00
|
|
Immunodiffusion nes
|
$189.75 |
$189.75 |
$189.75 |
$148.80
|
|
Immunofixation electrophoresis serum
|
$231.00 |
$231.00 |
$231.00 |
$219.60
|
|
Immunofluorescence per specimen each additional single antibody stain
|
$511.50 |
$511.50 |
$511.50 |
$108.00
|
|
Immunofluorescence per specimen initial single antibody stain
|
$408.00 |
$408.00 |
$408.00 |
$168.00
|
|
Immunoglobulin assay
|
$258.00 |
$258.00 |
$258.00 |
$108.00
|
|
Impl neurostim electr perc
|
$5,517.75 |
$5,517.75 |
$5,517.75 |
$6,471.60
|
|
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 |
$18,039.00
|
|
Implant cochlear osia osi300
|
$20,655.00 |
$20,655.00 |
$20,655.00 |
$13,955.40
|
|
Implant hormone pellet(s) 11980
|
$315.75 |
$315.75 |
$315.75 |
$399.04
|
|
Implant neuroelectrodes
|
$5,517.75 |
$5,517.75 |
$5,517.75 |
$4,177.20
|
|
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 |
$10,672.50
|
|
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 |
$1,617.00
|
|
Implnt spinl canal catheter 62350
|
$7,722.75 |
$7,722.75 |
$7,722.75 |
$7,425.75
|
|
In situ hybridization per specimen each additional single probe stain
|
$435.00 |
$435.00 |
$435.00 |
$418.50
|
|
In situ hybridization per specimen initial single probe stain
|
$384.75 |
$384.75 |
$384.75 |
$300.00
|
|
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 |
$820.20
|
|
In-111 pentetreotide
|
$47,542.46 |
$47,542.46 |
$47,542.46 |
$4,204.80
|
|
Incise inner ear
|
$3,648.00 |
$3,648.00 |
$3,648.00 |
$1,481.28
|
|
Incise/drain eyelid lining
|
$1,104.00 |
$1,104.00 |
$1,104.00 |
$1,020.75
|
|
Incision & drainage hematoma/seroma/fluid collection
|
$3,867.00 |
$3,867.00 |
$3,867.00 |
$2,080.80
|
|
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 |
$2,715.60
|
|
Incision of eardrum
|
$1,272.00 |
$1,272.00 |
$1,272.00 |
$2,611.20
|
|
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 |
$3,244.61
|
|
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 |
$1,481.28
|
|
Incision tendon sheath
|
$2,124.75 |
$2,124.75 |
$2,124.75 |
$3,771.00
|
|
Incisn of toe tndn
|
$2,825.25 |
$2,825.25 |
$2,825.25 |
$1,608.60
|
|
Incobotulinumtoxin a
|
$1,889.43 |
$1,889.43 |
$1,889.43 |
$1,317.00
|
|
Indigotindisulfonate 8 mg/ml soln 5 ml ampule
|
$586.73 |
$586.73 |
$586.73 |
$24.00
|
|
Induced abortion d&c
|
$3,624.75 |
$3,624.75 |
$3,624.75 |
$3,179.53
|
|
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 |
$215.25
|
|
Infect ag drug suscept pheno predict
|
$479.25 |
$479.25 |
$479.25 |
$724.80
|
|
Infect ag genotype na cytomegalovirus
|
$2,588.25 |
$2,588.25 |
$2,588.25 |
$1,484.40
|
|
Infect ag genotype na hiv-1 other region
|
$301.50 |
$301.50 |
$301.50 |
$1,143.60
|
|
Infect ag genotype na hiv-1 revr trn/prt
|
$603.75 |
$603.75 |
$603.75 |
$1,404.00
|
|
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 |
$192.60
|
|
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 |
$385.80
|
|
Infect ag na hpv high-risk types
|
$272.25 |
$272.25 |
$272.25 |
$282.00
|
|
Infect ag na influenza r/amp 1st 2 types
|
$175.50 |
$175.50 |
$175.50 |
$520.20
|
|
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 |
$1,386.00
|
|
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 |
$108.00
|
|
Infectious agent antigen immunoassay ql/sq multi step cryptococcus neoformans
|
$60.75 |
$60.75 |
$60.75 |
$58.50
|
|
Infectious agent antigen immunoassay ql/sq multi step cryptosporidium
|
$96.00 |
$96.00 |
$96.00 |
$84.75
|
|
Infectious agent antigen immunoassay ql/sq multi step giardia
|
$87.00 |
$87.00 |
$87.00 |
$98.25
|
|
Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn
|
$64.50 |
$64.50 |
$64.50 |
$76.20
|
|
Infectious agent antigen immunoassay ql/sq multi step hiv-1 antigen(s) hiv-1&2 antibodies
|
$88.50 |
$88.50 |
$88.50 |
$168.60
|
|
Infectious agent antigen immunoassay ql/sq multi step legionella urine
|
$420.75 |
$420.75 |
$420.75 |
$303.00
|
|
Infectious agent antigen immunoassay ql/sq multi step rotavirus
|
$126.00 |
$126.00 |
$126.00 |
$130.50
|
|
Infectious agent nucleic acid amp probe mycobacterium tuberculosis rifampin resistance
|
$357.75 |
$357.75 |
$357.75 |
$195.60
|
|
Infectious agent nucleic acid amplified probe
|
$751.50 |
$751.50 |
$751.50 |
$349.80
|
|
Infectious agent nucleic acid amplified probe chlamydia trachomatis
|
$173.25 |
$173.25 |
$173.25 |
$203.40
|
|
Infectious agent nucleic acid amplified probe clostridium difficile toxin gene(s)
|
$141.00 |
$141.00 |
$141.00 |
$286.80
|
|
Infectious agent nucleic acid amplified probe cns pathogen 12-25 targets
|
$861.00 |
$861.00 |
$861.00 |
$933.00
|
|
Infectious agent nucleic acid amplified probe hsv-1
|
$306.75 |
$306.75 |
$306.75 |
$306.00
|
|
Infectious agent nucleic acid amplified probe methicillin resistant staphylococcus aureus
|
$129.00 |
$129.00 |
$129.00 |
$339.60
|
|
Infectious agent nucleic acid amplified probe mycobacteria tuberculosis
|
$596.25 |
$596.25 |
$596.25 |
$307.20
|
|
Infectious agent nucleic acid amplified probe neisseria gonorrhoeae
|
$168.75 |
$168.75 |
$168.75 |
$198.60
|
|
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 |
$194.40
|
|
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 |
$97.50
|
|
Infectious agent nucleic acid amplified probe trichomonas vaginalis
|
$129.00 |
$129.00 |
$129.00 |
$195.60
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 12-25 targets
|
$984.00 |
$984.00 |
$984.00 |
$481.80
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 3-5 targets
|
$436.50 |
$436.50 |
$436.50 |
$128.29
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 6-11 targets
|
$261.75 |
$261.75 |
$261.75 |
$553.20
|
|
Infectious agent nucleic acid quantification bk virus
|
$1,929.00 |
$1,929.00 |
$1,929.00 |
$483.00
|
|
Infectious agent nucleic acid quantification hepatitis b
|
$307.50 |
$307.50 |
$307.50 |
$385.80
|
|
Infectious agent nucleic acid quantification hepatitis c
|
$1,154.25 |
$1,154.25 |
$1,154.25 |
$542.40
|
|
Infectious agent nucleic acid quantification hiv-1
|
$588.00 |
$588.00 |
$588.00 |
$739.20
|
|
Infectious agent nucleic acid respiratory virus multiplex amplified probe 3-5 targets
|
$225.75 |
$225.75 |
$225.75 |
$571.20
|
|
Infliximab 100 mg intravenous solution
|
$1,702.78 |
$1,702.78 |
$1,702.78 |
$700.20
|
|
Infliximab-dyyb 100 mg intravenous solution
|
$1,713.99 |
$1,713.99 |
$1,713.99 |
$567.60
|
|
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 |
$530.60
|
|
Inhalation aerosol pentamidine pneumocystis pneumonia treatment/prophylaxis
|
$386.25 |
$386.25 |
$386.25 |
$377.40
|
|
Initiation & management bipap/cpap initial day
|
$576.00 |
$576.00 |
$576.00 |
$428.40
|
|
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 |
$10,166.40
|
|
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 |
$25.20
|
|
Inj ceftolozane tazobactam
|
$597.69 |
$597.69 |
$597.69 |
$286.20
|
|
Inj cntr knee arthro incl ct/mri
|
$461.25 |
$461.25 |
$461.25 |
$459.75
|
|
Inj disk cerv-thor ea lev
|
$3,232.50 |
$3,232.50 |
$3,232.50 |
$2,577.00
|
|
Inj dupuytren cord w/enzyme
|
$592.50 |
$592.50 |
$592.50 |
$373.50
|
|
Inj dx for sinogram
|
$1,089.75 |
$1,089.75 |
$1,089.75 |
$1,089.00
|
|
Inj epidural sgl cerv-thor without img
|
$2,184.75 |
$2,184.75 |
$2,184.75 |
$1,656.60
|
|
Inj epidural sgl lumb-sacral without img
|
$1,623.75 |
$1,623.75 |
$1,623.75 |
$1,524.80
|
|
Inj for ext venography
|
$1,434.75 |
$1,434.75 |
$1,434.75 |
$602.40
|
|
Inj for mammo ductogram
|
$150.00 |
$150.00 |
$150.00 |
$306.60
|
|
Inj givosiran 0.5 mg
|
$162,298.07 |
$162,298.07 |
$162,298.07 |
$119,349.60
|
|
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 |
$1,038.00
|
|
Inj hrt cath w/s&i sel hrt art
|
$1,192.50 |
$1,192.50 |
$1,192.50 |
$666.75
|
|
Inj hrt cath w/s&i sel left vent
|
$1,239.00 |
$1,239.00 |
$1,239.00 |
$693.75
|
|
Inj hrt cath w/s&i sel right vent
|
$5,894.25 |
$5,894.25 |
$5,894.25 |
$648.00
|
|
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 |
$7.20
|
|
Inj intralesional <= 7 lsn(s)
|
$206.25 |
$206.25 |
$206.25 |
$281.40
|
|
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 |
$4,345.80
|
|
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 |
$108.00
|
|
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 |
$126.60
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$522.75 |
$522.75 |
$522.75 |
$1,266.00
|
|
Inj non-compmd foam sclrsnt mlt trncl veins same leg
|
$2,371.50 |
$2,371.50 |
$2,371.50 |
$1,976.25
|
|
Inj non-compmd foam sclrsnt sgl trncl vein
|
$1,569.00 |
$1,569.00 |
$1,569.00 |
$1,829.23
|
|
Inj ogivri 10 mg
|
$8,661.59 |
$8,661.59 |
$8,661.59 |
$564.00
|
|
Inj pegfilgrastim-bmez 0.5mg
|
$12,400.57 |
$12,400.57 |
$12,400.57 |
$3,925.20
|
|
Inj proc ankle arthr
|
$219.00 |
$219.00 |
$219.00 |
$685.80
|
|
Inj proc elbow arthro
|
$212.25 |
$212.25 |
$212.25 |
$461.40
|
|
Inj proc lumbr disk ea lvl
|
$3,232.50 |
$3,232.50 |
$3,232.50 |
$3,214.20
|
|
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 |
$12.60
|
|
Inj retro urethrocysto
|
$629.25 |
$629.25 |
$629.25 |
$2,981.40
|
|
Inj scleros sol mult veins
|
$520.50 |
$520.50 |
$520.50 |
$1,108.20
|
|
Inj scleros sol sgl vein
|
$489.00 |
$489.00 |
$489.00 |
$1,108.20
|
|
Inj secretin synthetic human
|
$2,444.05 |
$2,444.05 |
$2,444.05 |
$169.20
|
|
Inj sulf hexa lipid microsph
|
$336.56 |
$336.56 |
$336.56 |
$336.56
|
|
Inj testosterone cypionate
|
$473.66 |
$473.66 |
$473.66 |
$72.60
|
|
Inj thiotepa nos 1 mg
|
$8,689.13 |
$8,689.13 |
$8,689.13 |
$450.00
|
|
Inj thrc fascial pln blk bi w/wo image
|
$2,207.25 |
$2,207.25 |
$2,207.25 |
$135.00
|
|
Inj thrc fascial pln blk uni w/wo image
|
$1,471.50 |
$1,471.50 |
$1,471.50 |
$120.00
|
|
Inj w/fluor eval cv device
|
$1,032.00 |
$1,032.00 |
$1,032.00 |
$711.00
|
|
Inj(s) sclerosant spider veins limb/trunk
|
$467.25 |
$467.25 |
$467.25 |
$389.25
|
|
Inj, abilify maintena, 1 mg
|
$9,281.66 |
$9,281.66 |
$9,281.66 |
$7,107.60
|
|
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 |
$6.00
|
|
Inj, durolane 1 mg
|
$4,122.72 |
$4,122.72 |
$4,122.72 |
$106.40
|
|
Inj, factor x, (human), 1iu
|
$33.28 |
$33.28 |
$33.28 |
$32.40
|
|
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 |
$413.40
|
|
Inj. inebilizumab-cdon, 1 mg
|
$172,856.28 |
$172,856.28 |
$172,856.28 |
$871.80
|
|
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 |
$544.80
|
|
Inj. teprotumumab-trbw 10 mg
|
$66,625.08 |
$66,625.08 |
$66,625.08 |
$38,425.20
|
|
Inj., benralizumab, 1 mg
|
$19,707.27 |
$19,707.27 |
$19,707.27 |
$5,853.00
|
|
Inj., emicizumab-kxwh 0.5 mg
|
$58,842.17 |
$58,842.17 |
$58,842.17 |
$39,043.20
|
|
Inj., meropenem, vaborbactam
|
$759.87 |
$759.87 |
$759.87 |
$991.20
|
|
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 |
$2,231.25
|
|
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 |
$692.52
|
|
Injection arthrography hip without anesthesia (both sides)
|
$660.00 |
$660.00 |
$660.00 |
$780.60
|
|
Injection carpal tunnel therapeutic (both sides)
|
$853.50 |
$853.50 |
$853.50 |
$596.40
|
|
Injection during cath supravalvular aortography
|
$2,211.75 |
$2,211.75 |
$2,211.75 |
$1,728.00
|
|
Injection epidural blood patch or clot
|
$1,618.50 |
$1,618.50 |
$1,618.50 |
$1,470.60
|
|
Injection eye drug
|
$387.00 |
$387.00 |
$387.00 |
$331.69
|
|
Injection for arthrography wrist (both sides)
|
$551.25 |
$551.25 |
$551.25 |
$666.60
|
|
Injection for bladder x-ray
|
$498.00 |
$498.00 |
$498.00 |
$1,726.80
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$540.75 |
$540.75 |
$540.75 |
$771.60
|
|
Injection for ureter x-ray
|
$544.50 |
$544.50 |
$544.50 |
$783.00
|
|
Injection glatiramer acetate
|
$1,749.29 |
$1,749.29 |
$1,749.29 |
$1,207.20
|
|
Injection into hemorrhoid(s)
|
$1,058.25 |
$1,058.25 |
$1,058.25 |
$911.71
|
|
Injection jugular
|
$1,890.00 |
$1,890.00 |
$1,890.00 |
$1,539.75
|
|
Injection of sinus tract
|
$1,670.25 |
$1,670.25 |
$1,670.25 |
$1,481.28
|
|
Injection px peyronie ds
|
$287.25 |
$287.25 |
$287.25 |
$239.25
|
|
Injection radioactive tracer sentinel node (both sides)
|
$787.50 |
$787.50 |
$787.50 |
$614.40
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$609.75 |
$609.75 |
$609.75 |
$238.80
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$573.00 |
$573.00 |
$573.00 |
$177.60
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$573.00 |
$573.00 |
$573.00 |
$168.80
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$174.00 |
$174.00 |
$174.00 |
$141.00
|
|
Injection treatment of nerve
|
$2,708.25 |
$2,708.25 |
$2,708.25 |
$2,706.75
|
|
Injection treatment of nerve
|
$2,238.00 |
$2,238.00 |
$2,238.00 |
$1,866.00
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$1,471.50 |
$1,471.50 |
$1,471.50 |
$1,021.50
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$1,567.50 |
$1,567.50 |
$1,567.50 |
$911.25
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$1,668.00 |
$1,668.00 |
$1,668.00 |
$1,671.75
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level
|
$1,236.75 |
$1,236.75 |
$1,236.75 |
$1,320.00
|
|
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 |
$1,713.00
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$2,233.50 |
$2,233.50 |
$2,233.50 |
$2,164.80
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$1,943.25 |
$1,943.25 |
$1,943.25 |
$2,047.80
|
|
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 |
$595.80
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$656.25 |
$656.25 |
$656.25 |
$654.00
|
|
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 |
$2,314.80
|
|
Injection, doxercalciferol
|
$23.86 |
$23.86 |
$23.86 |
$95.20
|
|
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 |
$6.75
|
|
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 |
$3,603.00
|
|
Injection,onabotulinumtoxina
|
$4,814.15 |
$4,814.15 |
$4,814.15 |
$2,876.40
|
|
Inotuzumab ozogamicin 0.9 mg(0.25 mg/ml initial concentration) IV soln
|
$88,429.23 |
$88,429.23 |
$88,429.23 |
$8,027.40
|
|
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 |
$4,692.00
|
|
Ins cath ren art 2nd+ bi
|
$7,922.25 |
$7,922.25 |
$7,922.25 |
$6,376.50
|
|
Ins cath ren art 2nd+ uni
|
$5,184.00 |
$5,184.00 |
$5,184.00 |
$5,405.70
|
|
Ins cerv dilator (sep proc)
|
$1,127.25 |
$1,127.25 |
$1,127.25 |
$678.00
|
|
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 |
$33,033.60
|
|
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 |
$2,523.00
|
|
Ins mark thor for right perq
|
$2,831.25 |
$2,831.25 |
$2,831.25 |
$1,368.26
|
|
Ins picad w subq port 5yr>
|
$5,089.50 |
$5,089.50 |
$5,089.50 |
$3,510.75
|
|
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 |
$8,416.80
|
|
Ins tun cv cath wo subq prt/pm
|
$4,564.50 |
$4,564.50 |
$4,564.50 |
$5,405.70
|
|
Ins tun cv cath wo subq prt/pm
|
$4,218.00 |
$4,218.00 |
$4,218.00 |
$3,582.00
|
|
Ins tun intraperit dia cath
|
$4,896.00 |
$4,896.00 |
$4,896.00 |
$4,187.40
|
|
Ins/rpl ldless pm right vent w img & eval
|
$14,352.75 |
$14,352.75 |
$14,352.75 |
$16,670.40
|
|
Ins/rpl pm gen exist dual lead
|
$11,005.50 |
$11,005.50 |
$11,005.50 |
$10,465.33
|
|
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 |
$15,256.20
|
|
Ins/rpl prph sac/gstr npg/r
|
$25,362.75 |
$25,362.75 |
$25,362.75 |
$21,134.25
|
|
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 |
$29,999.25
|
|
Insert abdomen-venous drain
|
$7,121.25 |
$7,121.25 |
$7,121.25 |
$5,264.25
|
|
Insert cath pleura with image
|
$1,734.75 |
$1,734.75 |
$1,734.75 |
$2,320.80
|
|
Insert cath pleura without image
|
$2,019.00 |
$2,019.00 |
$2,019.00 |
$1,896.99
|
|
Insert drug delivery implant
|
$1,418.25 |
$1,418.25 |
$1,418.25 |
$377.25
|
|
Insert hepatic shunt (tips)
|
$10,536.00 |
$10,536.00 |
$10,536.00 |
$9,741.00
|
|
Insert intrauterine device iud
|
$723.75 |
$723.75 |
$723.75 |
$513.00
|
|
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 |
$8,275.98
|
|
Insert sq defib electrode
|
$6,820.50 |
$6,820.50 |
$6,820.50 |
$12,994.80
|
|
Insert swan-ganz cath
|
$6,580.50 |
$6,580.50 |
$6,580.50 |
$2,472.00
|
|
Insert tunneled cv 2cath 2sits without port/pmp 36565
|
$5,018.25 |
$5,018.25 |
$5,018.25 |
$4,040.25
|
|
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 |
$9,195.00
|
|
Insert vad art access left hrt arterial access
|
$5,240.25 |
$5,240.25 |
$5,240.25 |
$2,497.20
|
|
Insert/repl sq defib w/eltrd
|
$26,801.25 |
$26,801.25 |
$26,801.25 |
$30,741.60
|
|
Insertion catheter bladder non indwelling
|
$327.75 |
$327.75 |
$327.75 |
$298.40
|
|
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 |
$5,079.00
|
|
Insertion intra aortic balloon assist device percutaneous
|
$3,576.75 |
$3,576.75 |
$3,576.75 |
$2,809.20
|
|
Insertion intravascular vena cava (ivc) access supervision & interpretation w/imaging guidance
|
$6,702.00 |
$6,702.00 |
$6,702.00 |
$6,646.50
|
|
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 |
$1,761.75
|
|
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 |
$8,275.98
|
|
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 |
$10,465.33
|
|
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 |
$2,472.00
|
|
Insertion picc without port or pump with imaging guidance=>5y
|
$1,242.75 |
$1,242.75 |
$1,242.75 |
$1,553.44
|
|
Insertion single tranvenous electrode/ppm/implantable defibrillator
|
$6,820.50 |
$6,820.50 |
$6,820.50 |
$7,267.20
|
|
Insertion subcutaneous cardiac rhythm monitor
|
$7,037.25 |
$7,037.25 |
$7,037.25 |
$8,275.98
|
|
Insertion tunneled centrally inserted central venous access device with port >= 5 years old (both sides)
|
$4,604.25 |
$4,604.25 |
$4,604.25 |
$4,011.60
|
|
Insertion/replacement implantable defibrillator w/lead(s) single/dual chamber
|
$26,801.25 |
$26,801.25 |
$26,801.25 |
$32,061.58
|
|
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 |
$664.80
|
|
Insitu hybridization manual
|
$459.75 |
$459.75 |
$459.75 |
$531.75
|
|
Insj phrnc nrv stim sys
|
$54,756.75 |
$54,756.75 |
$54,756.75 |
$45,000.50
|
|
Insj stablj dev without dcmprn
|
$15,258.00 |
$15,258.00 |
$15,258.00 |
$12,715.50
|
|
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 |
$1,097.40
|
|
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 |
$2,146.80
|
|
Instillation anticarcinogenic agent bladder
|
$970.50 |
$970.50 |
$970.50 |
$897.00
|
|
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 |
$2,572.50
|
|
Int hrhc lig 2+hroid without img
|
$3,767.25 |
$3,767.25 |
$3,767.25 |
$2,682.00
|
|
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 |
$4,959.00
|
|
Intermediate visual field xm
|
$73.50 |
$73.50 |
$73.50 |
$59.40
|
|
Interrog dev eval icpms ip
|
$112.50 |
$112.50 |
$112.50 |
$112.50
|
|
Interrog dev eval scrms ip
|
$285.75 |
$285.75 |
$285.75 |
$163.80
|
|
Interrog device eval heart
|
$636.75 |
$636.75 |
$636.75 |
$220.20
|
|
Interrog evl pm/ldls pm ip
|
$202.50 |
$202.50 |
$202.50 |
$113.25
|
|
Interrog without prgrmg ipnss
|
$108.00 |
$108.00 |
$108.00 |
$90.00
|
|
Interrog&prgrmg ipnss
|
$108.00 |
$108.00 |
$108.00 |
$90.00
|
|
Interrogate subq defib
|
$336.75 |
$336.75 |
$336.75 |
$117.00
|
|
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 |
$4,080.60
|
|
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 |
$1,169.40
|
|
Intracranial limited study
|
$1,091.25 |
$1,091.25 |
$1,091.25 |
$732.75
|
|
Intranasal biopsy 30100
|
$3,322.50 |
$3,322.50 |
$3,322.50 |
$1,481.28
|
|
Intrapul surf admin endo tube
|
$256.50 |
$256.50 |
$256.50 |
$203.39
|
|
Intrauterine transfusion ftl
|
$1,788.00 |
$1,788.00 |
$1,788.00 |
$645.00
|
|
Intraventricular pacing
|
$5,625.00 |
$5,625.00 |
$5,625.00 |
$5,625.00
|
|
Intrinsic factor antibody
|
$77.25 |
$77.25 |
$77.25 |
$117.00
|
|
Intrm oph exam est patient
|
$161.25 |
$161.25 |
$161.25 |
$128.87
|
|
Intro cath dialysis circuit
|
$1,643.25 |
$1,643.25 |
$1,643.25 |
$3,121.20
|
|
Intro cath dialysis circuit w/pta
|
$8,422.50 |
$8,422.50 |
$8,422.50 |
$7,787.25
|
|
Intro cath dialysis circuit w/stent plcmnt
|
$13,140.75 |
$13,140.75 |
$13,140.75 |
$10,578.00
|
|
Intro cath svc/ivc
|
$1,942.50 |
$1,942.50 |
$1,942.50 |
$2,478.60
|
|
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 |
$684.60
|
|
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 |
$3,632.40
|
|
Intubation endotracheal emergency procedure
|
$934.50 |
$934.50 |
$934.50 |
$868.80
|
|
Ionm in operatng room 15 min
|
$320.25 |
$320.25 |
$320.25 |
$191.40
|
|
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 |
$173.40
|
|
Iopamidol 300 mg iodine/ml (61 %) intravenous solution
|
$244.04 |
$244.04 |
$244.04 |
$61.20
|
|
Ipilimumab 5 mg/ml intravenous solution (wrapper)
|
$133,919.31 |
$133,919.31 |
$133,919.31 |
$440.40
|
|
Ipratropium bromide non-comp
|
$2.43 |
$2.43 |
$2.43 |
$7.20
|
|
Irinotecan 20 mg/ml intravenous solution (wrapper)
|
$378.32 |
$378.32 |
$378.32 |
$1,091.20
|
|
Irinotecan liposomal 4.3 mg/ml intravenous
|
$11,014.86 |
$11,014.86 |
$11,014.86 |
$115.80
|
|
Iron
|
$428.25 |
$428.25 |
$428.25 |
$60.00
|
|
Iron binding capacity
|
$89.25 |
$89.25 |
$89.25 |
$89.25
|
|
Iron dextran 50 mg/ml injection solution
|
$140.34 |
$140.34 |
$140.34 |
$99.00
|
|
Iron sucrose 20 mg iron/ml intravenous solution (wrapper)
|
$133.11 |
$133.11 |
$133.11 |
$315.00
|
|
Irradiation of blood product each unit reference
|
$206.25 |
$206.25 |
$206.25 |
$135.00
|
|
Irrigation implantable venous access device for drug delivery systems
|
$153.75 |
$153.75 |
$153.75 |
$142.20
|
|
Isatuximab-irfc 20 mg/ml intravenous solution
|
$15,760.97 |
$15,760.97 |
$15,760.97 |
$149.40
|
|
Ivc venogram s&i
|
$4,438.50 |
$4,438.50 |
$4,438.50 |
$3,147.50
|
|
Ixabepilone 15 mg intravenous solution
|
$22,346.52 |
$22,346.52 |
$22,346.52 |
$399.60
|
|
J-tube placement
|
$904.50 |
$904.50 |
$904.50 |
$556.80
|
|
Jejunstmy tube plcmt
|
$3,895.50 |
$3,895.50 |
$3,895.50 |
$3,168.00
|
|
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 |
$174.60
|
|
Ketorolac 15 mg/ml injection (wrapper)
|
$17.11 |
$17.11 |
$17.11 |
$24.60
|
|
Kidney (Retroperitoneal) Ultrasound (complete)
|
$972.75 |
$972.75 |
$972.75 |
$683.50
|
|
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 |
$1,228.80
|
|
Kidney img w/bldflw sgl without rx
|
$1,584.75 |
$1,584.75 |
$1,584.75 |
$1,552.20
|
|
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 |
$1,111.20
|
|
Kit hfx iq ipg bundle
|
$58,500.00 |
$58,500.00 |
$58,500.00 |
$56,811.60
|
|
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 |
$13,784.80
|
|
Kit montgmry thyrplasty impl f 5 implants 1meas dev inst set
|
$801.57 |
$801.57 |
$801.57 |
$1,650.60
|
|
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 |
$2,205.00
|
|
Knee X-ray
|
$508.50 |
$508.50 |
$508.50 |
$387.20
|
|
Kyleena, 19.5 mg
|
$4,491.10 |
$4,491.10 |
$4,491.10 |
$2,489.60
|
|
Labetalol 5 mg/ml IV (wrapper)
|
$22.19 |
$22.19 |
$22.19 |
$7.80
|
|
Lacosamide 200 mg/20 ml intravenous solution
|
$237.75 |
$237.75 |
$237.75 |
$237.75
|
|
Lactate dehydrogenase (ldh)
|
$65.25 |
$65.25 |
$65.25 |
$52.00
|
|
Lactated ringers intravenous solution
|
$22.19 |
$22.19 |
$22.19 |
$32.40
|
|
Lactic acid
|
$209.25 |
$209.25 |
$209.25 |
$121.80
|
|
Lactoferrin fecal qualitative
|
$72.75 |
$72.75 |
$72.75 |
$119.40
|
|
Lanreotide 120 mg/0.5 ml subcutaneous syringe
|
$35,355.50 |
$35,355.50 |
$35,355.50 |
$33,573.60
|
|
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 |
$5,688.75
|
|
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 |
$3,686.95
|
|
Largsc w/ther injection
|
$3,151.50 |
$3,151.50 |
$3,151.50 |
$1,724.47
|
|
Laronidase injection
|
$4,116.73 |
$4,116.73 |
$4,116.73 |
$4,116.73
|
|
Laryngeal function studies
|
$360.00 |
$360.00 |
$360.00 |
$333.00
|
|
Laryngoscope w/vc inj
|
$4,485.00 |
$4,485.00 |
$4,485.00 |
$3,686.95
|
|
Laryngoscopy direct w/wo tracheoscopy dx exc newborn
|
$1,968.00 |
$1,968.00 |
$1,968.00 |
$2,632.20
|
|
Laryngoscopy telescopic
|
$1,185.75 |
$1,185.75 |
$1,185.75 |
$907.50
|
|
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 |
$1,724.47
|
|
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 |
$5,543.40
|
|
Lavage cannulation maxillary sinus
|
$1,871.25 |
$1,871.25 |
$1,871.25 |
$232.22
|
|
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 |
$90.60
|
|
Lead ingevity 45cm pfret MRI
|
$7,616.25 |
$7,616.25 |
$7,616.25 |
$4,174.20
|
|
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 |
$159.00
|
|
Lens iol 23.0 d 1.5 cyl eyhance toric
|
$2,238.75 |
$2,238.75 |
$2,238.75 |
$609.00
|
|
Lens iol ant bicnvx 24.0 multi
|
$1,136.25 |
$1,136.25 |
$1,136.25 |
$1,429.20
|
|
Lens iol ant chamb 10.5
|
$191.25 |
$191.25 |
$191.25 |
$322.20
|
|
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 |
$3,559.80
|
|
Leuprolide 30 mg (4 month) intramuscular syringe kit
|
$30,791.46 |
$30,791.46 |
$30,791.46 |
$6,209.40
|
|
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 |
$276.00
|
|
Levetiracetam therapeutic drug level
|
$215.25 |
$215.25 |
$215.25 |
$155.25
|
|
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 |
$24.00
|
|
Liberta rc ipg
|
$63,376.43 |
$63,376.43 |
$63,376.43 |
$52,306.80
|
|
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 |
$104.40
|
|
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 |
$59.40
|
|
Linezolid in 5% dextrose in water 600 mg/300 ml intravenous piggyback
|
$119.81 |
$119.81 |
$119.81 |
$253.60
|
|
Lipase
|
$177.75 |
$177.75 |
$177.75 |
$139.80
|
|
Lipoprotein blood quant
|
$254.25 |
$254.25 |
$254.25 |
$280.20
|
|
Lipoprotein direct measurement hdl
|
$93.75 |
$93.75 |
$93.75 |
$63.60
|
|
Lipoprotein direct measurement ldl
|
$104.25 |
$104.25 |
$104.25 |
$75.00
|
|
Lithium therapeutic drug level
|
$94.50 |
$94.50 |
$94.50 |
$82.80
|
|
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 |
$92.85
|
|
Liver ds alys 3 bmrk srm alg
|
$812.25 |
$812.25 |
$812.25 |
$917.40
|
|
Liver elastography 91200
|
$552.75 |
$552.75 |
$552.75 |
$552.75
|
|
Liver imaging
|
$1,241.25 |
$1,241.25 |
$1,241.25 |
$901.80
|
|
Liver/spleen imag static only
|
$1,856.25 |
$1,856.25 |
$1,856.25 |
$1,228.80
|
|
Loncastuximab tesirine-lpyl 10 mg intravenous solution
|
$104,719.60 |
$104,719.60 |
$104,719.60 |
$15,780.00
|
|
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 |
$1,909.80
|
|
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 |
$2,409.75
|
|
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 |
$109.60
|
|
Lung perfusion imaging
|
$1,789.50 |
$1,789.50 |
$1,789.50 |
$700.50
|
|
Lurbinectedin 4 mg intravenous solution
|
$30,504.38 |
$30,504.38 |
$30,504.38 |
$380.40
|
|
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 |
$1,539.60
|
|
Lymph vessel x-ray arms/legs
|
$2,379.00 |
$2,379.00 |
$2,379.00 |
$1,553.44
|
|
Lymph vessel x-ray trunk
|
$2,489.25 |
$2,489.25 |
$2,489.25 |
$2,343.60
|
|
Lymph vessel x-ray trunk
|
$2,489.25 |
$2,489.25 |
$2,489.25 |
$2,131.80
|
|
Lymphatics/lymph node imaging
|
$2,091.75 |
$2,091.75 |
$2,091.75 |
$1,417.60
|
|
Lymphocyte transformation mitogen
|
$858.75 |
$858.75 |
$858.75 |
$537.60
|
|
Lysis intranasal synechia 30560
|
$3,098.25 |
$3,098.25 |
$3,098.25 |
$509.25
|
|
M.avium-intra dna amp prob
|
$489.75 |
$489.75 |
$489.75 |
$471.60
|
|
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 |
$2,429.25
|
|
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 |
$2,526.75
|
|
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 |
$1,496.25
|
|
MRA upper extremity post contrast-bil
|
$1,574.25 |
$1,574.25 |
$1,574.25 |
$1,929.00
|
|
MRI brain without & w/dye
|
$2,608.50 |
$2,608.50 |
$2,608.50 |
$2,185.50
|
|
MRI breast c-+ w/cad uni
|
$303.75 |
$303.75 |
$303.75 |
$351.00
|
|
MRI breast w IV cont bi
|
$303.75 |
$303.75 |
$303.75 |
$351.00
|
|
MRI breast without cont bi
|
$262.50 |
$262.50 |
$262.50 |
$565.80
|
|
MRI cardiac morph & func wo IV cont
|
$2,379.00 |
$2,379.00 |
$2,379.00 |
$2,562.00
|
|
MRI cardiac morph & func wwo IV cont
|
$2,945.25 |
$2,945.25 |
$2,945.25 |
$3,051.00
|
|
MRI cardiac morph & func wwo IV cont w/stress img
|
$3,879.75 |
$3,879.75 |
$3,879.75 |
$4,758.75
|
|
MRI chest w IV cont
|
$2,105.25 |
$2,105.25 |
$2,105.25 |
$3,051.00
|
|
MRI chest without & w/contrast
|
$2,877.75 |
$2,877.75 |
$2,877.75 |
$3,815.40
|
|
MRI chest without contrast
|
$1,818.00 |
$1,818.00 |
$1,818.00 |
$2,439.75
|
|
MRI guid ndl plc s&i
|
$1,454.25 |
$1,454.25 |
$1,454.25 |
$1,431.00
|
|
MRI loex nonjt w IV cont
|
$2,259.00 |
$2,259.00 |
$2,259.00 |
$3,051.00
|
|
MRI lower extremity other than joint without & w/contrast (both sides)
|
$2,628.75 |
$2,628.75 |
$2,628.75 |
$3,815.40
|
|
MRI lower extremity other than joint without contrast (both sides)
|
$2,127.00 |
$2,127.00 |
$2,127.00 |
$2,439.75
|
|
MRI orbit fac&nck w IV cont
|
$2,776.50 |
$2,776.50 |
$2,776.50 |
$2,910.60
|
|
MRI orbit/face/neck without & w/contrast
|
$2,181.00 |
$2,181.00 |
$2,181.00 |
$3,804.00
|
|
MRI orbit/face/neck without contrast
|
$1,883.25 |
$1,883.25 |
$1,883.25 |
$2,307.75
|
|
MRI tmj
|
$1,860.00 |
$1,860.00 |
$1,860.00 |
$2,332.50
|
|
MRI upper extremity other than joint without & w/contrast (both sides)
|
$2,628.75 |
$2,628.75 |
$2,628.75 |
$3,815.40
|
|
MRI upper extremity other than joint without contrast (both sides)
|
$2,127.00 |
$2,127.00 |
$2,127.00 |
$2,514.00
|
|
MRI upper extremity w/dye
|
$2,550.75 |
$2,550.75 |
$2,550.75 |
$3,126.75
|
|
Magnesium
|
$96.00 |
$96.00 |
$96.00 |
$78.00
|
|
Magnesium sulfate 2 gram/50 ml (4 %) in water intravenous piggyback
|
$23.30 |
$23.30 |
$23.30 |
$74.40
|
|
Manipulat palm cord post inj
|
$532.50 |
$532.50 |
$532.50 |
$492.75
|
|
Manipulation chest wall demonstration/evaluation subsequent
|
$216.75 |
$216.75 |
$216.75 |
$186.00
|
|
Manipulation chest wall initial demonstration/evaluation
|
$219.00 |
$219.00 |
$219.00 |
$235.20
|
|
Map tachycard site(s)
|
$10,926.00 |
$10,926.00 |
$10,926.00 |
$3,500.40
|
|
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 |
$94.80
|
|
Marker biop eviva buckle ss
|
$819.00 |
$819.00 |
$819.00 |
$819.00
|
|
Mastoids complete
|
$524.25 |
$524.25 |
$524.25 |
$405.00
|
|
Mayo a1app alpha 1 antitrypsin phenotype
|
$117.00 |
$117.00 |
$117.00 |
$108.60
|
|
Mayo aathr protein s free
|
$226.50 |
$226.50 |
$226.50 |
$159.60
|
|
Mayo activated protein c resistance assay
|
$170.25 |
$170.25 |
$170.25 |
$158.40
|
|
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 |
$440.40
|
|
Mayo alkaline phosphatase isoenzyme
|
$222.00 |
$222.00 |
$222.00 |
$153.75
|
|
Mayo alkaloids definitive assay nicotine/cotinine
|
$270.75 |
$270.75 |
$270.75 |
$270.75
|
|
Mayo alpha 1 antitrypsin
|
$398.25 |
$398.25 |
$398.25 |
$197.40
|
|
Mayo amikacin trough therapeutic drug level
|
$207.75 |
$207.75 |
$207.75 |
$153.00
|
|
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 |
$89.25
|
|
Mayo analysis gene jak2 p.val617phe variant
|
$215.25 |
$215.25 |
$215.25 |
$1,323.00
|
|
Mayo analysis gene smn1 dosage/deletion
|
$368.25 |
$368.25 |
$368.25 |
$1,135.80
|
|
Mayo analysis microarray cytogenomic copy number/snp variants
|
$1,416.75 |
$1,416.75 |
$1,416.75 |
$6,701.40
|
|
Mayo androstenedione
|
$249.00 |
$249.00 |
$249.00 |
$186.40
|
|
Mayo angiotensin 1 converting enzyme (ace) csf
|
$59.25 |
$59.25 |
$59.25 |
$74.40
|
|
Mayo antithrombin iii antigen
|
$88.50 |
$88.50 |
$88.50 |
$108.60
|
|
Mayo aspergillus fumigatus antibody
|
$106.50 |
$106.50 |
$106.50 |
$106.50
|
|
Mayo avwpr vw factor activity
|
$911.25 |
$911.25 |
$911.25 |
$322.80
|
|
Mayo babpb infectious agent nucleic acid amplified probe babesia microti
|
$105.00 |
$105.00 |
$105.00 |
$290.40
|
|
Mayo barbiturates definitive assay confirmation urine
|
$501.00 |
$501.00 |
$501.00 |
$450.00
|
|
Mayo bart bartonella henselae antibody igg
|
$104.25 |
$104.25 |
$104.25 |
$66.75
|
|
Mayo bcrfx analysis translocation bcr/abl1 minor breakpoint qualitative/quantitative
|
$318.75 |
$318.75 |
$318.75 |
$364.20
|
|
Mayo blastomyces antibody immunodiffusion
|
$262.50 |
$262.50 |
$262.50 |
$178.20
|
|
Mayo bnzu sedative hypnotics definitive urine
|
$128.25 |
$128.25 |
$128.25 |
$118.50
|
|
Mayo bordetella pertussis antibody igg
|
$135.75 |
$135.75 |
$135.75 |
$100.80
|
|
Mayo brcmg brucella antibody igm
|
$324.75 |
$324.75 |
$324.75 |
$118.80
|
|
Mayo c1 esterase inhibitor
|
$183.00 |
$183.00 |
$183.00 |
$130.80
|
|
Mayo cannabinoids natural definitive assay thc confirmation urine
|
$333.75 |
$333.75 |
$333.75 |
$300.00
|
|
Mayo carnitine total and free quantitative each specimen plasma
|
$110.25 |
$110.25 |
$110.25 |
$166.20
|
|
Mayo cd20b mononuclear cell antigen nos quantitative each
|
$773.25 |
$773.25 |
$773.25 |
$351.00
|
|
Mayo cdcom hla class ii typing low resolution one locus each
|
$333.00 |
$333.00 |
$333.00 |
$465.00
|
|
Mayo ceruloplasmin
|
$117.75 |
$117.75 |
$117.75 |
$97.80
|
|
Mayo chemiluminescent parathyroid related peptide
|
$377.25 |
$377.25 |
$377.25 |
$294.60
|
|
Mayo chikv chikungunya antibodies igg
|
$423.00 |
$423.00 |
$423.00 |
$360.60
|
|
Mayo chlap chlamydia pneumoniae antibody igg
|
$128.25 |
$128.25 |
$128.25 |
$114.75
|
|
Mayo chlap chlamydia pneumoniae antibody igm
|
$93.00 |
$93.00 |
$93.00 |
$82.50
|
|
Mayo chrcb tissue culture non-neoplastic disorders lymphocyte
|
$519.00 |
$519.00 |
$519.00 |
$833.40
|
|
Mayo chromium
|
$129.75 |
$129.75 |
$129.75 |
$129.75
|
|
Mayo cocaine definitive assay confirmation urine
|
$297.00 |
$297.00 |
$297.00 |
$267.00
|
|
Mayo coccidioides antibody
|
$124.50 |
$124.50 |
$124.50 |
$128.25
|
|
Mayo cocou cortisone urine
|
$1,213.50 |
$1,213.50 |
$1,213.50 |
$305.40
|
|
Mayo cortisol free
|
$183.00 |
$183.00 |
$183.00 |
$133.20
|
|
Mayo covid-19 antibody nucleocapsid total
|
$122.25 |
$122.25 |
$122.25 |
$123.00
|
|
Mayo coxiella brunetii (q fever) igg antibody
|
$110.25 |
$110.25 |
$110.25 |
$115.80
|
|
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 |
$123.00
|
|
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 |
$239.40
|
|
Mayo efpo chloride stool
|
$102.00 |
$102.00 |
$102.00 |
$102.00
|
|
Mayo estriol
|
$173.25 |
$173.25 |
$173.25 |
$138.00
|
|
Mayo estrone
|
$123.00 |
$123.00 |
$123.00 |
$157.50
|
|
Mayo ethosuximide therapeutic drug level
|
$138.75 |
$138.75 |
$138.75 |
$138.75
|
|
Mayo everolimus therapeutic drug level
|
$245.25 |
$245.25 |
$245.25 |
$210.00
|
|
Mayo factor ii
|
$190.50 |
$190.50 |
$190.50 |
$97.20
|
|
Mayo factor v
|
$219.00 |
$219.00 |
$219.00 |
$189.00
|
|
Mayo factor vii
|
$204.00 |
$204.00 |
$204.00 |
$185.40
|
|
Mayo factor viii vw factor antigen
|
$150.00 |
$150.00 |
$150.00 |
$176.40
|
|
Mayo factor viii vw factor multimetric analysis
|
$656.25 |
$656.25 |
$656.25 |
$239.40
|
|
Mayo factor viii vw factor ristocetin cofactor
|
$414.75 |
$414.75 |
$414.75 |
$243.60
|
|
Mayo factor x
|
$250.50 |
$250.50 |
$250.50 |
$191.25
|
|
Mayo factor xi
|
$288.75 |
$288.75 |
$288.75 |
$162.60
|
|
Mayo fat/lipids feces quantitative
|
$62.25 |
$62.25 |
$62.25 |
$126.60
|
|
Mayo fbl culture fungi blood
|
$127.50 |
$127.50 |
$127.50 |
$126.00
|
|
Mayo ffspg allergen clam igg
|
$57.75 |
$57.75 |
$57.75 |
$51.75
|
|
Mayo fibrinogen antigen
|
$230.25 |
$230.25 |
$230.25 |
$109.80
|
|
Mayo gabapentin bld/srm/plasma therapeutic drug level
|
$159.75 |
$159.75 |
$159.75 |
$129.60
|
|
Mayo gamma-globin full gene sequencing
|
$7,125.00 |
$7,125.00 |
$7,125.00 |
$8,992.20
|
|
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 |
$288.60
|
|
Mayo hiser histoplasma antibodies immunodiffusion
|
$161.25 |
$161.25 |
$161.25 |
$161.25
|
|
Mayo hvdip HIV 1 antibody
|
$274.50 |
$274.50 |
$274.50 |
$88.20
|
|
Mayo hydroxyprogesterone 17-d
|
$120.75 |
$120.75 |
$120.75 |
$140.25
|
|
Mayo immunoassay c1 esterase inhibitor antibody quantitative
|
$1,192.50 |
$1,192.50 |
$1,192.50 |
$259.80
|
|
Mayo immunoassay infectious agent antibody quantitative diptheria igg
|
$154.50 |
$154.50 |
$154.50 |
$109.20
|
|
Mayo immunoassay tumor antigen quantitative ca 27.29
|
$83.25 |
$83.25 |
$83.25 |
$141.00
|
|
Mayo immunoassay tumor antigen quantitative chromogranin a
|
$186.75 |
$186.75 |
$186.75 |
$176.40
|
|
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 |
$218.40
|
|
Mayo infectious agent nucleic acid amplified probe enterovirus
|
$554.25 |
$554.25 |
$554.25 |
$428.40
|
|
Mayo infectious agent nucleic acid amplified probe mycoplasma genitalium urine
|
$98.25 |
$98.25 |
$98.25 |
$189.00
|
|
Mayo infectious agent nucleic acid amplified probe mycoplasma pneumoniae
|
$744.75 |
$744.75 |
$744.75 |
$349.80
|
|
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 |
$350.40
|
|
Mayo infectious disease hepatitis c chronic six biochemical assays
|
$258.75 |
$258.75 |
$258.75 |
$516.60
|
|
Mayo infliximab therapeutic drug level
|
$4,117.50 |
$4,117.50 |
$4,117.50 |
$523.20
|
|
Mayo inhab inhibin a
|
$309.75 |
$309.75 |
$309.75 |
$267.75
|
|
Mayo insft insulin free
|
$56.25 |
$56.25 |
$56.25 |
$117.00
|
|
Mayo insulin antibodies
|
$117.00 |
$117.00 |
$117.00 |
$119.40
|
|
Mayo iodine
|
$571.50 |
$571.50 |
$571.50 |
$202.20
|
|
Mayo itraconazole therapeutic drug level
|
$159.00 |
$159.00 |
$159.00 |
$140.40
|
|
Mayo lacosamide therapeutic drug level
|
$265.50 |
$265.50 |
$265.50 |
$199.50
|
|
Mayo lamotrigine therapeutic drug level
|
$171.00 |
$171.00 |
$171.00 |
$141.00
|
|
Mayo ld_i lactate dehydrogenase isoenzymes
|
$104.25 |
$104.25 |
$104.25 |
$70.80
|
|
Mayo legionella antibody
|
$87.00 |
$87.00 |
$87.00 |
$104.40
|
|
Mayo leptospira antibody igm
|
$82.50 |
$82.50 |
$82.50 |
$60.75
|
|
Mayo lipoprotein electrophoresis
|
$45.75 |
$45.75 |
$45.75 |
$99.00
|
|
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 |
$100.80
|
|
Mayo metanephrines plasma
|
$803.25 |
$803.25 |
$803.25 |
$384.00
|
|
Mayo methadone definitive assay confirmation urine
|
$127.50 |
$127.50 |
$127.50 |
$114.00
|
|
Mayo mgle voltage-gated calcium channel antibody each
|
$507.00 |
$507.00 |
$507.00 |
$235.20
|
|
Mayo microsomal antibody liver-kidney
|
$177.00 |
$177.00 |
$177.00 |
$136.20
|
|
Mayo mitotane (lysodren) therapeutic drug level
|
$503.25 |
$503.25 |
$503.25 |
$206.40
|
|
Mayo molecular pathology procedure level 2 apoe genotype
|
$886.50 |
$886.50 |
$886.50 |
$1,204.20
|
|
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 |
$235.20
|
|
Mayo mycophenolic acid therapeutic drug level
|
$581.25 |
$581.25 |
$581.25 |
$202.20
|
|
Mayo myoglobin
|
$165.00 |
$165.00 |
$165.00 |
$129.75
|
|
Mayo nickel
|
$90.00 |
$90.00 |
$90.00 |
$178.20
|
|
Mayo opatu opiates definitive assay >=1
|
$99.00 |
$99.00 |
$99.00 |
$87.00
|
|
Mayo opatu opioid/analogs definitive assay 1 or 2
|
$86.25 |
$86.25 |
$86.25 |
$62.25
|
|
Mayo opatu oxycodone definitive assay
|
$111.00 |
$111.00 |
$111.00 |
$98.25
|
|
Mayo organic acid methylmalonic single quantitative
|
$375.75 |
$375.75 |
$375.75 |
$298.20
|
|
Mayo oxalate 24 hour urine
|
$183.00 |
$183.00 |
$183.00 |
$163.50
|
|
Mayo parvs parvovirus b19 antibody igg
|
$136.50 |
$136.50 |
$136.50 |
$123.00
|
|
Mayo paval fluorescent antibody screen agna type 1
|
$1,833.00 |
$1,833.00 |
$1,833.00 |
$132.60
|
|
Mayo pborb infectious agent nucleic acid amplified probe borrelia burgdorferi (lyme)
|
$735.00 |
$735.00 |
$735.00 |
$306.00
|
|
Mayo phospholipid neutralization hexagonal lupus anticoagulant
|
$255.75 |
$255.75 |
$255.75 |
$204.60
|
|
Mayo pntft phenytoin free therapeutic drug level
|
$120.75 |
$120.75 |
$120.75 |
$92.25
|
|
Mayo pqnu porphobilinogen urine quantitative 24 hour urine
|
$131.25 |
$131.25 |
$131.25 |
$131.25
|
|
Mayo pregnenolone
|
$175.50 |
$175.50 |
$175.50 |
$222.00
|
|
Mayo prmb primidone therapeutic drug level
|
$157.50 |
$157.50 |
$157.50 |
$118.80
|
|
Mayo proinsulin
|
$206.25 |
$206.25 |
$206.25 |
$206.25
|
|
Mayo psaft prostate specific antigen free
|
$128.25 |
$128.25 |
$128.25 |
$129.60
|
|
Mayo radioimmunoassay procollagen i intact n-terminal antibody quantitative
|
$1,768.50 |
$1,768.50 |
$1,768.50 |
$300.00
|
|
Mayo rbcme osmotic fragility rbc incubated
|
$277.50 |
$277.50 |
$277.50 |
$223.80
|
|
Mayo receptor assay transferrin soluble
|
$159.00 |
$159.00 |
$159.00 |
$193.50
|
|
Mayo renin
|
$147.75 |
$147.75 |
$147.75 |
$165.60
|
|
Mayo repu protein electrophoresis urine
|
$69.00 |
$69.00 |
$69.00 |
$181.20
|
|
Mayo selenium
|
$177.00 |
$177.00 |
$177.00 |
$168.00
|
|
Mayo serotonin
|
$202.50 |
$202.50 |
$202.50 |
$235.20
|
|
Mayo sfgp rickettsia rickettsii antibody igg
|
$122.25 |
$122.25 |
$122.25 |
$109.50
|
|
Mayo sirolimus therapeutic drug level
|
$250.50 |
$250.50 |
$250.50 |
$150.60
|
|
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 |
$41.40
|
|
Mayo tau phosphorylated 217 each
|
$504.00 |
$504.00 |
$504.00 |
$259.80
|
|
Mayo tcgr analysis gene rearrangement trb@ abnormal clonal population(s) amplification
|
$501.75 |
$501.75 |
$501.75 |
$859.80
|
|
Mayo tgrp testosterone free
|
$121.50 |
$121.50 |
$121.50 |
$121.50
|
|
Mayo tgrp testosterone total
|
$193.50 |
$193.50 |
$193.50 |
$184.20
|
|
Mayo thyroglobulin
|
$665.25 |
$665.25 |
$665.25 |
$184.20
|
|
Mayo ticks anaplasma phagocytophilum antibody igg
|
$189.00 |
$189.00 |
$189.00 |
$97.80
|
|
Mayo ticks babesia microti antibody igg
|
$153.75 |
$153.75 |
$153.75 |
$126.00
|
|
Mayo tramadol definitive assay w metabolite quantitative urine
|
$69.75 |
$69.75 |
$69.75 |
$48.60
|
|
Mayo tulab francisella tularensis antibody igg
|
$55.50 |
$55.50 |
$55.50 |
$96.60
|
|
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 |
$138.60
|
|
Mayo vitamin b3 (niacin)
|
$147.00 |
$147.00 |
$147.00 |
$147.00
|
|
Mayo vitamin k
|
$458.25 |
$458.25 |
$458.25 |
$317.25
|
|
Mayo zonisamide therapeutic drug level
|
$300.00 |
$300.00 |
$300.00 |
$207.75
|
|
Measurement post void urine by ultrasound
|
$266.25 |
$266.25 |
$266.25 |
$176.40
|
|
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 |
$16.40
|
|
Mepolizumab 100 mg/ml subcutaneous auto-injector
|
$11,523.04 |
$11,523.04 |
$11,523.04 |
$8,127.60
|
|
Meropenem 1 gram intravenous solution
|
$102.84 |
$102.84 |
$102.84 |
$77.20
|
|
Mesna 100 mg/ml intravenous solution
|
$73.95 |
$73.95 |
$73.95 |
$153.60
|
|
Metabolic Blood Panel (Basic)
|
$123.00 |
$123.00 |
$123.00 |
$97.20
|
|
Metabolic Blood Panel (Comprehensive)
|
$198.00 |
$198.00 |
$198.00 |
$130.97
|
|
Metabolic panel ionized ca
|
$121.50 |
$121.50 |
$121.50 |
$160.50
|
|
Methacholine chloride 0.0625 mg/ml nebulization soln
|
$2,776.62 |
$2,776.62 |
$2,776.62 |
$463.20
|
|
Methadone injection
|
$725.09 |
$725.09 |
$725.09 |
$55.95
|
|
Methocarbamol ivpb 250 mg in 50 ml ns - cnr (headpain)
|
$38.39 |
$38.39 |
$38.39 |
$78.20
|
|
Methotrexate sodium (pf) 1 gram solution for injection
|
$215.83 |
$215.83 |
$215.83 |
$284.80
|
|
Methotrexate sodium 2.5 mg tablet
|
$466.63 |
$466.63 |
$466.63 |
$28.65
|
|
Methotrexate therapeutic drug level
|
$66.75 |
$66.75 |
$66.75 |
$124.20
|
|
Methylene blue (antidote) 5 mg/ml intravenous solution
|
$4,037.33 |
$4,037.33 |
$4,037.33 |
$1,620.00
|
|
Methylergonovine 0.2 mg/ml (1 ml) injection solution
|
$76.59 |
$76.59 |
$76.59 |
$42.45
|
|
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 |
$10.80
|
|
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 |
$10.35
|
|
Metoprolol tartrate 5 mg/5 ml intravenous (wrapper)
|
$7.59 |
$7.59 |
$7.59 |
$4.80
|
|
Metronidazole 500 mg/100 ml in sodium chlor(iso) intravenous piggyback
|
$11.84 |
$11.84 |
$11.84 |
$3.15
|
|
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 |
$538.20
|
|
Microvolt t-wave assess
|
$1,542.00 |
$1,542.00 |
$1,542.00 |
$156.46
|
|
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 |
$36.60
|
|
Middle cerebral artery echo
|
$645.75 |
$645.75 |
$645.75 |
$285.60
|
|
Milrinone 20 mg/100 ml(200 mcg/ml) in 5 % dextrose intravenous piggybk
|
$58.43 |
$58.43 |
$58.43 |
$73.20
|
|
Minocycline hydrochloride
|
$884.76 |
$884.76 |
$884.76 |
$403.80
|
|
Mitomycin 40 mg intravenous solution
|
$4,332.81 |
$4,332.81 |
$4,332.81 |
$1,714.80
|
|
Mitoxantrone 2 mg/ml concentrate,intravenous
|
$437.16 |
$437.16 |
$437.16 |
$437.16
|
|
Mlh1 gene
|
$290.25 |
$290.25 |
$290.25 |
$1,123.80
|
|
Mog-igg1 antb flo cytmtry ea
|
$924.00 |
$924.00 |
$924.00 |
$192.60
|
|
Monitor reveal linq ii cardiac
|
$10,575.00 |
$10,575.00 |
$10,575.00 |
$12,083.40
|
|
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 |
$873.75
|
|
Mopath procedure level 5
|
$1,825.50 |
$1,825.50 |
$1,825.50 |
$2,734.80
|
|
Mopath procedure level 6
|
$2,340.75 |
$2,340.75 |
$2,340.75 |
$5,054.40
|
|
Mopath procedure level 7
|
$2,340.75 |
$2,340.75 |
$2,340.75 |
$8,366.40
|
|
Mopath procedure level 8
|
$1,587.00 |
$1,587.00 |
$1,587.00 |
$1,687.80
|
|
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 |
$102.60
|
|
Morphine 4 mg/ml injection (wrapper)
|
$46.08 |
$46.08 |
$46.08 |
$27.20
|
|
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 |
$599.40
|
|
Morphometric analysis tumor ihc qn/sq per specimen each single antibody stain manual
|
$311.25 |
$311.25 |
$311.25 |
$337.20
|
|
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 |
$58.50
|
|
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 |
$1,987.50
|
|
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 |
$280.80
|
|
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 |
$4,164.75
|
|
Mumps antibody igg
|
$148.50 |
$148.50 |
$148.50 |
$148.50
|
|
Muscle test cran nerv unilat
|
$773.25 |
$773.25 |
$773.25 |
$441.00
|
|
Muscle test hemidiaphragm
|
$733.50 |
$733.50 |
$733.50 |
$622.20
|
|
Muscle test larynx
|
$771.00 |
$771.00 |
$771.00 |
$327.60
|
|
Muscle test one fiber
|
$645.75 |
$645.75 |
$645.75 |
$520.80
|
|
Mycobacteria dna amp probe
|
$444.75 |
$444.75 |
$444.75 |
$411.00
|
|
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 |
$21.60
|
|
Mycoplasma antibody igm
|
$183.00 |
$183.00 |
$183.00 |
$129.75
|
|
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 |
$2,289.60
|
|
Myelography via inj w/s&i cervical
|
$3,186.00 |
$3,186.00 |
$3,186.00 |
$2,289.60
|
|
Myelography via inj w/s&i lumbosacral
|
$2,333.25 |
$2,333.25 |
$2,333.25 |
$2,289.60
|
|
Myelography via inj w/s&i thoracic
|
$3,226.50 |
$3,226.50 |
$3,226.50 |
$2,289.60
|
|
Myeloperoxidase ab multi step qualitative/semiquantitative
|
$911.25 |
$911.25 |
$911.25 |
$108.60
|
|
Myocrd img pet 1std rst/strs
|
$4,928.25 |
$4,928.25 |
$4,928.25 |
$4,556.25
|
|
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 |
$1,878.75
|
|
N-invas est c ffr sw aly cta
|
$2,020.50 |
$2,020.50 |
$2,020.50 |
$1,017.39
|
|
Nafcillin 2 gram solution for injection
|
$79.98 |
$79.98 |
$79.98 |
$2.00
|
|
Nalbuphine 10 mg/ml injection solution
|
$178.93 |
$178.93 |
$178.93 |
$22.20
|
|
Naloxone 0.4 mg/ml injection (wrapper)
|
$116.48 |
$116.48 |
$116.48 |
$1.20
|
|
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 |
$135.00
|
|
Nasal/sinus endoscopy surg w/bx 31237
|
$4,086.00 |
$4,086.00 |
$4,086.00 |
$4,080.00
|
|
Nasopharyngoscopy w/endoscope
|
$279.75 |
$279.75 |
$279.75 |
$365.40
|
|
Natalizumab 300 mg/15 ml intravenous solution
|
$32,830.92 |
$32,830.92 |
$32,830.92 |
$28,621.80
|
|
Natriuretic peptide
|
$206.25 |
$206.25 |
$206.25 |
$273.00
|
|
Natural killer cells total count
|
$262.50 |
$262.50 |
$262.50 |
$243.00
|
|
Navigational bronchoscopy 31627
|
$190.50 |
$190.50 |
$190.50 |
$5,596.80
|
|
Ndl emg musc 1 xtr/non-limb
|
$376.50 |
$376.50 |
$376.50 |
$241.20
|
|
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 |
$31.50
|
|
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 |
$1,708.20
|
|
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 |
$2,750.00
|
|
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 |
$1,914.00
|
|
Neck MRA (blood vessel MRI, with and without contrast)
|
$2,229.00 |
$2,229.00 |
$2,229.00 |
$2,733.00
|
|
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 |
$223.80
|
|
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 |
$1,498.80
|
|
Nerve conduction studies 1-2
|
$797.25 |
$797.25 |
$797.25 |
$210.00
|
|
Nerve conduction studies 11-12
|
$3,818.25 |
$3,818.25 |
$3,818.25 |
$2,280.00
|
|
Nerve conduction studies 13+
|
$4,900.50 |
$4,900.50 |
$4,900.50 |
$2,693.40
|
|
Nerve conduction studies 3-4
|
$1,221.75 |
$1,221.75 |
$1,221.75 |
$642.60
|
|
Nerve conduction studies 5-6
|
$1,914.00 |
$1,914.00 |
$1,914.00 |
$1,069.20
|
|
Nerve conduction studies 9-10
|
$3,230.25 |
$3,230.25 |
$3,230.25 |
$1,926.60
|
|
Neuroeltrd stim post tibial
|
$710.25 |
$710.25 |
$710.25 |
$510.75
|
|
Neurolysis celiac plexus
|
$2,847.00 |
$2,847.00 |
$2,847.00 |
$3,501.75
|
|
Neurolysis trigeminal nerve
|
$1,056.75 |
$1,056.75 |
$1,056.75 |
$890.29
|
|
Neuromuscular junction testing ea nerve any 1 method
|
$420.00 |
$420.00 |
$420.00 |
$357.60
|
|
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 |
$104.40
|
|
Njx aa&/strd nrv nrvtg si jt
|
$801.75 |
$801.75 |
$801.75 |
$685.80
|
|
Njx aa&/strd vagus nrv
|
$345.75 |
$345.75 |
$345.75 |
$295.19
|
|
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 |
$2,476.80
|
|
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 |
$908.40
|
|
Nm imaging bone/joint 3 phase study
|
$2,543.25 |
$2,543.25 |
$2,543.25 |
$1,684.80
|
|
Nm imaging bone/joint whole body
|
$2,499.75 |
$2,499.75 |
$2,499.75 |
$1,474.20
|
|
Nm imaging cardiac blood pooling planar single study at rest or stress
|
$1,746.00 |
$1,746.00 |
$1,746.00 |
$1,651.20
|
|
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 |
$1,626.00
|
|
Nm imaging hepatobiliary system w/pharmacologic intervention
|
$2,326.50 |
$2,326.50 |
$2,326.50 |
$1,663.20
|
|
Nm imaging kidney morphology vascular flow/function single study w/pharmacological intervention
|
$1,674.75 |
$1,674.75 |
$1,674.75 |
$1,385.40
|
|
Nm imaging pulmonary ventilation/perfusion
|
$2,622.00 |
$2,622.00 |
$2,622.00 |
$1,574.40
|
|
Nm imaging thyroid single/multiple uptake(s) quantitative measurement(s)
|
$1,419.00 |
$1,419.00 |
$1,419.00 |
$1,335.00
|
|
Nm radiopharmaceutical therapy oral administration
|
$1,642.50 |
$1,642.50 |
$1,642.50 |
$944.40
|
|
Non-card vasc flow imaging
|
$914.25 |
$914.25 |
$914.25 |
$504.80
|
|
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 |
$1,905.60
|
|
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 |
$5,915.66
|
|
Nuclear Stress Test (Heart)
|
$5,417.25 |
$5,417.25 |
$5,417.25 |
$3,799.90
|
|
Nuclear exam of tear flow
|
$951.75 |
$951.75 |
$951.75 |
$637.20
|
|
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 |
$666.00
|
|
Nuclear rx intra-articular
|
$288.75 |
$288.75 |
$288.75 |
$231.00
|
|
Nuclear rx intracav admin
|
$1,755.00 |
$1,755.00 |
$1,755.00 |
$1,622.25
|
|
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 |
$519.60
|
|
Ob Ultrasound nuchal meas add-on
|
$409.50 |
$409.50 |
$409.50 |
$175.20
|
|
Obinutuzumab 1,000 mg/40 ml intravenous solution
|
$33,278.55 |
$33,278.55 |
$33,278.55 |
$213.60
|
|
Observation direct referral from physician office for admission
|
$551.25 |
$551.25 |
$551.25 |
$141.00
|
|
Observation per hour
|
$3,767.25 |
$3,767.25 |
$3,767.25 |
$793.20
|
|
Obtaining screen pap smear
|
$23.25 |
$23.25 |
$23.25 |
$24.60
|
|
Ocrelizumab 30 mg/ml intravenous solution
|
$76,319.96 |
$76,319.96 |
$76,319.96 |
$156.60
|
|
Octreotide acetate 100 mcg/ml injection (wrapper)
|
$887.40 |
$887.40 |
$887.40 |
$558.60
|
|
Octreotide,microspheres ER 20 mg intramuscular susp, extended release
|
$23,458.95 |
$23,458.95 |
$23,458.95 |
$8,451.00
|
|
Ofatumumab 20 mg/ml intravenous solution (wrapper)
|
$2,224.00 |
$2,224.00 |
$2,224.00 |
$201.60
|
|
Oil silicone ophth 8.5ml silikon 1000
|
$857.48 |
$857.48 |
$857.48 |
$1,824.80
|
|
Olanzapine 10 mg intramuscular solution
|
$172.31 |
$172.31 |
$172.31 |
$30.00
|
|
Omalizumab 150 mg/ml subcutaneous syringe (wrapper)
|
$5,445.54 |
$5,445.54 |
$5,445.54 |
$333.60
|
|
Oncology prostate prob score
|
$1,623.75 |
$1,623.75 |
$1,623.75 |
$1,501.50
|
|
Oncoprotein dcp
|
$537.00 |
$537.00 |
$537.00 |
$537.00
|
|
Oncoprotein her-2/neu
|
$237.00 |
$237.00 |
$237.00 |
$141.75
|
|
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 |
$105.75
|
|
Ophthalmic mitomycin
|
$1,327.41 |
$1,327.41 |
$1,327.41 |
$1,663.20
|
|
Oral aprepitant
|
$3,616.34 |
$3,616.34 |
$3,616.34 |
$1,012.80
|
|
Oral everolimus
|
$2,255.34 |
$2,255.34 |
$2,255.34 |
$1,208.40
|
|
Organic acids total quant ea spec
|
$508.50 |
$508.50 |
$508.50 |
$277.20
|
|
Oritavancin 400 mg intravenous solution
|
$11,913.61 |
$11,913.61 |
$11,913.61 |
$105.60
|
|
Oropharyngeal biopsy 42800
|
$3,186.00 |
$3,186.00 |
$3,186.00 |
$836.40
|
|
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 |
$90.00
|
|
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 |
$235.20
|
|
Osmolality blood
|
$77.25 |
$77.25 |
$77.25 |
$63.75
|
|
Osmolality urine
|
$75.75 |
$75.75 |
$75.75 |
$75.75
|
|
Osteopath manip tx/5-6 body region 98927
|
$125.25 |
$125.25 |
$125.25 |
$25.30
|
|
Osteopath manip tx/7-8 body region 98928
|
$147.00 |
$147.00 |
$147.00 |
$25.30
|
|
Osteopath manip tx/9-10 body region98929
|
$183.75 |
$183.75 |
$183.75 |
$25.30
|
|
Ot evaluation high complexity patient/family
|
$297.00 |
$297.00 |
$297.00 |
$272.40
|
|
Ot evaluation low complexity patient/family
|
$297.00 |
$297.00 |
$297.00 |
$265.50
|
|
Ot evaluation moderate complexity patient/family
|
$297.00 |
$297.00 |
$297.00 |
$272.40
|
|
Ot management orthotic(s)/prosthetic subsequent encounter each 15 minutes
|
$138.00 |
$138.00 |
$138.00 |
$119.25
|
|
Ot management/training orthotic(s) upper/lower extremities and/or trunk each 15 minutes
|
$138.75 |
$138.75 |
$138.75 |
$112.50
|
|
Ot manual therpy techniques >=1 region each 15 minutes
|
$138.75 |
$138.75 |
$138.75 |
$130.20
|
|
Ot re-evaluation patient/family
|
$212.25 |
$212.25 |
$212.25 |
$138.00
|
|
Ot therapeutic activities direct patient contact each 15 minutes
|
$156.75 |
$156.75 |
$156.75 |
$126.60
|
|
Ot therapeutic interventions cognitive skills direct patient contact each additional 15 minutes
|
$98.25 |
$98.25 |
$98.25 |
$106.20
|
|
Ot therapeutic interventions cognitive skills direct patient contact initial 15 minutes
|
$98.25 |
$98.25 |
$98.25 |
$106.20
|
|
Ot therapeutic procedure >=1 area therapeutic exercise each 15 minutes
|
$143.25 |
$143.25 |
$143.25 |
$117.00
|
|
Ot therapeutic procedure neuromuscular reeducate each 15 minutes
|
$138.75 |
$138.75 |
$138.75 |
$110.40
|
|
Ot training self care/home management direct contact each 15 minutes
|
$138.75 |
$138.75 |
$138.75 |
$106.50
|
|
Oth resp proc, group
|
$187.50 |
$187.50 |
$187.50 |
$144.00
|
|
Other immunoelectrophoresis
|
$186.00 |
$186.00 |
$186.00 |
$132.60
|
|
Otolaryngo binocular microscopy 92504
|
$104.25 |
$104.25 |
$104.25 |
$104.25
|
|
Oxaliplatin 5 mg/ml desensitization
|
$342.84 |
$342.84 |
$342.84 |
$97.20
|
|
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 |
$47.20
|
|
Paclitaxel protein-bound 100 mg intravenous suspension
|
$5,416.36 |
$5,416.36 |
$5,416.36 |
$61.80
|
|
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 |
$99.20
|
|
Palivizumab 50 mg/0.5 ml inj
|
$9,797.53 |
$9,797.53 |
$9,797.53 |
$6,940.20
|
|
Palonosetron hcl
|
$184.88 |
$184.88 |
$184.88 |
$378.60
|
|
Pamidronate 30 mg/10 ml (3 mg/ml) intravenous solution
|
$148.35 |
$148.35 |
$148.35 |
$200.00
|
|
Panitumumab 20 mg/ml intravenous solution (wrapper)
|
$27,287.26 |
$27,287.26 |
$27,287.26 |
$364.20
|
|
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 |
$123.60
|
|
Parathormone (pth) intact
|
$500.25 |
$500.25 |
$500.25 |
$226.20
|
|
Parathyrd planar w/spect&ct
|
$2,445.00 |
$2,445.00 |
$2,445.00 |
$1,989.75
|
|
Parathyroid planar imaging
|
$1,436.25 |
$1,436.25 |
$1,436.25 |
$1,228.80
|
|
Parathyroid planar img w/tomo spect
|
$2,424.75 |
$2,424.75 |
$2,424.75 |
$1,859.40
|
|
Paricalcitol
|
$35.52 |
$35.52 |
$35.52 |
$35.52
|
|
Paring/cutting benign hyperkeratotic lesion single
|
$291.75 |
$291.75 |
$291.75 |
$251.40
|
|
Particle matristem matrix 1000mg micron-q4118-cost per mg
|
$7,702.14 |
$7,702.14 |
$7,702.14 |
$7,136.40
|
|
Passy muir valve metal trach
|
$1,016.73 |
$1,016.73 |
$1,016.73 |
$350.40
|
|
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 |
$1,189.80
|
|
Pegaspargase injection
|
$82,241.50 |
$82,241.50 |
$82,241.50 |
$62,371.80
|
|
Pegfilgrastim 6 mg/0.6 ml (deliverable) wearable subcutaneous injector
|
$16,623.78 |
$16,623.78 |
$16,623.78 |
$6,417.60
|
|
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 |
$2,112.00
|
|
Pegloticase 8 mg/ml intravenous solution
|
$113,672.22 |
$113,672.22 |
$113,672.22 |
$94,586.40
|
|
Pelvic CT scan (with and without contrast)
|
$1,881.00 |
$1,881.00 |
$1,881.00 |
$1,992.00
|
|
Pelvic CT scan (with contrast)
|
$1,710.75 |
$1,710.75 |
$1,710.75 |
$1,680.60
|
|
Pelvic CT scan (without contrast)
|
$1,392.75 |
$1,392.75 |
$1,392.75 |
$1,313.40
|
|
Pelvic MRI (with and without contrast)
|
$2,590.50 |
$2,590.50 |
$2,590.50 |
$2,713.80
|
|
Pelvic MRI (with contrast)
|
$2,373.75 |
$2,373.75 |
$2,373.75 |
$1,966.42
|
|
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 |
$7,026.00
|
|
Pemetrexed disodium 100 mg intravenous powder for solution
|
$13,859.24 |
$13,859.24 |
$13,859.24 |
$3,134.40
|
|
Penicillin g benzathine 1,200,000 unit/2 ml intramuscular syringe
|
$2,592.13 |
$2,592.13 |
$2,592.13 |
$1,422.60
|
|
Penicillin g potassium in ns IV syringe 100,000 units/ml (neo/ped) - cnr
|
$203.37 |
$203.37 |
$203.37 |
$192.60
|
|
Penile injection
|
$306.75 |
$306.75 |
$306.75 |
$403.80
|
|
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 |
$809.60
|
|
Penile vascular study
|
$792.00 |
$792.00 |
$792.00 |
$435.00
|
|
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 |
$63.60
|
|
Pentostatin 10 mg intravenous solution
|
$8,715.64 |
$8,715.64 |
$8,715.64 |
$6,720.00
|
|
Perc cryo ablate renal tum
|
$6,669.00 |
$6,669.00 |
$6,669.00 |
$10,411.22
|
|
Perc d-e cor revasc chro sin
|
$32,979.75 |
$32,979.75 |
$32,979.75 |
$17,956.72
|
|
Perc d-e cor revasc t cabg b
|
$27,913.50 |
$27,913.50 |
$27,913.50 |
$23,011.50
|
|
Perc d-e cor revasc t cabg s
|
$32,979.75 |
$32,979.75 |
$32,979.75 |
$15,411.00
|
|
Perc d-e cor stent ather br
|
$27,915.00 |
$27,915.00 |
$27,915.00 |
$16,909.50
|
|
Perc d-e cor stent ather s
|
$32,979.75 |
$32,979.75 |
$32,979.75 |
$18,556.80
|
|
Perc drug-el cor stent bran
|
$16,054.50 |
$16,054.50 |
$16,054.50 |
$11,088.60
|
|
Perc drug-el cor stent sing
|
$16,258.50 |
$16,258.50 |
$16,258.50 |
$15,411.00
|
|
Perc rf ablate renal tumor
|
$5,724.00 |
$5,724.00 |
$5,724.00 |
$5,834.36
|
|
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 |
$1,066.20
|
|
Peri-proc device eval icd
|
$609.75 |
$609.75 |
$609.75 |
$159.00
|
|
Peri-proc device eval pm
|
$327.75 |
$327.75 |
$327.75 |
$202.50
|
|
Pericardial drain w/cath pq w/ct guid
|
$3,796.50 |
$3,796.50 |
$3,796.50 |
$3,314.40
|
|
Pericardiocentesis wwo imaging
|
$2,472.75 |
$2,472.75 |
$2,472.75 |
$2,461.80
|
|
Peripheral vascular rehab
|
$184.50 |
$184.50 |
$184.50 |
$148.50
|
|
Perq art m-thrombect &/nfs
|
$9,473.25 |
$9,473.25 |
$9,473.25 |
$12,590.40
|
|
Perq clsr tcat l atr apndge
|
$7,520.25 |
$7,520.25 |
$7,520.25 |
$5,311.20
|
|
Perq dev breast 1st mr guide
|
$4,497.00 |
$4,497.00 |
$4,497.00 |
$2,153.40
|
|
Perq dev breast 1st strtctc
|
$3,114.75 |
$3,114.75 |
$3,114.75 |
$1,793.40
|
|
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 |
$8,839.80
|
|
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 |
$12,221.25
|
|
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 |
$10,098.75
|
|
Perq transcath septal reduxn
|
$15,793.50 |
$15,793.50 |
$15,793.50 |
$5,606.40
|
|
Pertuzu, trastuzu, 10 mg
|
$51,456.39 |
$51,456.39 |
$51,456.39 |
$324.60
|
|
Pertuzumab 30 mg/ml desensitization
|
$25,218.78 |
$25,218.78 |
$25,218.78 |
$22,539.60
|
|
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 |
$4,298.25
|
|
Pet image ltd area
|
$4,590.75 |
$4,590.75 |
$4,590.75 |
$4,245.00
|
|
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 |
$39.60
|
|
Phencyclidine (pcp)
|
$498.00 |
$498.00 |
$498.00 |
$402.75
|
|
Phenobarbital in ns IV syringe 10 mg/ml (neonate) - cnr
|
$203.37 |
$203.37 |
$203.37 |
$42.15
|
|
Phenobarbital therapeutic drug level
|
$153.00 |
$153.00 |
$153.00 |
$150.00
|
|
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 |
$417.00
|
|
Phenytoin total therapeutic drug level
|
$135.00 |
$135.00 |
$135.00 |
$114.00
|
|
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 |
$3,147.50
|
|
Phlebotomy therapeutic
|
$308.25 |
$308.25 |
$308.25 |
$284.40
|
|
Phosphorus
|
$57.75 |
$57.75 |
$57.75 |
$56.40
|
|
Phosphorus 24 hour urine
|
$108.75 |
$108.75 |
$108.75 |
$91.20
|
|
Phytonadione (vitamin k1) 10 mg/ml injection solution
|
$158.14 |
$158.14 |
$158.14 |
$52.80
|
|
Pin caspar distraction 12mm
|
$53,100.00 |
$53,100.00 |
$53,100.00 |
$33,127.20
|
|
Pinworm exam
|
$40.50 |
$40.50 |
$40.50 |
$49.20
|
|
Piperacillin-tazobactam 3.375 gram intravenous solution
|
$407.95 |
$407.95 |
$407.95 |
$115.20
|
|
Place cath intracranial art
|
$7,997.25 |
$7,997.25 |
$7,997.25 |
$6,072.60
|
|
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 |
$4,182.60
|
|
Place gastrostomy tube perc
|
$2,093.25 |
$2,093.25 |
$2,093.25 |
$3,587.40
|
|
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 |
$6,360.60
|
|
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 |
$7,552.20
|
|
Place slctv cath carotid/inom art intcrn uni
|
$10,186.50 |
$10,186.50 |
$10,186.50 |
$10,549.80
|
|
Place slctv cath subclavian art
|
$5,625.00 |
$5,625.00 |
$5,625.00 |
$7,476.75
|
|
Place slctv cath vertebral art uni
|
$9,490.50 |
$9,490.50 |
$9,490.50 |
$10,549.80
|
|
Placement localization device(s) breast percutaneous mammographic guidance 1st lesion (both sides)
|
$2,732.25 |
$2,732.25 |
$2,732.25 |
$1,562.25
|
|
Placement localization device(s) breast percutaneous mammographic guide ea addl lesion left
|
$2,658.00 |
$2,658.00 |
$2,658.00 |
$1,380.00
|
|
Placement localization device(s) breast percutaneous ultrasound guidance 1st lesion (both sides)
|
$2,838.00 |
$2,838.00 |
$2,838.00 |
$1,564.20
|
|
Placement nephrostomy catheter (both sides)
|
$1,842.00 |
$1,842.00 |
$1,842.00 |
$2,483.40
|
|
Placement occlusive device venous/arterial access site post procedure
|
$1,262.25 |
$1,262.25 |
$1,262.25 |
$1,051.50
|
|
Placement stent(s) intravascular transcatheter artery initial
|
$12,427.50 |
$12,427.50 |
$12,427.50 |
$12,780.00
|
|
Platelet aggregation each agent teg
|
$223.50 |
$223.50 |
$223.50 |
$202.80
|
|
Platelet automated
|
$43.50 |
$43.50 |
$43.50 |
$38.25
|
|
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 |
$1,659.00
|
|
Platelets each unit
|
$1,876.50 |
$1,876.50 |
$1,876.50 |
$477.00
|
|
Platelets pheresis leukocytes reduced each unit
|
$1,982.25 |
$1,982.25 |
$1,982.25 |
$2,713.80
|
|
Platelets pheresis leukocytes reduced irradiated each unit
|
$1,989.00 |
$1,989.00 |
$1,989.00 |
$2,893.20
|
|
Platelets pheresis pathogen-reduced each unit
|
$2,487.00 |
$2,487.00 |
$2,487.00 |
$1,791.00
|
|
Plc pq device breast ea addl lesion MRI guide
|
$4,497.00 |
$4,497.00 |
$4,497.00 |
$2,954.25
|
|
Plc pq device breast ea addl lesion Ultrasound guide
|
$2,616.00 |
$2,616.00 |
$2,616.00 |
$969.00
|
|
Plcmnt biliary drainage cath w/img ext
|
$2,959.50 |
$2,959.50 |
$2,959.50 |
$4,144.20
|
|
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 |
$4,913.40
|
|
Plcmnt ureteral stent pq w/img new w/cath
|
$2,677.50 |
$2,677.50 |
$2,677.50 |
$7,729.80
|
|
Plcmt dlyd xtn pros 1st vsl
|
$7,148.25 |
$7,148.25 |
$7,148.25 |
$6,775.20
|
|
Plcmt sft tiss loc pq w/img 1st lsn
|
$1,124.25 |
$1,124.25 |
$1,124.25 |
$1,039.50
|
|
Plcmt sft tiss loc pq w/img ea addl lsn
|
$560.25 |
$560.25 |
$560.25 |
$517.50
|
|
Plcmt xtn pros evasc rpr per vsl
|
$5,988.00 |
$5,988.00 |
$5,988.00 |
$4,002.00
|
|
Plerixafor injection
|
$36,856.95 |
$36,856.95 |
$36,856.95 |
$1,570.80
|
|
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 |
$4,144.20
|
|
Plmt nephroureteral catheter
|
$2,677.50 |
$2,677.50 |
$2,677.50 |
$4,763.40
|
|
Plmt ureteral stent prq
|
$2,677.50 |
$2,677.50 |
$2,677.50 |
$7,729.80
|
|
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 |
$228.60
|
|
Polatuzumab vedotin-piiq 140 mg intravenous solution
|
$68,815.70 |
$68,815.70 |
$68,815.70 |
$36,544.20
|
|
Polysomnography sleep staging >=4 parameters age >=6 years w/cpap bipap
|
$6,604.50 |
$6,604.50 |
$6,604.50 |
$6,491.40
|
|
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 |
$52.20
|
|
Potassium chloride 10 meq/100ml in sterile water intravenous piggyback
|
$137.19 |
$137.19 |
$137.19 |
$70.80
|
|
Potassium serum/plasma/whole blood
|
$101.25 |
$101.25 |
$101.25 |
$39.60
|
|
Pq biliary strict dil s&i
|
$1,803.00 |
$1,803.00 |
$1,803.00 |
$1,547.40
|
|
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 |
$8,849.25
|
|
Pq thr inj ext pse
|
$993.00 |
$993.00 |
$993.00 |
$899.40
|
|
Pq vrtbrplst 1 bdy inj crv-thr w/img ini
|
$3,752.25 |
$3,752.25 |
$3,752.25 |
$3,244.61
|
|
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 |
$3,244.61
|
|
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 |
$288.75
|
|
Pr assessment emotional/behavioral per instrument brief
|
$39.75 |
$39.75 |
$39.75 |
$39.25
|
|
Pr biopsy skin punch single lesion
|
$311.25 |
$311.25 |
$311.25 |
$399.53
|
|
Pr counseling smoke/tobacco intermediate greater 3 - 10 minutes
|
$120.75 |
$120.75 |
$120.75 |
$30.00
|
|
Pr debridement open wound topical appl/wound asmt per session 20 sq cm/<
|
$578.25 |
$578.25 |
$578.25 |
$378.60
|
|
Pr e&m preventive medicine initial comprehensive new patient 12-17 years
|
$167.25 |
$167.25 |
$167.25 |
$122.25
|
|
Pr egd flexible transoral w/placement percutaneous gastrostomy tube
|
$3,061.50 |
$3,061.50 |
$3,061.50 |
$2,795.25
|
|
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 |
$1,896.00
|
|
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 |
$1,233.00
|
|
Pr incision & drainage abscess complicated/multiple
|
$382.50 |
$382.50 |
$382.50 |
$712.80
|
|
Pr incision & drainage abscess simple/single
|
$561.75 |
$561.75 |
$561.75 |
$484.20
|
|
Pr incision & drainage abscess vulva/perineal
|
$465.75 |
$465.75 |
$465.75 |
$831.60
|
|
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 |
$143.25
|
|
Pr removal drug delivery implant
|
$1,448.25 |
$1,448.25 |
$1,448.25 |
$1,440.00
|
|
Pr removal foreign body external auditory canal without anesthesia
|
$313.50 |
$313.50 |
$313.50 |
$298.40
|
|
Pr removal intrauterine device
|
$270.75 |
$270.75 |
$270.75 |
$589.80
|
|
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 |
$477.00
|
|
Pr repair sprfcl wd simple face/ears/eyelids/nose/lips/muc memb <= 2.5 cm
|
$317.25 |
$317.25 |
$317.25 |
$477.00
|
|
Pr repair sprfcl wounds simple scalp/neck/axillae/gent/trunk/ext <= 2.5 cm
|
$330.00 |
$330.00 |
$330.00 |
$477.00
|
|
Pr repair superficial wd simple scalp/neck/ax/gent/trunk/ext 2.6-7.5 cm
|
$352.50 |
$352.50 |
$352.50 |
$520.80
|
|
Pr tube thoracostomy w/connection to drainage open
|
$2,108.25 |
$2,108.25 |
$2,108.25 |
$2,412.60
|
|
Pralatrexate injection
|
$46,709.38 |
$46,709.38 |
$46,709.38 |
$4,072.20
|
|
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 |
$2,783.40
|
|
Prcrd drg 6+yr without anomly
|
$3,798.00 |
$3,798.00 |
$3,798.00 |
$2,783.40
|
|
Prealbumin
|
$144.75 |
$144.75 |
$144.75 |
$114.00
|
|
Prednisolone sodium phosphate 15 mg/5 ml (3 mg/ml) oral solution
|
$3,856.50 |
$3,856.50 |
$3,856.50 |
$13.80
|
|
Prednisone 1 mg tablet
|
$398.89 |
$398.89 |
$398.89 |
$3.00
|
|
Pregabalin - sendout
|
$65.25 |
$65.25 |
$65.25 |
$57.75
|
|
Pregnancy Ultrasound (complete, after first trimester)
|
$867.00 |
$867.00 |
$867.00 |
$607.12
|
|
Pregnancy Ultrasound (first trimester)
|
$801.75 |
$801.75 |
$801.75 |
$580.03
|
|
Pregnancy associated plasma protein-a
|
$75.00 |
$75.00 |
$75.00 |
$136.20
|
|
Prep skin to 100cm2 other
|
$2,049.75 |
$2,049.75 |
$2,049.75 |
$1,401.75
|
|
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 |
$696.75
|
|
Pressure max expiratory/inspiratory
|
$260.25 |
$260.25 |
$260.25 |
$156.46
|
|
Pressure velocity wire add ves
|
$2,646.00 |
$2,646.00 |
$2,646.00 |
$1,746.00
|
|
Pretreat rbc absorption reference
|
$131.25 |
$131.25 |
$131.25 |
$128.25
|
|
Pretreat rbc w enzyme reference
|
$270.75 |
$270.75 |
$270.75 |
$219.00
|
|
Prgr stim/pace a/iv drug
|
$5,091.75 |
$5,091.75 |
$5,091.75 |
$3,905.40
|
|
Prgrmg dev eval impltbl sys
|
$336.75 |
$336.75 |
$336.75 |
$226.20
|
|
Prgrmg dev eval pm/ldls pm
|
$204.00 |
$204.00 |
$204.00 |
$176.40
|
|
Prgrmg dev eval scrms ip
|
$289.50 |
$289.50 |
$289.50 |
$225.00
|
|
Prgrmg eval implantable dfb
|
$300.00 |
$300.00 |
$300.00 |
$176.40
|
|
Prgrmg eval implantable dfb
|
$510.00 |
$510.00 |
$510.00 |
$265.20
|
|
Prgrmg eval implantable dfb
|
$329.25 |
$329.25 |
$329.25 |
$316.80
|
|
Prim art mech thrmbc non-intracranial
|
$18,078.00 |
$18,078.00 |
$18,078.00 |
$17,956.72
|
|
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 |
$225.00
|
|
Procalcitonin
|
$99.00 |
$99.00 |
$99.00 |
$138.00
|
|
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 |
$1,663.20
|
|
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 |
$3,114.00
|
|
Proctosigmoidoscopy w/fb remove 45307
|
$3,251.25 |
$3,251.25 |
$3,251.25 |
$3,015.00
|
|
Progesterone
|
$99.00 |
$99.00 |
$99.00 |
$105.00
|
|
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 |
$534.75
|
|
Propofol infusion 10 mg/ml
|
$35.88 |
$35.88 |
$35.88 |
$21.45
|
|
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 |
$309.00
|
|
Prosthesis voc advantage 20f 14mm
|
$1,329.00 |
$1,329.00 |
$1,329.00 |
$1,228.50
|
|
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 |
$121.20
|
|
Protein electrophoretic fractionation & quantitation serum
|
$84.00 |
$84.00 |
$84.00 |
$139.50
|
|
Protein s total
|
$181.50 |
$181.50 |
$181.50 |
$156.00
|
|
Protein total 24 hour urine
|
$62.25 |
$62.25 |
$62.25 |
$39.60
|
|
Protein total body fluid
|
$114.00 |
$114.00 |
$114.00 |
$67.80
|
|
Protein total serum plasma whole blood
|
$46.50 |
$46.50 |
$46.50 |
$37.50
|
|
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 |
$66.00
|
|
Prq av fstl crt uxtr sep acs
|
$20,328.00 |
$20,328.00 |
$20,328.00 |
$33,250.80
|
|
Prq card revasc mi 1 vsl
|
$31,300.50 |
$31,300.50 |
$31,300.50 |
$21,910.50
|
|
Prq card revasc mi 1 vsl drug-eluting
|
$35,208.75 |
$35,208.75 |
$35,208.75 |
$15,411.00
|
|
Prq revasc byp graft 1 art and/or branches
|
$29,319.00 |
$29,319.00 |
$29,319.00 |
$15,411.00
|
|
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 |
$3,865.50
|
|
Prq trl rvs ch occ ant&rtrgr
|
$32,826.75 |
$32,826.75 |
$32,826.75 |
$14,048.25
|
|
Prq trlml c athrc st angiop1
|
$29,319.00 |
$29,319.00 |
$29,319.00 |
$23,616.60
|
|
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 |
$12,754.50
|
|
Prq trluml revsc ch occ ant
|
$29,319.00 |
$29,319.00 |
$29,319.00 |
$20,522.25
|
|
Psy/npsy phys/qhp 2> tst 1st 30 min
|
$316.50 |
$316.50 |
$316.50 |
$225.60
|
|
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 |
$311.40
|
|
Psych test eval svc phys/qhp ea addl hr
|
$127.50 |
$127.50 |
$127.50 |
$183.60
|
|
Psychotherapy group therapy
|
$271.50 |
$271.50 |
$271.50 |
$58.20
|
|
Psychotherapy patient individual therapy 30 minutes
|
$193.50 |
$193.50 |
$193.50 |
$168.00
|
|
Psychotherapy patient individual therapy 45 minutes
|
$267.00 |
$267.00 |
$267.00 |
$175.80
|
|
Psychotherapy patient individual therapy 60 minutes
|
$328.50 |
$328.50 |
$328.50 |
$254.40
|
|
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 |
$178.20
|
|
Psytx pt w/e&m 38-52 min
|
$399.00 |
$399.00 |
$399.00 |
$287.40
|
|
Psytx pt w/e&m 53+ min
|
$492.00 |
$492.00 |
$492.00 |
$324.00
|
|
Pt application of modality >=1 area electrical stimulation each 15 minutes
|
$164.25 |
$164.25 |
$164.25 |
$103.20
|
|
Pt application of modality >=1 area hot/cold packs
|
$19.50 |
$19.50 |
$19.50 |
$47.00
|
|
Pt application of modality >=1 area iontophoresis each 15 minutes
|
$133.50 |
$133.50 |
$133.50 |
$103.20
|
|
Pt application of modality >=1 area ultrasound each 15 minutes
|
$117.00 |
$117.00 |
$117.00 |
$99.00
|
|
Pt application of modality traction mechanical
|
$135.75 |
$135.75 |
$135.75 |
$119.25
|
|
Pt evaluation high complexity patient/family
|
$297.00 |
$297.00 |
$297.00 |
$274.20
|
|
Pt evaluation low complexity patient/family
|
$264.00 |
$264.00 |
$264.00 |
$238.40
|
|
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 |
$117.60
|
|
Pt repositioning canalith procedure(s) per day
|
$150.75 |
$150.75 |
$150.75 |
$223.20
|
|
Pt therapeutic procedure >=1 area gait training each 15 minutes
|
$138.75 |
$138.75 |
$138.75 |
$110.25
|
|
Pt therapeutic procedure >=1 area massage each 15 minutes
|
$115.50 |
$115.50 |
$115.50 |
$105.00
|
|
Pt wheelchair management each 15 minutes
|
$123.00 |
$123.00 |
$123.00 |
$76.20
|
|
Pul art balloon repr percut
|
$4,406.25 |
$4,406.25 |
$4,406.25 |
$4,956.00
|
|
Pul art balloon repr percut
|
$8,869.50 |
$8,869.50 |
$8,869.50 |
$10,756.50
|
|
Pulmonary vent imaging
|
$478.50 |
$478.50 |
$478.50 |
$672.00
|
|
Pulse ox continuous overnight monitoring
|
$376.50 |
$376.50 |
$376.50 |
$302.40
|
|
Pulse ox multiple
|
$309.00 |
$309.00 |
$309.00 |
$251.40
|
|
Pulse ox single
|
$151.50 |
$151.50 |
$151.50 |
$91.20
|
|
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 |
$87.60
|
|
Puncture aspiration abscess/hematoma/bulla/cyst
|
$382.50 |
$382.50 |
$382.50 |
$496.20
|
|
Puncture spinal lumbar diagnostic
|
$1,088.25 |
$1,088.25 |
$1,088.25 |
$1,212.00
|
|
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 |
$543.75
|
|
Pvb thoracic single inj site
|
$801.75 |
$801.75 |
$801.75 |
$692.52
|
|
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 |
$130.80
|
|
Quant diff pulm perf and vent w/imaging
|
$2,580.00 |
$2,580.00 |
$2,580.00 |
$2,655.60
|
|
Quant diff pulm perf w/imaging
|
$1,789.50 |
$1,789.50 |
$1,789.50 |
$1,362.40
|
|
Quest t3 uptake
|
$108.75 |
$108.75 |
$108.75 |
$81.75
|
|
R hrt cath chd nml nt cnj
|
$7,495.50 |
$7,495.50 |
$7,495.50 |
$3,216.41
|
|
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 |
$880.00
|
|
Radiation therapy dose plan
|
$949.50 |
$949.50 |
$949.50 |
$571.20
|
|
Radphm lcl tmr plnr bdy sgl day img
|
$2,841.00 |
$2,841.00 |
$2,841.00 |
$1,936.80
|
|
Radphm lcl tmr plnr bdy two day img
|
$3,232.50 |
$3,232.50 |
$3,232.50 |
$2,386.20
|
|
Radphm lcl tomogr sgl area sgl day
|
$2,619.00 |
$2,619.00 |
$2,619.00 |
$2,767.80
|
|
Radphm quant measure sgl area add-on
|
$46.50 |
$46.50 |
$46.50 |
$2,764.20
|
|
Rapid Strep Test
|
$100.50 |
$100.50 |
$100.50 |
$72.00
|
|
Rasburicase 1.5 mg intravenous solution
|
$20,465.52 |
$20,465.52 |
$20,465.52 |
$9,544.20
|
|
Ravulizumab-cwvz 100 mg/ml intravenous solution
|
$88,558.68 |
$88,558.68 |
$88,558.68 |
$71,857.80
|
|
Rbc count only automated
|
$37.50 |
$37.50 |
$37.50 |
$21.40
|
|
Rbc deglycerolized each unit
|
$1,524.00 |
$1,524.00 |
$1,524.00 |
$1,263.00
|
|
Rbc irradiated each unit
|
$1,046.25 |
$1,046.25 |
$1,046.25 |
$510.60
|
|
Red blood cells each unit
|
$1,275.00 |
$1,275.00 |
$1,275.00 |
$759.60
|
|
Red blood cells leukocytes reduced each unit
|
$830.25 |
$830.25 |
$830.25 |
$818.40
|
|
Red blood cells leukocytes reduced irradiated each unit
|
$837.00 |
$837.00 |
$837.00 |
$797.40
|
|
Red blood cells washed each unit
|
$1,280.25 |
$1,280.25 |
$1,280.25 |
$665.40
|
|
Redo endovas vena cava filtr
|
$3,682.50 |
$3,682.50 |
$3,682.50 |
$3,147.50
|
|
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 |
$423.60
|
|
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 |
$2,280.73
|
|
Relocation skin pocket aicd
|
$3,869.25 |
$3,869.25 |
$3,869.25 |
$3,513.00
|
|
Relocation skin pocket pm
|
$2,939.25 |
$2,939.25 |
$2,939.25 |
$2,504.40
|
|
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 |
$189.00
|
|
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 |
$115.80
|
|
Rem/biv cast full arm/leg
|
$320.25 |
$320.25 |
$320.25 |
$441.00
|
|
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 |
$1,179.08
|
|
Removal biliary drg cath
|
$2,025.75 |
$2,025.75 |
$2,025.75 |
$1,398.75
|
|
Removal central venous catheter tunneled without port/pump
|
$1,899.75 |
$1,899.75 |
$1,899.75 |
$2,172.00
|
|
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 |
$3,179.53
|
|
Removal cerclage without anes
|
$778.50 |
$778.50 |
$778.50 |
$722.40
|
|
Removal cerumen impacted (both sides)
|
$170.25 |
$170.25 |
$170.25 |
$168.00
|
|
Removal clot in graft oth/thn 35875
|
$5,270.25 |
$5,270.25 |
$5,270.25 |
$5,405.70
|
|
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 |
$276.00
|
|
Removal duct glbldr calculi
|
$3,895.50 |
$3,895.50 |
$3,895.50 |
$2,689.50
|
|
Removal embedded foreign body vestibule mouth smpl
|
$876.00 |
$876.00 |
$876.00 |
$937.56
|
|
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 |
$873.00
|
|
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 |
$3,355.20
|
|
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 |
$2,862.05
|
|
Removal of intranasal lesion
|
$3,732.00 |
$3,732.00 |
$3,732.00 |
$3,243.07
|
|
Removal of shunt
|
$6,577.50 |
$6,577.50 |
$6,577.50 |
$3,147.50
|
|
Removal of skin tags each add'l 10
|
$421.50 |
$421.50 |
$421.50 |
$384.00
|
|
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 |
$27.60
|
|
Removal tunnled intprtnl cath
|
$4,377.00 |
$4,377.00 |
$4,377.00 |
$3,209.40
|
|
Removal w/reinsrt nonbiogrdble
|
$3,072.00 |
$3,072.00 |
$3,072.00 |
$2,805.00
|
|
Removal/replacement ppm generator dual lead system
|
$9,527.25 |
$9,527.25 |
$9,527.25 |
$10,465.33
|
|
Remove anal fist complex
|
$3,371.25 |
$3,371.25 |
$3,371.25 |
$2,742.39
|
|
Remove anal fist subq
|
$3,249.75 |
$3,249.75 |
$3,249.75 |
$2,742.39
|
|
Remove cva lumen obstruct
|
$2,241.75 |
$2,241.75 |
$2,241.75 |
$1,428.00
|
|
Remove ear canal lesion(s)
|
$3,293.25 |
$3,293.25 |
$3,293.25 |
$2,862.05
|
|
Remove eyelid lesion
|
$1,133.25 |
$1,133.25 |
$1,133.25 |
$968.54
|
|
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 |
$2,790.00
|
|
Remove in/ex hem grps w/fist
|
$3,255.75 |
$3,255.75 |
$3,255.75 |
$2,742.39
|
|
Remove renal tube w/fluoro
|
$1,281.75 |
$1,281.75 |
$1,281.75 |
$1,830.00
|
|
Remove shoulder foreign body subq 23330
|
$1,879.50 |
$1,879.50 |
$1,879.50 |
$1,566.00
|
|
Remove spine eltrd perq aray
|
$2,238.75 |
$2,238.75 |
$2,238.75 |
$1,952.77
|
|
Remove stent via transureth
|
$1,638.75 |
$1,638.75 |
$1,638.75 |
$2,048.51
|
|
Remove tonsils and adenoids
|
$3,600.75 |
$3,600.75 |
$3,600.75 |
$3,243.07
|
|
Remove ureter stent percut
|
$3,552.00 |
$3,552.00 |
$3,552.00 |
$6,318.00
|
|
Remove vaginal foreign body 57415
|
$3,577.50 |
$3,577.50 |
$3,577.50 |
$3,308.25
|
|
Renal function panel
|
$188.25 |
$188.25 |
$188.25 |
$156.00
|
|
Renal venogram bil s&i
|
$3,386.25 |
$3,386.25 |
$3,386.25 |
$2,859.75
|
|
Repair blood vessel dir upper extr
|
$3,682.50 |
$3,682.50 |
$3,682.50 |
$3,147.50
|
|
Repair complex wound scalp/arms/legs 2.6 - 7.5 cm
|
$969.00 |
$969.00 |
$969.00 |
$2,172.00
|
|
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 |
$2,280.73
|
|
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 |
$2,473.50
|
|
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 |
$3,126.75
|
|
Repair lip full thkns =<one-half vert height
|
$579.00 |
$579.00 |
$579.00 |
$1,080.75
|
|
Repair lip full thkns >one-half vert height/cmplx
|
$1,768.50 |
$1,768.50 |
$1,768.50 |
$2,046.00
|
|
Repair of toe dislocation
|
$3,752.25 |
$3,752.25 |
$3,752.25 |
$3,126.75
|
|
Repair pm/icd lead dual
|
$6,205.50 |
$6,205.50 |
$6,205.50 |
$3,691.50
|
|
Repair pm/icd lead sgl
|
$4,257.75 |
$4,257.75 |
$4,257.75 |
$3,639.30
|
|
Repair rpr lac tongue floor mouth > 2.6 cm/cmplx
|
$262.50 |
$262.50 |
$262.50 |
$2,260.20
|
|
Repair rpr lip full thickness vermilion only
|
$579.00 |
$579.00 |
$579.00 |
$2,097.00
|
|
Repair stomach opening
|
$4,451.25 |
$4,451.25 |
$4,451.25 |
$3,709.50
|
|
Repair tendon/muscle forearm/wrist prime sngl ea
|
$3,752.25 |
$3,752.25 |
$3,752.25 |
$5,322.00
|
|
Repair tongue lac <2.5cm past 1/3 tongue 41251
|
$262.50 |
$262.50 |
$262.50 |
$232.22
|
|
Repair upper arm/elbow tendon/muscle ea
|
$8,293.50 |
$8,293.50 |
$8,293.50 |
$6,880.20
|
|
Replace aortic valve open femoral 33362
|
$31,283.25 |
$31,283.25 |
$31,283.25 |
$14,604.60
|
|
Replace aortic valve open iliac 33364
|
$44,969.25 |
$44,969.25 |
$44,969.25 |
$15,259.80
|
|
Replace aortic valve w/byp prq aprch 33367
|
$44,969.25 |
$44,969.25 |
$44,969.25 |
$18,614.25
|
|
Replace duod/jej tube perc
|
$1,464.75 |
$1,464.75 |
$1,464.75 |
$2,618.40
|
|
Replace g-j tube perc
|
$1,479.75 |
$1,479.75 |
$1,479.75 |
$3,105.00
|
|
Replace g/c tube perc
|
$1,059.75 |
$1,059.75 |
$1,059.75 |
$2,695.80
|
|
Replace tunneled cv cath
|
$4,034.25 |
$4,034.25 |
$4,034.25 |
$4,001.25
|
|
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 |
$4,831.80
|
|
Reposg phrnc nrv stim trnsvn
|
$4,023.75 |
$4,023.75 |
$4,023.75 |
$3,353.25
|
|
Reposition pm/icd lead
|
$4,089.00 |
$4,089.00 |
$4,089.00 |
$3,780.00
|
|
Reprogram cochlear implt 7/>
|
$382.50 |
$382.50 |
$382.50 |
$156.46
|
|
Reprogram cochlear implt <7
|
$762.75 |
$762.75 |
$762.75 |
$156.46
|
|
Reptilase test
|
$138.75 |
$138.75 |
$138.75 |
$87.60
|
|
Resect inferior turbinate
|
$3,810.75 |
$3,810.75 |
$3,810.75 |
$3,243.07
|
|
Reslizumab 10 mg/ml intravenous solution
|
$4,119.02 |
$4,119.02 |
$4,119.02 |
$34.40
|
|
Resp virus 6-11 targets
|
$1,559.25 |
$1,559.25 |
$1,559.25 |
$1,146.60
|
|
Resuscitation cardiopulmonary
|
$1,155.00 |
$1,155.00 |
$1,155.00 |
$741.75
|
|
Resuscitation delivery/birthing room
|
$721.50 |
$721.50 |
$721.50 |
$721.50
|
|
Reticulated platelet assay
|
$99.00 |
$99.00 |
$99.00 |
$85.50
|
|
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 |
$3,288.00
|
|
Revasc evasc fpvt angio cplx 1st
|
$9,528.00 |
$9,528.00 |
$9,528.00 |
$6,573.75
|
|
Revasc evasc fpvt angio sf 1st
|
$9,528.00 |
$9,528.00 |
$9,528.00 |
$6,573.75
|
|
Revasc evasc fpvt athrec cplx 1st
|
$16,954.50 |
$16,954.50 |
$16,954.50 |
$9,198.00
|
|
Revasc evasc fpvt athrec sf 1st
|
$16,954.50 |
$16,954.50 |
$16,954.50 |
$9,198.00
|
|
Revasc evasc fpvt st athrec sf 1st
|
$21,221.25 |
$21,221.25 |
$21,221.25 |
$17,082.75
|
|
Revasc evasc fpvt stent cplx 1st
|
$16,936.50 |
$16,936.50 |
$16,936.50 |
$16,699.50
|
|
Revasc evasc fpvt stent sf 1st
|
$16,936.50 |
$16,936.50 |
$16,936.50 |
$16,699.50
|
|
Revasc evasc imvt angio cplx 1st
|
$11,497.50 |
$11,497.50 |
$11,497.50 |
$9,255.00
|
|
Revasc evasc imvt angio sf 1st
|
$11,497.50 |
$11,497.50 |
$11,497.50 |
$9,255.00
|
|
Revasc evasc ivt angio cplx 1st
|
$9,998.25 |
$9,998.25 |
$9,998.25 |
$8,049.00
|
|
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 |
$8,235.00
|
|
Revasc evasc tpvt angio sf 1st
|
$9,804.00 |
$9,804.00 |
$9,804.00 |
$8,235.00
|
|
Revasc evasc tpvt athrec cplx 1st
|
$14,665.50 |
$14,665.50 |
$14,665.50 |
$12,046.50
|
|
Revasc evasc tpvt athrec sf 1st
|
$14,665.50 |
$14,665.50 |
$14,665.50 |
$12,046.50
|
|
Revasc intra lithotrip-ather
|
$20,329.50 |
$20,329.50 |
$20,329.50 |
$20,533.20
|
|
Revasc intra lithotrip-stent
|
$20,329.50 |
$20,329.50 |
$20,329.50 |
$20,533.20
|
|
Revasc intravasc lithotripsy
|
$12,754.50 |
$12,754.50 |
$12,754.50 |
$11,449.20
|
|
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 |
$30,547.80
|
|
Revise abdomen-venous shunt
|
$7,104.75 |
$7,104.75 |
$7,104.75 |
$3,529.06
|
|
Revise/remove sling repair
|
$3,720.00 |
$3,720.00 |
$3,720.00 |
$3,179.53
|
|
Revision of cervix
|
$5,771.25 |
$5,771.25 |
$5,771.25 |
$3,179.53
|
|
Revision of cervix
|
$7,213.50 |
$7,213.50 |
$7,213.50 |
$3,179.53
|
|
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 |
$3,367.50
|
|
Revision tips
|
$7,994.25 |
$7,994.25 |
$7,994.25 |
$7,508.40
|
|
Rf abltj nrv nrvtg si jt
|
$1,746.75 |
$1,746.75 |
$1,746.75 |
$3,768.60
|
|
Rheumatoid factor quantitative
|
$98.25 |
$98.25 |
$98.25 |
$74.40
|
|
Rho d immune globulin inj
|
$194.25 |
$194.25 |
$194.25 |
$622.40
|
|
Rho(d) immune globulin h, sd
|
$5,242.06 |
$5,242.06 |
$5,242.06 |
$1,551.00
|
|
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 |
$2,545.80
|
|
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 |
$4,199.40
|
|
Rituximab 1,400 mg/11.7 ml (120 mg/ml)-hyaluronidase subcutaneous soln
|
$27,790.74 |
$27,790.74 |
$27,790.74 |
$218.40
|
|
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 |
$7,826.40
|
|
Rmv implant contraceptive capsule 11976
|
$1,478.25 |
$1,478.25 |
$1,478.25 |
$1,314.00
|
|
Rmv&rplcmt phrnc nrv stim ld
|
$15,792.75 |
$15,792.75 |
$15,792.75 |
$13,161.00
|
|
Rmv&rplcmt phrnc nrv stim pg
|
$36,000.00 |
$36,000.00 |
$36,000.00 |
$30,000.00
|
|
Rmvl foreign body upper arm/elbow subcutaneous
|
$1,897.50 |
$1,897.50 |
$1,897.50 |
$1,470.60
|
|
Rmvl icd by tv extr
|
$4,848.75 |
$4,848.75 |
$4,848.75 |
$4,482.75
|
|
Rmvl icd gen w/rplc icd gen dual lead sys
|
$22,197.75 |
$22,197.75 |
$22,197.75 |
$22,446.19
|
|
Rmvl icd gen w/rplc icd gen mlt lead sys
|
$26,801.25 |
$26,801.25 |
$26,801.25 |
$32,061.58
|
|
Rmvl icd gen w/rplc icd gen sgl lead sys
|
$21,319.50 |
$21,319.50 |
$21,319.50 |
$22,446.19
|
|
Rmvl icd pulse gen only
|
$4,307.25 |
$4,307.25 |
$4,307.25 |
$3,655.80
|
|
Rmvl ndwellg tun pleural cath
|
$2,230.50 |
$2,230.50 |
$2,230.50 |
$1,826.40
|
|
Rmvl perm pm pulse gen
|
$6,820.50 |
$6,820.50 |
$6,820.50 |
$4,150.50
|
|
Rmvl phrnc nrv stim pg only
|
$4,023.75 |
$4,023.75 |
$4,023.75 |
$3,353.25
|
|
Rmvl phrnc nrv stim sys
|
$4,023.75 |
$4,023.75 |
$4,023.75 |
$3,353.25
|
|
Rmvl phrnc nrv stim transvns
|
$3,945.00 |
$3,945.00 |
$3,945.00 |
$3,287.25
|
|
Rmvl pm gen w/rplc pm gen mlt lead sys
|
$18,045.00 |
$18,045.00 |
$18,045.00 |
$19,071.16
|
|
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 |
$243.00
|
|
Rmvl pq vad left hrt vein sep session
|
$6,116.25 |
$6,116.25 |
$6,116.25 |
$1,467.60
|
|
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 |
$1,912.80
|
|
Rmvl tv pm lead dual
|
$3,988.50 |
$3,988.50 |
$3,988.50 |
$3,687.00
|
|
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 |
$127.20
|
|
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 |
$178.80
|
|
Rp loclzj tum spect w/ct 1
|
$2,531.25 |
$2,531.25 |
$2,531.25 |
$2,767.80
|
|
Rpl non-tun cvc wo sbq prt/pmp
|
$2,703.00 |
$2,703.00 |
$2,703.00 |
$2,587.20
|
|
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 |
$3,147.50
|
|
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 |
$165.00
|
|
Russell viper venom diluted
|
$108.00 |
$108.00 |
$108.00 |
$119.40
|
|
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 |
$5,043.00
|
|
Salivary gland imaging
|
$585.00 |
$585.00 |
$585.00 |
$541.50
|
|
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 |
$34.80
|
|
Scan duplex abd/pelvis/retroperitoneal complete
|
$1,225.50 |
$1,225.50 |
$1,225.50 |
$1,126.20
|
|
Scan duplex abd/pelvis/retroperitoneal limited
|
$977.25 |
$977.25 |
$977.25 |
$873.00
|
|
Scan duplex aorta/ivc/iliac or bypass grafts complete
|
$994.50 |
$994.50 |
$994.50 |
$819.60
|
|
Scan duplex aorta/ivc/iliac unilateral/limited
|
$724.50 |
$724.50 |
$724.50 |
$715.80
|
|
Scan duplex extracranial arteries unilateral/limited study
|
$127.50 |
$127.50 |
$127.50 |
$518.40
|
|
Scan duplex extremity veins unilateral/limited study
|
$999.75 |
$999.75 |
$999.75 |
$810.75
|
|
Scan duplex lower extremity arteries complete bilateral
|
$1,207.50 |
$1,207.50 |
$1,207.50 |
$1,108.20
|
|
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 |
$1,864.80
|
|
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 |
$15,714.60
|
|
Sec art mech thrmbc non-intracranial add-on
|
$8,255.25 |
$8,255.25 |
$8,255.25 |
$8,416.80
|
|
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 |
$51.00
|
|
Select picture audiometry
|
$67.50 |
$67.50 |
$67.50 |
$56.25
|
|
Self-mgmt educ/train 2-4 pt 30min
|
$135.00 |
$135.00 |
$135.00 |
$112.50
|
|
Sensorimotor examination
|
$109.50 |
$109.50 |
$109.50 |
$59.40
|
|
Sertraline (zoloft) - sendout
|
$101.25 |
$101.25 |
$101.25 |
$88.50
|
|
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 |
$2,564.40
|
|
Shave sgl skin lsn f/e/e/n/l/m 0.5cm/<
|
$987.75 |
$987.75 |
$987.75 |
$198.70
|
|
Shave sgl skin lsn f/e/e/n/l/m 0.6-1.0cm
|
$935.25 |
$935.25 |
$935.25 |
$615.00
|
|
Shave sgl skin lsn f/e/e/n/l/m 1.1-2cm
|
$935.25 |
$935.25 |
$935.25 |
$819.00
|
|
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 |
$494.40
|
|
Shave sgl skin lsn s/n/h/f/g 0.6-1.0 cm
|
$231.75 |
$231.75 |
$231.75 |
$520.80
|
|
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 |
$399.53
|
|
Shave sgl skin lsn t/a/l 0.5cm/<
|
$311.25 |
$311.25 |
$311.25 |
$520.80
|
|
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 |
$660.00
|
|
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 |
$2,769.75
|
|
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 |
$306.88
|
|
Shunt glaucoma baerveldt 350mm
|
$4,050.00 |
$4,050.00 |
$4,050.00 |
$4,636.80
|
|
Shuntogram nonvascular supervision & interpretation
|
$539.25 |
$539.25 |
$539.25 |
$262.80
|
|
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 |
$1,976.25
|
|
Sigmoidoscopy and biopsy
|
$1,942.50 |
$1,942.50 |
$1,942.50 |
$1,831.50
|
|
Sigmoidoscopy flex decompression 45337
|
$1,058.25 |
$1,058.25 |
$1,058.25 |
$2,571.60
|
|
Sigmoidoscopy for bleeding
|
$2,765.25 |
$2,765.25 |
$2,765.25 |
$1,885.20
|
|
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 |
$1,885.20
|
|
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 |
$2,712.75
|
|
Sigmoidoscopy w/tumr remove
|
$2,502.75 |
$2,502.75 |
$2,502.75 |
$1,885.20
|
|
Sigmoidoscopy w/ultrasound
|
$3,027.00 |
$3,027.00 |
$3,027.00 |
$1,380.60
|
|
Sigmoidoscopy w/us guide bx
|
$4,014.75 |
$4,014.75 |
$4,014.75 |
$2,106.60
|
|
Sigmoidoscopy/submucosal injection 45335
|
$2,389.50 |
$2,389.50 |
$2,389.50 |
$1,650.75
|
|
Simple cystometrogram 51725
|
$759.00 |
$759.00 |
$759.00 |
$759.00
|
|
Sincalide 5 mcg solution for injection
|
$456.17 |
$456.17 |
$456.17 |
$475.20
|
|
Sinus CT scan (with and without contrast)
|
$1,576.50 |
$1,576.50 |
$1,576.50 |
$1,871.00
|
|
Sinus CT scan (with contrast)
|
$1,519.50 |
$1,519.50 |
$1,519.50 |
$1,566.40
|
|
Sinus CT scan (without contrast)
|
$1,303.50 |
$1,303.50 |
$1,303.50 |
$1,275.30
|
|
Sinus/juglr venogram s&i
|
$2,489.25 |
$2,489.25 |
$2,489.25 |
$2,226.60
|
|
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 |
$378.65
|
|
Skyla, 13.5 mg
|
$3,739.59 |
$3,739.59 |
$3,739.59 |
$2,343.60
|
|
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 |
$632.25
|
|
Sleeve fing rolyan med
|
$32.25 |
$32.25 |
$32.25 |
$32.25
|
|
Sling arm deluxe w/pad xs
|
$30.35 |
$30.35 |
$30.35 |
$197.40
|
|
Sling suprapubic suburetheral
|
$21,217.50 |
$21,217.50 |
$21,217.50 |
$7,586.40
|
|
Slp pure tone screening
|
$64.50 |
$64.50 |
$64.50 |
$64.50
|
|
Small bowel endoscopy
|
$3,970.50 |
$3,970.50 |
$3,970.50 |
$3,414.00
|
|
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 |
$2,350.50
|
|
Small bowel endoscopy
|
$3,048.00 |
$3,048.00 |
$3,048.00 |
$1,896.99
|
|
Small bowel endoscopy
|
$3,657.00 |
$3,657.00 |
$3,657.00 |
$2,466.00
|
|
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 |
$2,040.75
|
|
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 |
$1,896.99
|
|
Small bowel endoscopy br/wa
|
$2,166.75 |
$2,166.75 |
$2,166.75 |
$1,895.40
|
|
Small bowel endoscopy/biopsy
|
$4,161.00 |
$4,161.00 |
$4,161.00 |
$3,414.00
|
|
Small bowel endoscopy/biopsy
|
$2,205.75 |
$2,205.75 |
$2,205.75 |
$1,896.99
|
|
Small bowel endoscopy/stent 44370
|
$6,607.50 |
$6,607.50 |
$6,607.50 |
$7,896.80
|
|
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 |
$55.80
|
|
Smear nasal eosinophil
|
$46.50 |
$46.50 |
$46.50 |
$47.25
|
|
Smear special stain inclusion bodies/parasites
|
$52.50 |
$52.50 |
$52.50 |
$43.20
|
|
Smear wet mount
|
$88.50 |
$88.50 |
$88.50 |
$77.25
|
|
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 |
$1,137.00
|
|
Sodium 24 hour urine
|
$60.00 |
$60.00 |
$60.00 |
$52.20
|
|
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 |
$21.60
|
|
Sodium ferric gluconate complex in sucrose 62.5 mg/5 ml intravenous
|
$28.46 |
$28.46 |
$28.46 |
$43.20
|
|
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 |
$40.20
|
|
Somatosensory testing
|
$1,404.00 |
$1,404.00 |
$1,404.00 |
$760.80
|
|
Somatropin injection
|
$2,600.83 |
$2,600.83 |
$2,600.83 |
$2,111.40
|
|
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 |
$927.00
|
|
Speech recep thresh
|
$104.25 |
$104.25 |
$104.25 |
$59.40
|
|
Spinal puncture lumbar diagnostic w/fluoroscopic or CT guidance
|
$1,416.00 |
$1,416.00 |
$1,416.00 |
$1,439.40
|
|
Spirometry bronchodilation responsiveness pre/post bronchodilator administration
|
$672.00 |
$672.00 |
$672.00 |
$526.80
|
|
Spirometry up to 2 yrs old
|
$1,005.75 |
$1,005.75 |
$1,005.75 |
$929.25
|
|
Spleen imaging
|
$469.50 |
$469.50 |
$469.50 |
$401.83
|
|
Splint dorsal bloc wh med perf 3.2mm lf polyflex ii
|
$48.75 |
$48.75 |
$48.75 |
$542.40
|
|
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 |
$122.40
|
|
Split blood or products
|
$606.00 |
$606.00 |
$606.00 |
$303.00
|
|
Sputum specimen collection
|
$337.50 |
$337.50 |
$337.50 |
$337.50
|
|
St analysis behavior qualitative voice/resonance
|
$393.00 |
$393.00 |
$393.00 |
$318.75
|
|
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 |
$334.80
|
|
St evaluation motion fluoroscopic swallow function cine/video
|
$551.25 |
$551.25 |
$551.25 |
$354.75
|
|
St evaluation swallow function
|
$442.50 |
$442.50 |
$442.50 |
$383.25
|
|
St treatment speech individual
|
$332.25 |
$332.25 |
$332.25 |
$203.40
|
|
St treatment swallow dysfunction/oral
|
$415.50 |
$415.50 |
$415.50 |
$216.80
|
|
Staggered spondaic word test
|
$474.75 |
$474.75 |
$474.75 |
$156.46
|
|
Staph a dna amp probe
|
$129.00 |
$129.00 |
$129.00 |
$129.00
|
|
Stem cells total count
|
$96.00 |
$96.00 |
$96.00 |
$102.75
|
|
Stenger test pure tone
|
$162.00 |
$162.00 |
$162.00 |
$59.40
|
|
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 |
$32,602.80
|
|
Stent bili dbl pgtl 10fx5cm
|
$5,076.00 |
$5,076.00 |
$5,076.00 |
$810.00
|
|
Stent bili rx wallflx 10x80 uncvr
|
$38,815.81 |
$38,815.81 |
$38,815.81 |
$33,109.80
|
|
Str markers specimen anal
|
$1,678.50 |
$1,678.50 |
$1,678.50 |
$1,270.50
|
|
Strapping of ankle and/or ft 29540
|
$183.75 |
$183.75 |
$183.75 |
$315.60
|
|
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 |
$272.25
|
|
Strapping of hip
|
$147.00 |
$147.00 |
$147.00 |
$147.00
|
|
Strapping of knee
|
$204.75 |
$204.75 |
$204.75 |
$243.60
|
|
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 |
$309.00
|
|
Stress tte complete
|
$2,007.00 |
$2,007.00 |
$2,007.00 |
$1,989.60
|
|
Subq njx filling matrl 1cc/<
|
$1,392.00 |
$1,392.00 |
$1,392.00 |
$198.70
|
|
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 |
$131.40
|
|
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 |
$58.20
|
|
Surgical pathology level 2 gross & microscopic examination
|
$193.50 |
$193.50 |
$193.50 |
$168.75
|
|
Surgical pathology level 3 gross & microscopic examination
|
$240.00 |
$240.00 |
$240.00 |
$212.40
|
|
Surgical pathology level 4 gross & microscopic examination
|
$330.75 |
$330.75 |
$330.75 |
$250.20
|
|
Surgical pathology level 5 gross & microscopic examination
|
$507.00 |
$507.00 |
$507.00 |
$472.50
|
|
Surgical pathology level 6 gross & microscopic examination
|
$720.75 |
$720.75 |
$720.75 |
$691.20
|
|
Susceptibility agar dilution per agent
|
$130.50 |
$130.50 |
$130.50 |
$69.75
|
|
Susceptibility enzyme detection per enzyme
|
$31.50 |
$31.50 |
$31.50 |
$24.75
|
|
Susceptibility mic per plate
|
$96.00 |
$96.00 |
$96.00 |
$88.20
|
|
Svc venogram s&i
|
$4,438.50 |
$4,438.50 |
$4,438.50 |
$2,241.75
|
|
Synvisc or synvisc-one
|
$1,696.83 |
$1,696.83 |
$1,696.83 |
$73.20
|
|
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 |
$28,759.80
|
|
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 |
$112.80
|
|
T3 (triiodothyronine) free
|
$62.25 |
$62.25 |
$62.25 |
$86.40
|
|
T3 (triiodothyronine) total
|
$52.50 |
$52.50 |
$52.50 |
$72.00
|
|
T4 (thyroxine) free
|
$45.75 |
$45.75 |
$45.75 |
$78.00
|
|
T4 (thyroxine) total
|
$99.75 |
$99.75 |
$99.75 |
$82.80
|
|
Tacrol astagraf ex rel oral
|
$2,970.47 |
$2,970.47 |
$2,970.47 |
$3.15
|
|
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 |
$1,588.00
|
|
Tacrolimus therapeutic drug level
|
$174.75 |
$174.75 |
$174.75 |
$171.00
|
|
Tafasitamab-cxix 200 mg intravenous solution
|
$5,161.23 |
$5,161.23 |
$5,161.23 |
$28.80
|
|
Talimogene laherparepvec 10exp6 (1 million) pfu/ml susp for injection
|
$25,827.38 |
$25,827.38 |
$25,827.38 |
$133.80
|
|
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 |
$931.50
|
|
Tavr perq femoral
|
$25,185.75 |
$25,185.75 |
$25,185.75 |
$14,986.50
|
|
Tb test cell mediated immunity antigen response enumeration gamma interferon t-cells
|
$460.50 |
$460.50 |
$460.50 |
$615.60
|
|
Tbo-filgrastim 300 mcg/0.5 ml subcutaneous syringe
|
$959.55 |
$959.55 |
$959.55 |
$357.60
|
|
Tc-99m mebrofenin
|
$1,248.75 |
$1,248.75 |
$1,248.75 |
$303.00
|
|
Tc-99m mertiatide
|
$4,717.50 |
$4,717.50 |
$4,717.50 |
$1,978.20
|
|
Tc-99m pentetate dtpa
|
$975.00 |
$975.00 |
$975.00 |
$122.40
|
|
Tc-99m sestamibi p study dose
|
$6,044.97 |
$6,044.97 |
$6,044.97 |
$725.40
|
|
Tc-99m sulfur colloid
|
$3,734.48 |
$3,734.48 |
$3,734.48 |
$191.20
|
|
Tcd emboli detect w/inj
|
$1,061.25 |
$1,061.25 |
$1,061.25 |
$585.00
|
|
Tcd emboli detect without inj
|
$1,269.00 |
$1,269.00 |
$1,269.00 |
$240.60
|
|
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 |
$865.50
|
|
Tee w or without fol w/cont,cong
|
$1,826.25 |
$1,826.25 |
$1,826.25 |
$1,626.00
|
|
Telavancin injection
|
$2,428.05 |
$2,428.05 |
$2,428.05 |
$987.60
|
|
Telehealth original site facility fee
|
$151.50 |
$151.50 |
$151.50 |
$120.00
|
|
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 |
$1,714.80
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$29,758.74 |
$29,758.74 |
$29,758.74 |
$14,427.60
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$68.57 |
$68.57 |
$68.57 |
$102.00
|
|
Tert gene targeted seq alys
|
$347.25 |
$347.25 |
$347.25 |
$347.25
|
|
Test for chlorohydrocarbons
|
$225.00 |
$225.00 |
$225.00 |
$94.80
|
|
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 |
$1,193.40
|
|
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 |
$369.00
|
|
Therapy activation ipnss
|
$108.00 |
$108.00 |
$108.00 |
$90.00
|
|
Therapy nutrition individual initial f2f w/patient each 15 minutes
|
$65.25 |
$65.25 |
$65.25 |
$40.94
|
|
Therapy nutrition individual reassessment/intervention f2f w/patient each 15 minutes
|
$65.25 |
$65.25 |
$65.25 |
$25.80
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$23.67 |
$23.67 |
$23.67 |
$38.20
|
|
Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides)
|
$1,687.50 |
$1,687.50 |
$1,687.50 |
$1,542.40
|
|
Thoracotomy with cardiac massage
|
$4,610.25 |
$4,610.25 |
$4,610.25 |
$3,385.80
|
|
Thrombectmy crnry perq mechanical
|
$4,489.50 |
$4,489.50 |
$4,489.50 |
$3,855.60
|
|
Thrombectomy/inf pq dialysis circuit
|
$6,205.50 |
$6,205.50 |
$6,205.50 |
$5,701.52
|
|
Thrombectomy/inf pq dialysis circuit w/pta
|
$10,103.25 |
$10,103.25 |
$10,103.25 |
$8,133.75
|
|
Thrombectomy/inf pq dialysis circuit w/stent plcmnt
|
$15,313.50 |
$15,313.50 |
$15,313.50 |
$12,329.25
|
|
Thrombin time
|
$87.00 |
$87.00 |
$87.00 |
$86.40
|
|
Thromboplastin time partial (ptt) substitution fractions each
|
$99.75 |
$99.75 |
$99.75 |
$96.60
|
|
Thyroglobulin antibody
|
$47.25 |
$47.25 |
$47.25 |
$154.80
|
|
Thyroid (TSH) Test
|
$136.50 |
$136.50 |
$136.50 |
$110.00
|
|
Thyroid Ultrasound
|
$885.75 |
$885.75 |
$885.75 |
$603.90
|
|
Thyroid mets imag whole body
|
$2,506.50 |
$2,506.50 |
$2,506.50 |
$2,013.75
|
|
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 |
$96.60
|
|
Tib/per revasc stent & ather 37231
|
$21,900.00 |
$21,900.00 |
$21,900.00 |
$17,956.72
|
|
Tigecycline injection
|
$534.77 |
$534.77 |
$534.77 |
$58.20
|
|
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 |
$334.80
|
|
Tissue culture placenta
|
$6,844.50 |
$6,844.50 |
$6,844.50 |
$1,024.20
|
|
Tissue culture skin/biopsy
|
$1,468.50 |
$1,468.50 |
$1,468.50 |
$1,299.00
|
|
Tissue culture tumor
|
$945.00 |
$945.00 |
$945.00 |
$873.75
|
|
Tissue exam koh skin/hair/nails
|
$66.00 |
$66.00 |
$66.00 |
$70.80
|
|
Tissue matrix 1.8x1.8cm collagen dermacell porous 4sq cm cost per sq cm
|
$2,516.07 |
$2,516.07 |
$2,516.07 |
$3,150.60
|
|
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 |
$100.20
|
|
Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr
|
$286.24 |
$286.24 |
$286.24 |
$97.60
|
|
Tobramycin non-comp unit
|
$124.14 |
$124.14 |
$124.14 |
$124.14
|
|
Tobramycin peak therapeutic drug level
|
$93.00 |
$93.00 |
$93.00 |
$115.80
|
|
Tomosynthesis breast screen bilateral
|
$81.75 |
$81.75 |
$81.75 |
$65.52
|
|
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 |
$130.80
|
|
Total tau
|
$504.00 |
$504.00 |
$504.00 |
$282.60
|
|
Toxoplasma antibody igg
|
$60.00 |
$60.00 |
$60.00 |
$108.60
|
|
Toxoplasma antibody igm
|
$93.00 |
$93.00 |
$93.00 |
$106.50
|
|
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 |
$2,068.20
|
|
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 |
$1,812.00
|
|
Training self management diabetes individual outpatient department per 30 minutes
|
$101.25 |
$101.25 |
$101.25 |
$121.20
|
|
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 |
$338.25
|
|
Transcath biopsy
|
$4,294.50 |
$4,294.50 |
$4,294.50 |
$3,482.25
|
|
Transcath closure of asd
|
$16,096.50 |
$16,096.50 |
$16,096.50 |
$15,283.20
|
|
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 |
$11,292.00
|
|
Transcath occlusion cns
|
$19,546.50 |
$19,546.50 |
$19,546.50 |
$7,125.60
|
|
Transcath occlusion non-cns
|
$16,788.75 |
$16,788.75 |
$16,788.75 |
$11,340.57
|
|
Transcath rmvl perm ldss pmkr rv
|
$3,696.00 |
$3,696.00 |
$3,696.00 |
$2,724.00
|
|
Transcatheter bx s&i
|
$3,122.25 |
$3,122.25 |
$3,122.25 |
$2,886.75
|
|
Transferrin
|
$136.50 |
$136.50 |
$136.50 |
$108.00
|
|
Transfusion blood/blood component(s)
|
$1,166.25 |
$1,166.25 |
$1,166.25 |
$1,008.60
|
|
Transorl lwr esophgl myotomy
|
$6,978.00 |
$6,978.00 |
$6,978.00 |
$5,814.75
|
|
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 |
$1,410.00
|
|
Trauma partial team response w/critical care services level 4
|
$3,822.00 |
$3,822.00 |
$3,822.00 |
$6,448.80
|
|
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 |
$1,980.00
|
|
Treat clavicle dislocation 23545
|
$261.75 |
$261.75 |
$261.75 |
$998.40
|
|
Treat elbow dislocation
|
$1,815.75 |
$1,815.75 |
$1,815.75 |
$2,074.80
|
|
Treat elbow fracture
|
$1,815.75 |
$1,815.75 |
$1,815.75 |
$3,135.00
|
|
Treat finger fracture each
|
$1,815.75 |
$1,815.75 |
$1,815.75 |
$2,055.00
|
|
Treat foot dislocation
|
$261.75 |
$261.75 |
$261.75 |
$261.75
|
|
Treat fracture of radius
|
$1,514.25 |
$1,514.25 |
$1,514.25 |
$1,600.41
|
|
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 |
$1,728.60
|
|
Treat hip dislocation
|
$1,815.75 |
$1,815.75 |
$1,815.75 |
$3,050.40
|
|
Treat humerus fracture
|
$1,815.75 |
$1,815.75 |
$1,815.75 |
$2,055.00
|
|
Treat humerus fracture
|
$1,815.75 |
$1,815.75 |
$1,815.75 |
$2,552.40
|
|
Treat knee dislocation
|
$1,815.75 |
$1,815.75 |
$1,815.75 |
$2,630.40
|
|
Treat knee fracture 27530
|
$344.25 |
$344.25 |
$344.25 |
$759.00
|
|
Treat knee fracture(s)
|
$642.00 |
$642.00 |
$642.00 |
$642.00
|
|
Treat metacarpal fracture
|
$3,767.25 |
$3,767.25 |
$3,767.25 |
$3,244.61
|
|
Treat sternum fracture
|
$423.00 |
$423.00 |
$423.00 |
$390.75
|
|
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 |
$1,678.50
|
|
Treat ulnar fracture
|
$1,198.50 |
$1,198.50 |
$1,198.50 |
$2,874.60
|
|
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 |
$825.60
|
|
Treatment fx radial distal open w/internal fixation 2 frag left (restricted method ii cah)
|
$8,370.75 |
$8,370.75 |
$8,370.75 |
$7,747.20
|
|
Treatment fx radial distal open w/internal fixation 3+ frag left (restricted method ii cah)
|
$8,370.75 |
$8,370.75 |
$8,370.75 |
$7,747.20
|
|
Treatment fx radial distal open w/internal fixation left (restricted method ii cah)
|
$8,370.75 |
$8,370.75 |
$8,370.75 |
$7,747.20
|
|
Treatment incomplete abortion completed surgically any trimester
|
$3,996.00 |
$3,996.00 |
$3,996.00 |
$5,405.40
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$333.75 |
$333.75 |
$333.75 |
$246.60
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$320.25 |
$320.25 |
$320.25 |
$234.00
|
|
Treatment inhalation pressurized/nonpressurized acute airway obstruction
|
$198.75 |
$198.75 |
$198.75 |
$286.80
|
|
Treatment missed abortion completed surgically 1st trimester
|
$7,085.25 |
$7,085.25 |
$7,085.25 |
$5,405.40
|
|
Treatment of ankle fracture 27786
|
$358.50 |
$358.50 |
$358.50 |
$825.60
|
|
Treatment of fibula fracture 27780
|
$558.75 |
$558.75 |
$558.75 |
$769.80
|
|
Treatment of foot infection
|
$1,872.75 |
$1,872.75 |
$1,872.75 |
$1,560.75
|
|
Treatment of heel fracture 28400
|
$352.50 |
$352.50 |
$352.50 |
$759.00
|
|
Treatment of miscarriage
|
$9,051.75 |
$9,051.75 |
$9,051.75 |
$3,179.53
|
|
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 |
$677.25
|
|
Treatment of thigh fracture
|
$525.75 |
$525.75 |
$525.75 |
$759.00
|
|
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 |
$371.40
|
|
Treatment x10sv retinopathy
|
$674.25 |
$674.25 |
$674.25 |
$548.60
|
|
Treponema pallidum antibody
|
$169.50 |
$169.50 |
$169.50 |
$146.40
|
|
Treprostinil injection
|
$21,186.46 |
$21,186.46 |
$21,186.46 |
$1,570.80
|
|
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 |
$696.00
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$162.88 |
$162.88 |
$162.88 |
$45.00
|
|
Trichinella antibody
|
$140.25 |
$140.25 |
$140.25 |
$140.25
|
|
Triglycerides
|
$78.75 |
$78.75 |
$78.75 |
$80.40
|
|
Trim nail(s)
|
$69.75 |
$69.75 |
$69.75 |
$105.60
|
|
Trim nondyst nails
|
$318.75 |
$318.75 |
$318.75 |
$138.60
|
|
Trimethobenzamide hcl inj
|
$191.20 |
$191.20 |
$191.20 |
$99.20
|
|
Triptorelin pamoate
|
$16,454.18 |
$16,454.18 |
$16,454.18 |
$3,103.20
|
|
Trml dstrj ios bvn 1st 2 l/s
|
$15,258.00 |
$15,258.00 |
$15,258.00 |
$12,715.50
|
|
Trml dstrj ios bvn ea addl
|
$10,173.00 |
$10,173.00 |
$10,173.00 |
$9,781.50
|
|
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 |
$10,516.80
|
|
Trnscath plc vas stent w/s&i ea addl vein
|
$7,374.00 |
$7,374.00 |
$7,374.00 |
$9,800.25
|
|
Trnscath plc vas stent w/s&i ini vein
|
$10,059.75 |
$10,059.75 |
$10,059.75 |
$13,370.25
|
|
Trnscath retrv pq vasc fb w/guide
|
$3,869.25 |
$3,869.25 |
$3,869.25 |
$6,120.00
|
|
Trnscath tx thromblytc art/ven sbsq day
|
$4,505.25 |
$4,505.25 |
$4,505.25 |
$4,949.25
|
|
Trnscath tx thromblytc artery non-intracrn ini day
|
$8,034.75 |
$8,034.75 |
$8,034.75 |
$6,966.60
|
|
Trnscath tx thromblytc cath rmv sbsq day
|
$15,764.25 |
$15,764.25 |
$15,764.25 |
$5,324.40
|
|
Trnscath tx thromblytc vein ini day
|
$2,489.25 |
$2,489.25 |
$2,489.25 |
$5,236.20
|
|
Troponin quantitative
|
$180.00 |
$180.00 |
$180.00 |
$114.60
|
|
Tte w or without fol w/con,stres
|
$1,949.25 |
$1,949.25 |
$1,949.25 |
$1,171.20
|
|
Tte w or without fol w/cont, com
|
$1,922.25 |
$1,922.25 |
$1,922.25 |
$1,098.00
|
|
Tte w or without fol w/cont, f/u
|
$1,341.75 |
$1,341.75 |
$1,341.75 |
$693.75
|
|
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 |
$134.40
|
|
Tx closed hip disl traumatic without anes
|
$261.75 |
$261.75 |
$261.75 |
$998.40
|
|
Tx closed tib fx proximal w/w/o manip w/skel trac
|
$3,767.25 |
$3,767.25 |
$3,767.25 |
$3,483.00
|
|
Tx closed tib shaft fx without manip
|
$362.25 |
$362.25 |
$362.25 |
$718.20
|
|
Tx contour defects 1.1-5.0cc 11951
|
$2,245.50 |
$2,245.50 |
$2,245.50 |
$612.13
|
|
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 |
$509.40
|
|
Tympanometry & reflex thresh
|
$141.75 |
$141.75 |
$141.75 |
$156.46
|
|
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 |
$25.80
|
|
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 |
$288.00
|
|
Ultrasound breast complete
|
$510.00 |
$510.00 |
$510.00 |
$546.60
|
|
Ultrasound breast unilateral limited (both sides)
|
$478.50 |
$478.50 |
$478.50 |
$423.00
|
|
Ultrasound chest
|
$695.25 |
$695.25 |
$695.25 |
$461.40
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$561.00 |
$561.00 |
$561.00 |
$257.40
|
|
Ultrasound dx ophth b-scan
|
$404.25 |
$404.25 |
$404.25 |
$438.00
|
|
Ultrasound elastography ea l target les
|
$177.00 |
$177.00 |
$177.00 |
$177.00
|
|
Ultrasound elastography parenchyma
|
$284.25 |
$284.25 |
$284.25 |
$202.20
|
|
Ultrasound encephalogram
|
$463.50 |
$463.50 |
$463.50 |
$463.50
|
|
Ultrasound exam k transpl w/doppler
|
$967.50 |
$967.50 |
$967.50 |
$718.80
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$535.50 |
$535.50 |
$535.50 |
$540.00
|
|
Ultrasound guidance for vascular access
|
$511.50 |
$511.50 |
$511.50 |
$400.20
|
|
Ultrasound guide intraoperative
|
$822.00 |
$822.00 |
$822.00 |
$628.80
|
|
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 |
$295.50
|
|
Ultrasound joint complete left
|
$808.50 |
$808.50 |
$808.50 |
$785.40
|
|
Ultrasound joint/nonvascular extremity limited left
|
$542.25 |
$542.25 |
$542.25 |
$571.80
|
|
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 |
$373.60
|
|
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 |
$678.60
|
|
Ultrasound prostate/transrectal
|
$954.75 |
$954.75 |
$954.75 |
$695.40
|
|
Ultrasound retroperitoneal limited
|
$718.50 |
$718.50 |
$718.50 |
$543.00
|
|
Ultrasound scrotum and contents
|
$735.75 |
$735.75 |
$735.75 |
$693.75
|
|
Ultrasound spinal canal and contents
|
$352.50 |
$352.50 |
$352.50 |
$411.00
|
|
Ultrasound transabd ea addl gest
|
$701.25 |
$701.25 |
$701.25 |
$631.50
|
|
Ultrasound transvaginal non obstetric
|
$877.50 |
$877.50 |
$877.50 |
$704.25
|
|
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 |
$758.40
|
|
Unlisted dx gi procedure
|
$2,470.50 |
$2,470.50 |
$2,470.50 |
$247.20
|
|
Unlisted hystsc px uterus
|
$3,720.00 |
$3,720.00 |
$3,720.00 |
$201.17
|
|
Unlisted misc path test
|
$1,014.00 |
$1,014.00 |
$1,014.00 |
$299.40
|
|
Unlisted mr procedure
|
$1,616.25 |
$1,616.25 |
$1,616.25 |
$1,037.40
|
|
Unlisted orl service/px
|
$121.50 |
$121.50 |
$121.50 |
$117.00
|
|
Unlisted procedure colon
|
$6,297.75 |
$6,297.75 |
$6,297.75 |
$2,595.60
|
|
Unlisted procedure esophagus
|
$6,297.75 |
$6,297.75 |
$6,297.75 |
$152.40
|
|
Unlisted procedure larynx
|
$4,960.50 |
$4,960.50 |
$4,960.50 |
$232.22
|
|
Unlisted procedure liver
|
$2,802.00 |
$2,802.00 |
$2,802.00 |
$2,694.00
|
|
Unlisted procedure microbiology
|
$277.50 |
$277.50 |
$277.50 |
$277.50
|
|
Unlisted procedure pancreas
|
$2,967.75 |
$2,967.75 |
$2,967.75 |
$152.40
|
|
Unlisted procedure rectum
|
$1,058.25 |
$1,058.25 |
$1,058.25 |
$882.75
|
|
Unlisted px abdomen muscskel
|
$1,824.75 |
$1,824.75 |
$1,824.75 |
$1,461.75
|
|
Unlisted px casting/strpg
|
$316.50 |
$316.50 |
$316.50 |
$152.00
|
|
Unlisted px foot/toes
|
$3,846.75 |
$3,846.75 |
$3,846.75 |
$3,556.50
|
|
Unlisted px neck/thorax
|
$2,340.75 |
$2,340.75 |
$2,340.75 |
$1,989.00
|
|
Unlisted px small intestine
|
$2,493.00 |
$2,493.00 |
$2,493.00 |
$2,744.40
|
|
Unlisted px tongue flr mouth
|
$1,627.50 |
$1,627.50 |
$1,627.50 |
$286.80
|
|
Unlisted ultrasound procedure
|
$532.50 |
$532.50 |
$532.50 |
$306.00
|
|
Upgrade pm system
|
$13,140.75 |
$13,140.75 |
$13,140.75 |
$7,818.75
|
|
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 |
$1,751.66
|
|
Upper Endoscopy (EGD, with biopsy)
|
$2,464.50 |
$2,464.50 |
$2,464.50 |
$1,675.80
|
|
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 |
$39.60
|
|
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 |
$1,251.75
|
|
Urethrcystgrphy rtrgrde s&i
|
$810.75 |
$810.75 |
$810.75 |
$642.60
|
|
Urethrocystography void s&i
|
$880.50 |
$880.50 |
$880.50 |
$707.25
|
|
Uric acid blood
|
$58.50 |
$58.50 |
$58.50 |
$48.60
|
|
Uric acid urine
|
$55.50 |
$55.50 |
$55.50 |
$52.20
|
|
Urinalysis (with microscopy)
|
$123.00 |
$123.00 |
$123.00 |
$36.52
|
|
Urinalysis (without microscopy)
|
$62.25 |
$62.25 |
$62.25 |
$32.50
|
|
Urine Culture Test
|
$126.00 |
$126.00 |
$126.00 |
$65.15
|
|
Urine flow measurement 51736
|
$148.50 |
$148.50 |
$148.50 |
$128.90
|
|
Urine pregnancy test
|
$69.75 |
$69.75 |
$69.75 |
$63.00
|
|
Urography, antegrade
|
$808.50 |
$808.50 |
$808.50 |
$1,132.80
|
|
Use 1st target lesion
|
$252.00 |
$252.00 |
$252.00 |
$189.00
|
|
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 |
$746.40
|
|
Vaccine covid-19 moderna 6mos-11yrs 25mcg/0.25ml
|
$368.25 |
$368.25 |
$368.25 |
$209.40
|
|
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 |
$34.20
|
|
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 |
$36.60
|
|
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 |
$31.20
|
|
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 |
$117.60
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im
|
$135.00 |
$135.00 |
$135.00 |
$86.40
|
|
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 |
$168.80
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$75.39 |
$75.39 |
$75.39 |
$63.20
|
|
Vaccine hpv types 6/11/16/18 quadrivalent (4vhpv) 3 dose im
|
$599.25 |
$599.25 |
$599.25 |
$186.00
|
|
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 |
$186.00
|
|
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 |
$12.60
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im
|
$25.50 |
$25.50 |
$25.50 |
$12.00
|
|
Vaccine influenza quadrivalent (riv4) rdna antibiotic/preservative free im
|
$50.25 |
$50.25 |
$50.25 |
$54.00
|
|
Vaccine influenza quadrivalent live (laiv4) intranasal
|
$102.00 |
$102.00 |
$102.00 |
$72.75
|
|
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 |
$109.60
|
|
Vaccine mengingoccocal serogroup b 2 or 3 dose im
|
$747.00 |
$747.00 |
$747.00 |
$73.20
|
|
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 |
$40.20
|
|
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 |
$504.00
|
|
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 |
$372.30
|
|
Vaccine rotavirus pentavalent (rv5) live 3 dose oral
|
$344.25 |
$344.25 |
$344.25 |
$291.89
|
|
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 |
$39.00
|
|
Vaccine varicella live subcutaneous
|
$642.96 |
$642.96 |
$642.96 |
$642.96
|
|
Vaccine yellow fever live subcutaneous
|
$714.00 |
$714.00 |
$714.00 |
$632.19
|
|
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 |
$184.50
|
|
Vaginal hysterectomy
|
$5,766.00 |
$5,766.00 |
$5,766.00 |
$4,936.45
|
|
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 |
$6,420.60
|
|
Valvuloplasty mitral
|
$9,472.50 |
$9,472.50 |
$9,472.50 |
$11,340.57
|
|
Valvuloplasty pulmonary
|
$14,701.50 |
$14,701.50 |
$14,701.50 |
$12,754.50
|
|
Vancomycin 1,000 mg intravenous injection
|
$366.03 |
$366.03 |
$366.03 |
$0.60
|
|
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 |
$117.00
|
|
Varicella-zoster immue globin im
|
$8,070.06 |
$8,070.06 |
$8,070.06 |
$2,359.90
|
|
Vasc emb/occ w/prs cath
|
$21,009.00 |
$21,009.00 |
$21,009.00 |
$17,508.00
|
|
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 |
$1,194.00
|
|
Veeg ea 12-26hr cont mntr
|
$4,640.25 |
$4,640.25 |
$4,640.25 |
$2,109.60
|
|
Veeg intrmnt 2-12 hrs
|
$1,329.00 |
$1,329.00 |
$1,329.00 |
$783.60
|
|
Veeg unmon 12-26 hrs
|
$422.25 |
$422.25 |
$422.25 |
$530.60
|
|
Veeg unmon 2-12 hrs
|
$422.25 |
$422.25 |
$422.25 |
$586.80
|
|
Vein x-ray adrenal gland
|
$2,489.25 |
$2,489.25 |
$2,489.25 |
$3,147.50
|
|
Vein x-ray eye socket
|
$2,040.00 |
$2,040.00 |
$2,040.00 |
$1,141.50
|
|
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 |
$3,147.50
|
|
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 |
$3,147.50
|
|
Vein x-ray liver without hemodyn
|
$2,489.25 |
$2,489.25 |
$2,489.25 |
$3,476.40
|
|
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 |
$797.25
|
|
Vein x-ray spleen/liver
|
$3,682.50 |
$3,682.50 |
$3,682.50 |
$3,324.60
|
|
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 |
$336.60
|
|
Vemp test i&r ocular
|
$632.25 |
$632.25 |
$632.25 |
$336.60
|
|
Vemp tst i&r cervical&ocular
|
$1,181.25 |
$1,181.25 |
$1,181.25 |
$636.60
|
|
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 |
$122.40
|
|
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 |
$1,553.44
|
|
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 |
$12,268.80
|
|
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 |
$693.75
|
|
Version cephalic external
|
$2,361.75 |
$2,361.75 |
$2,361.75 |
$1,444.80
|
|
Very long chain fatty acids
|
$465.00 |
$465.00 |
$465.00 |
$342.75
|
|
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 |
$159.60
|
|
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 |
$417.00
|
|
Visual audiometry (vra)
|
$202.50 |
$202.50 |
$202.50 |
$156.46
|
|
Vital capacity test
|
$256.50 |
$256.50 |
$256.50 |
$156.46
|
|
Vitamin D Test
|
$265.50 |
$265.50 |
$265.50 |
$142.35
|
|
Vitamin b-12
|
$111.00 |
$111.00 |
$111.00 |
$111.00
|
|
Voiding pressure study/intra-abd 51797
|
$810.00 |
$810.00 |
$810.00 |
$605.25
|
|
Vol reduction of blood/prod
|
$131.25 |
$131.25 |
$131.25 |
$131.25
|
|
Volume measurement urine timed
|
$43.50 |
$43.50 |
$43.50 |
$25.80
|
|
Voriconazole in ns IV syringe 5 mg/ml (pediatric) - cnr
|
$221.85 |
$221.85 |
$221.85 |
$690.60
|
|
Warde 1003990 aldosterone
|
$189.00 |
$189.00 |
$189.00 |
$244.50
|
|
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 |
$138.00
|
|
Warde 1006955 catecholamines fractionated 24 hour urine
|
$127.50 |
$127.50 |
$127.50 |
$225.60
|
|
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 |
$130.80
|
|
Warde 3004000 immunoglobulin subclass 1
|
$157.50 |
$157.50 |
$157.50 |
$128.40
|
|
Warde 3008005 oligoclonal bands
|
$94.50 |
$94.50 |
$94.50 |
$138.60
|
|
Warde 3016000 west nile virus antibody
|
$174.75 |
$174.75 |
$174.75 |
$111.20
|
|
Warde 3016000 west nile virus antibody igg
|
$173.25 |
$173.25 |
$173.25 |
$111.20
|
|
Warde 3016300 saccharomyces cerevisiae iga antibody
|
$44.25 |
$44.25 |
$44.25 |
$100.80
|
|
Warde 3400652 ova & parasites direct smear concentration and id
|
$36.00 |
$36.00 |
$36.00 |
$49.20
|
|
Warde 3400652 smear complex special stain ova/parasites
|
$36.00 |
$36.00 |
$36.00 |
$100.20
|
|
Warde 3400683 amplification rna markers infectious disease bacterial vaginosis
|
$400.50 |
$400.50 |
$400.50 |
$447.60
|
|
Warde 3400852 arsenic
|
$232.50 |
$232.50 |
$232.50 |
$142.20
|
|
Warde 3708165 mercury urine
|
$150.00 |
$150.00 |
$150.00 |
$109.20
|
|
Warde acetylcholine receptor blocking antibody
|
$357.75 |
$357.75 |
$357.75 |
$355.80
|
|
Warde actin (smooth muscle) antibody each
|
$135.00 |
$135.00 |
$135.00 |
$132.60
|
|
Warde adenosine deaminase pleural fluid
|
$347.25 |
$347.25 |
$347.25 |
$87.60
|
|
Warde adrenocorticotropic hormone (acth)
|
$141.75 |
$141.75 |
$141.75 |
$195.00
|
|
Warde aldolase
|
$72.75 |
$72.75 |
$72.75 |
$79.50
|
|
Warde amino acids 6 or more quantitative each specimen
|
$480.00 |
$480.00 |
$480.00 |
$552.75
|
|
Warde amiodarone therapeutic drug level
|
$96.00 |
$96.00 |
$96.00 |
$141.00
|
|
Warde analysis gene hfe common variants
|
$153.75 |
$153.75 |
$153.75 |
$1,048.20
|
|
Warde analysis translocation bcr/abl1 major breakpoint qualitative/quantitative
|
$318.75 |
$318.75 |
$318.75 |
$718.20
|
|
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 |
$118.50
|
|
Warde apolipoprotein b
|
$141.00 |
$141.00 |
$141.00 |
$117.00
|
|
Warde bile acids
|
$124.50 |
$124.50 |
$124.50 |
$143.25
|
|
Warde cadmium blood
|
$84.75 |
$84.75 |
$84.75 |
$111.60
|
|
Warde calcitonin
|
$111.00 |
$111.00 |
$111.00 |
$136.20
|
|
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 |
$148.50
|
|
Warde complement total hemolytic
|
$171.75 |
$171.75 |
$171.75 |
$171.75
|
|
Warde copper
|
$243.00 |
$243.00 |
$243.00 |
$159.00
|
|
Warde cryoglobulin
|
$164.25 |
$164.25 |
$164.25 |
$75.60
|
|
Warde erythropoietin
|
$127.50 |
$127.50 |
$127.50 |
$127.50
|
|
Warde fluorescent antibody screen endomysial iga
|
$222.75 |
$222.75 |
$222.75 |
$102.00
|
|
Warde folic acid rbc
|
$52.50 |
$52.50 |
$52.50 |
$90.60
|
|
Warde g6pd (glucose 6 phosphate dehydrogenase) quantitative
|
$252.75 |
$252.75 |
$252.75 |
$252.75
|
|
Warde gastrin
|
$121.50 |
$121.50 |
$121.50 |
$146.40
|
|
Warde growth hormone (hgh)
|
$110.25 |
$110.25 |
$110.25 |
$114.00
|
|
Warde haloperidol therapeutic drug level
|
$81.00 |
$81.00 |
$81.00 |
$72.75
|
|
Warde helminth antibody strongyloides igg
|
$205.50 |
$205.50 |
$205.50 |
$139.80
|
|
Warde hemoglobin fractionation/quantitation electrophoresis
|
$506.25 |
$506.25 |
$506.25 |
$102.60
|
|
Warde hepatitis a antibody
|
$87.00 |
$87.00 |
$87.00 |
$111.75
|
|
Warde hepatitis be antibody
|
$77.25 |
$77.25 |
$77.25 |
$94.50
|
|
Warde hepatitis delta agent antibody
|
$198.00 |
$198.00 |
$198.00 |
$142.20
|
|
Warde immunofixation electrophoresis urine
|
$349.50 |
$349.50 |
$349.50 |
$241.20
|
|
Warde infectious agent antigen immunoassay ql/sq multi step hepatitis be agn
|
$70.50 |
$70.50 |
$70.50 |
$93.75
|
|
Warde infectious agent nucleic acid genotype hepatitis c
|
$1,140.00 |
$1,140.00 |
$1,140.00 |
$1,579.80
|
|
Warde islet cell antibody zinc transporter 8
|
$615.75 |
$615.75 |
$615.75 |
$202.80
|
|
Warde lipoprotein (a)
|
$168.00 |
$168.00 |
$168.00 |
$93.00
|
|
Warde mitochondrial antibody each
|
$123.00 |
$123.00 |
$123.00 |
$114.00
|
|
Warde neutralization rabies
|
$183.00 |
$183.00 |
$183.00 |
$105.00
|
|
Warde oxcarbazepine therapeutic drug level
|
$60.00 |
$60.00 |
$60.00 |
$129.60
|
|
Warde pancreatic elastase fecal quantitative
|
$144.75 |
$144.75 |
$144.75 |
$129.00
|
|
Warde protein c antigen
|
$141.75 |
$141.75 |
$141.75 |
$110.40
|
|
Warde sex hormone binding globulin
|
$141.00 |
$141.00 |
$141.00 |
$141.00
|
|
Warde somatomedin
|
$93.75 |
$93.75 |
$93.75 |
$119.25
|
|
Warde sugars single qualitative each specimen stool
|
$54.75 |
$54.75 |
$54.75 |
$28.80
|
|
Warde t3 (triiodothyronine) reverse
|
$77.25 |
$77.25 |
$77.25 |
$133.20
|
|
Warde thyroid stimulating immunoglobulins
|
$403.50 |
$403.50 |
$403.50 |
$407.25
|
|
Warde topiramate therapeutic drug level
|
$384.75 |
$384.75 |
$384.75 |
$130.20
|
|
Warde virus isolation tissue culture innoculation presumptive id herpes simplex
|
$113.25 |
$113.25 |
$113.25 |
$162.00
|
|
Warde viscosity
|
$153.00 |
$153.00 |
$153.00 |
$119.40
|
|
Warde vitamin a
|
$90.00 |
$90.00 |
$90.00 |
$97.20
|
|
Warde vitamin b-1 (thiamine)
|
$109.50 |
$109.50 |
$109.50 |
$147.60
|
|
Warde vitamin b6 (pyridoxine)
|
$114.00 |
$114.00 |
$114.00 |
$198.00
|
|
Warde vitamin c (ascorbic acid)
|
$36.75 |
$36.75 |
$36.75 |
$72.00
|
|
Warde vitamin d (1 25 dihydroxy)
|
$193.50 |
$193.50 |
$193.50 |
$205.50
|
|
Warde vitamin e (alpha-tocopherol)
|
$52.50 |
$52.50 |
$52.50 |
$102.00
|
|
Warde zinc
|
$90.00 |
$90.00 |
$90.00 |
$95.25
|
|
Wbc automated
|
$63.00 |
$63.00 |
$63.00 |
$36.60
|
|
Western blot test
|
$603.00 |
$603.00 |
$603.00 |
$181.20
|
|
Wnd prep f/n/hf/g addl cm
|
$1,496.25 |
$1,496.25 |
$1,496.25 |
$1,022.25
|
|
Wound therapy negative pressure per session <= 50 sq cm
|
$729.00 |
$729.00 |
$729.00 |
$230.40
|
|
Wound therapy negative pressure per session <= 50 sq cm dme
|
$318.75 |
$318.75 |
$318.75 |
$204.00
|
|
Wound therapy negative pressure per session > 50 sq cm
|
$822.75 |
$822.75 |
$822.75 |
$230.40
|
|
Wound therapy negative pressure per session > 50 sq cm dme
|
$414.75 |
$414.75 |
$414.75 |
$348.60
|
|
Wrist X-ray
|
$461.25 |
$461.25 |
$461.25 |
$311.17
|
|
X-ray abdomen 1 view
|
$284.25 |
$284.25 |
$284.25 |
$284.25
|
|
X-ray abdomen 2 views
|
$489.00 |
$489.00 |
$489.00 |
$327.00
|
|
X-ray abdomen >=3 views
|
$502.50 |
$502.50 |
$502.50 |
$336.00
|
|
X-ray abdomen complete acute series including spine erect and/or decubitus single view chest
|
$471.75 |
$471.75 |
$471.75 |
$504.00
|
|
X-ray acromioclavicular joints without or w/weighted distraction bilateral
|
$525.75 |
$525.75 |
$525.75 |
$397.80
|
|
X-ray ankle 2 views (both sides)
|
$361.50 |
$361.50 |
$361.50 |
$398.25
|
|
X-ray arthrogram shoulder supervision & interpretation (both sides)
|
$1,134.00 |
$1,134.00 |
$1,134.00 |
$814.20
|
|
X-ray bone age studies
|
$367.50 |
$367.50 |
$367.50 |
$289.80
|
|
X-ray bone length studies
|
$287.25 |
$287.25 |
$287.25 |
$366.00
|
|
X-ray bone survey complete
|
$963.75 |
$963.75 |
$963.75 |
$682.20
|
|
X-ray bone survey infant
|
$403.50 |
$403.50 |
$403.50 |
$292.80
|
|
X-ray cervical spine 2-3 views
|
$432.75 |
$432.75 |
$432.75 |
$405.00
|
|
X-ray cervical spine 4-5 views
|
$663.75 |
$663.75 |
$663.75 |
$526.20
|
|
X-ray cervical spine >= 6 views
|
$781.50 |
$781.50 |
$781.50 |
$666.60
|
|
X-ray clavicle complete (both sides)
|
$364.50 |
$364.50 |
$364.50 |
$267.75
|
|
X-ray colon abdominal radiograph(s) & delayed images single contrast study
|
$814.50 |
$814.50 |
$814.50 |
$690.75
|
|
X-ray colon abdominal radiograph(s) & delayed images with glucagon double contrast study
|
$966.00 |
$966.00 |
$966.00 |
$1,107.00
|
|
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 |
$373.80
|
|
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 |
$399.00
|
|
X-ray exam of femur 1
|
$295.50 |
$295.50 |
$295.50 |
$237.60
|
|
X-ray exam of jaw joint
|
$429.00 |
$429.00 |
$429.00 |
$331.50
|
|
X-ray exam of mastoids
|
$374.25 |
$374.25 |
$374.25 |
$310.80
|
|
X-ray exam of perineum
|
$284.25 |
$284.25 |
$284.25 |
$284.25
|
|
X-ray exam of sinuses
|
$444.75 |
$444.75 |
$444.75 |
$318.60
|
|
X-ray exam thorac spine4/>vw
|
$616.50 |
$616.50 |
$616.50 |
$405.00
|
|
X-ray facial bones complete > 3 views
|
$663.00 |
$663.00 |
$663.00 |
$444.00
|
|
X-ray fallopian tube
|
$940.50 |
$940.50 |
$940.50 |
$682.50
|
|
X-ray femur >=2 views (both sides)
|
$300.75 |
$300.75 |
$300.75 |
$405.00
|
|
X-ray finger(s) >= 2 views (both sides)
|
$387.00 |
$387.00 |
$387.00 |
$294.60
|
|
X-ray foot 2 views (both sides)
|
$333.00 |
$333.00 |
$333.00 |
$398.25
|
|
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 |
$405.00
|
|
X-ray heel/calcaneus > 2 views (both sides)
|
$385.50 |
$385.50 |
$385.50 |
$292.80
|
|
X-ray hip uni w/wo pelvis min 4 views
|
$531.00 |
$531.00 |
$531.00 |
$414.00
|
|
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 |
$414.00
|
|
X-ray hip with pelvis when performed bilateral >= 5 views
|
$683.25 |
$683.25 |
$683.25 |
$456.60
|
|
X-ray hip with pelvis when performed unilateral 1 view left
|
$265.50 |
$265.50 |
$265.50 |
$270.75
|
|
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 |
$343.50
|
|
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 |
$237.60
|
|
X-ray l/s-spine bend vw only 2-3 vw
|
$408.00 |
$408.00 |
$408.00 |
$405.00
|
|
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 |
$577.50
|
|
X-ray lumbosacral spine complete including bending views >= 6 views
|
$702.75 |
$702.75 |
$702.75 |
$666.60
|
|
X-ray mandible complete > 4 views
|
$421.50 |
$421.50 |
$421.50 |
$412.80
|
|
X-ray mandible ltd <4 views
|
$319.50 |
$319.50 |
$319.50 |
$326.25
|
|
X-ray nasal bones complete > 3 views
|
$367.50 |
$367.50 |
$367.50 |
$283.50
|
|
X-ray neck soft tissue
|
$350.25 |
$350.25 |
$350.25 |
$285.60
|
|
X-ray nose to rectum for foreign body child
|
$367.50 |
$367.50 |
$367.50 |
$246.00
|
|
X-ray of mammary ducts
|
$634.50 |
$634.50 |
$634.50 |
$438.00
|
|
X-ray optic foramina
|
$426.75 |
$426.75 |
$426.75 |
$292.80
|
|
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 |
$405.00
|
|
X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation
|
$810.75 |
$810.75 |
$810.75 |
$839.25
|
|
X-ray ribs 2 views left
|
$448.50 |
$448.50 |
$448.50 |
$304.80
|
|
X-ray ribs 3 views bilateral
|
$492.75 |
$492.75 |
$492.75 |
$419.40
|
|
X-ray ribs w/posterior anterior chest 3 views left
|
$471.75 |
$471.75 |
$471.75 |
$399.00
|
|
X-ray ribs w/posterior anterior chest > 4 views bilateral
|
$524.25 |
$524.25 |
$524.25 |
$600.75
|
|
X-ray sacroiliac joints >= 3 views
|
$542.25 |
$542.25 |
$542.25 |
$397.80
|
|
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 |
$304.20
|
|
X-ray shoulder 1 view (both sides)
|
$244.50 |
$244.50 |
$244.50 |
$263.25
|
|
X-ray sinus tract/fistula/abscess
|
$944.25 |
$944.25 |
$944.25 |
$1,129.80
|
|
X-ray sinuses paranasal complete > 3 views
|
$629.25 |
$629.25 |
$629.25 |
$405.00
|
|
X-ray skull < 4 views
|
$377.25 |
$377.25 |
$377.25 |
$364.20
|
|
X-ray skull > 4 views complete
|
$749.25 |
$749.25 |
$749.25 |
$440.40
|
|
X-ray slg plne bdy sect without urogr
|
$1,032.75 |
$1,032.75 |
$1,032.75 |
$945.00
|
|
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 |
$419.40
|
|
X-ray spine single view
|
$360.00 |
$360.00 |
$360.00 |
$309.60
|
|
X-ray sternoclavicular joint(s) > 3 views
|
$527.25 |
$527.25 |
$527.25 |
$385.80
|
|
X-ray sternum > 2 views
|
$521.25 |
$521.25 |
$521.25 |
$331.80
|
|
X-ray surgical specimen
|
$432.75 |
$432.75 |
$432.75 |
$400.50
|
|
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 |
$419.40
|
|
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 |
$419.40
|
|
X-ray thoracolumbar spine >=2 views
|
$408.00 |
$408.00 |
$408.00 |
$348.00
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 1 view
|
$367.50 |
$367.50 |
$367.50 |
$396.00
|
|
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 |
$405.00
|
|
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 |
$589.50
|
|
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 |
$40.50
|
|
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 |
$197.25
|
|
Zika virus igm antibody
|
$128.25 |
$128.25 |
$128.25 |
$114.75
|
|
Ziprasidone 20 mg/ml (final concentration) intramuscular solution
|
$32.46 |
$32.46 |
$32.46 |
$229.80
|
|
Zoledronic acid 4 mg/5 ml intravenous solution
|
$146.06 |
$146.06 |
$146.06 |
$3,207.00
|
|
Zoster vaccine-live inj
|
$436.50 |
$436.50 |
$436.50 |
$262.20
|
|
_afb id by dna probe rflx ast
|
$150.00 |
$150.00 |
$150.00 |
$141.00
|
|
_propoxygc/msur
|
$240.00 |
$240.00 |
$240.00 |
$222.00
|