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Hospital prices in Westlake OH, Ohio

1 hospitals publish price files here.

Hospital Address System Priced procedures
University Hospitals St. John Medical Center 29000 Center Ridge Road University Hospitals 5308

Cash prices in Westlake OH

Procedure Lowest cash Median here Highest National median
#_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&lt 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