|
1st hosp/birthing center care per day nml nb 99460
|
$131.22 |
$131.22 |
$131.22 |
$172.80
|
|
3d recon without postprocess indpndt
|
$35.10 |
$35.10 |
$35.10 |
$480.00
|
|
99381 initial comp preventive med less than 1 year new
|
$142.02 |
$142.02 |
$142.02 |
$135.00
|
|
99382 initial comp preventive med 1 to 4 years new
|
$154.44 |
$154.44 |
$154.44 |
$135.00
|
|
99383 initial comp preventive med 5 to 11 years new
|
$153.36 |
$153.36 |
$153.36 |
$116.00
|
|
99391 periodic comp preventive med less than 1 year est
|
$117.72 |
$117.72 |
$117.72 |
$113.52
|
|
99392 periodic comp preventive med 1 to 4 years est
|
$132.30 |
$132.30 |
$132.30 |
$134.40
|
|
99393 periodic comp preventive med 5 to 11 years est
|
$131.22 |
$131.22 |
$131.22 |
$120.25
|
|
99394 periodic comp preventive med 12 to 17 years est
|
$144.18 |
$144.18 |
$144.18 |
$137.15
|
|
99397 periodic comp preventive med 65+ years est
|
$177.12 |
$177.12 |
$177.12 |
$164.73
|
|
Abatacept (with maltose) 250 mg intravenous solution
|
$2,008.80 |
$2,008.80 |
$2,008.80 |
$3,358.00
|
|
Abd exp/postop hem/throm/infec 35840
|
$2,475.36 |
$2,475.36 |
$2,475.36 |
$2,938.40
|
|
Abdominal CT scan (with and without contrast)
|
$246.24 |
$246.24 |
$246.24 |
$1,997.40
|
|
Abdominal CT scan (with contrast)
|
$224.64 |
$224.64 |
$224.64 |
$1,670.88
|
|
Abdominal CT scan (without contrast)
|
$210.06 |
$210.06 |
$210.06 |
$1,363.35
|
|
Abdominal MRI (with and without contrast)
|
$387.72 |
$387.72 |
$387.72 |
$3,061.80
|
|
Abdominal MRI (with contrast)
|
$305.64 |
$305.64 |
$305.64 |
$2,210.00
|
|
Abdominal MRI (without contrast)
|
$258.66 |
$258.66 |
$258.66 |
$2,048.36
|
|
Abdominal paracentesis w/image guidance
|
$332.10 |
$332.10 |
$332.10 |
$1,655.40
|
|
Abdominal Ultrasound (complete)
|
$142.56 |
$142.56 |
$142.56 |
$785.55
|
|
Abdominal Ultrasound (limited)
|
$104.76 |
$104.76 |
$104.76 |
$603.33
|
|
Abd paracentesis/w/o image guide 49082
|
$373.14 |
$373.14 |
$373.14 |
$1,145.00
|
|
Ablate inf turbinate submuc 30802
|
$421.20 |
$421.20 |
$421.20 |
$1,752.89
|
|
Ablation of upper extremity nerves rf
|
$121.50 |
$121.50 |
$121.50 |
$832.50
|
|
Abscess drain retroperitoneal surg code
|
$608.04 |
$608.04 |
$608.04 |
$2,957.17
|
|
Acetaminophen 10 mg/ml soln 100 ml glass cont
|
$25.98 |
$25.98 |
$25.98 |
$80.14
|
|
Acetylcysteine 200 mg/ml (20 %) intravenous solution
|
$115.17 |
$115.17 |
$115.17 |
$232.95
|
|
Acne surgery 10040
|
$244.08 |
$244.08 |
$244.08 |
$265.20
|
|
Aco annual medicare visit (awv), initial g0438aco
|
$231.93 |
$231.93 |
$231.93 |
$243.00
|
|
Aco annual medicare visit (awv), subsq g0439aco
|
$172.26 |
$172.26 |
$172.26 |
$190.20
|
|
Aco depression screen annual medicare g0444aco
|
$25.38 |
$25.38 |
$25.38 |
$38.28
|
|
Acoustic refl threshold tst
|
$32.13 |
$32.13 |
$32.13 |
$92.50
|
|
Acromp/acromionectomy prtl
|
$922.86 |
$922.86 |
$922.86 |
$3,839.54
|
|
Acyclovir 400 mg tablet
|
$38.86 |
$38.86 |
$38.86 |
$54.77
|
|
Adenosine 3 mg/250 ml bag for osm
|
$21.06 |
$21.06 |
$21.06 |
$234.26
|
|
Admelog u-100 insulin lispro 100 unit/ml subcutaneous solution
|
$14.90 |
$14.90 |
$14.90 |
$186.07
|
|
Administration immunization 1 vaccine
|
$37.26 |
$37.26 |
$37.26 |
$66.51
|
|
Administration immunization each additional vaccine
|
$25.38 |
$25.38 |
$25.38 |
$46.23
|
|
Administration immunization intranasal/oral route 1 vaccine
|
$27.00 |
$27.00 |
$27.00 |
$48.00
|
|
Administration immunization intranasal/oral route each additional vaccine
|
$16.74 |
$16.74 |
$16.74 |
$31.20
|
|
Administration rsv monoclonal ab seasonal dose im w/counseling
|
$33.48 |
$33.48 |
$33.48 |
$41.00
|
|
Administration vaccine hepatitis b
|
$25.38 |
$25.38 |
$25.38 |
$54.60
|
|
Administration vaccine rsv monoclonal ab seasonal dose im
|
$28.62 |
$28.62 |
$28.62 |
$39.10
|
|
Ado-trastuzumab emtansine 100 mg intravenous solution
|
$16.20 |
$16.20 |
$16.20 |
$11,350.31
|
|
Air conduction bilat
|
$65.34 |
$65.34 |
$65.34 |
$118.73
|
|
Albumin (human), 25%, 50ml
|
$314.93 |
$314.93 |
$314.93 |
$227.64
|
|
Albumin (human), 5%, 250 ml
|
$219.09 |
$219.09 |
$219.09 |
$237.90
|
|
Albuterol ipratrop non-comp
|
$0.57 |
$0.57 |
$0.57 |
$5.61
|
|
Albuterol non-comp unit
|
$0.57 |
$0.57 |
$0.57 |
$5.40
|
|
Allergy injections; 2 or more 95117
|
$21.60 |
$21.60 |
$21.60 |
$41.40
|
|
Allergy injection; single 95115
|
$18.36 |
$18.36 |
$18.36 |
$42.75
|
|
Allograft amniotic activebarrier 200 2x2cm-q4100-cost per sheet
|
$7,938.00 |
$7,938.00 |
$7,938.00 |
$11,121.17
|
|
Allograft graftjacket 2x12cm-q4107-cost per sq cm
|
$4,069.44 |
$4,069.44 |
$4,069.44 |
$4,677.40
|
|
Allograft umbil cord+amniotic membrane-q4148-cost per sq cm
|
$7,970.40 |
$7,970.40 |
$7,970.40 |
$4,687.16
|
|
Allograft umbilical epicord 15 sq cm-q4187-cost per sq cm
|
$6,889.32 |
$6,889.32 |
$6,889.32 |
$1,616.79
|
|
Alteplase 100 mg infusion from pyxis vial
|
$323.97 |
$323.97 |
$323.97 |
$15,857.45
|
|
Amiodarone 150 mg/100 ml (1.5 mg/ml) in dextrose, iso-osmotic IV
|
$103.15 |
$103.15 |
$103.15 |
$123.03
|
|
Amniocentesisdiagnostic 59000
|
$184.95 |
$184.95 |
$184.95 |
$943.50
|
|
Amp f/th 1/2 jt/phalanx w/neurect local flap
|
$1,443.42 |
$1,443.42 |
$1,443.42 |
$3,821.05
|
|
Ampicillin 1 gram solution for injection
|
$32.11 |
$32.11 |
$32.11 |
$61.96
|
|
Ampicillin-sulbactam 1.5 gram solution for injection
|
$24.38 |
$24.38 |
$24.38 |
$54.69
|
|
Amp metatarsal w/toe single 28810
|
$936.90 |
$936.90 |
$936.90 |
$4,289.04
|
|
Amputate thigh through femur 27590
|
$1,589.22 |
$1,589.22 |
$1,589.22 |
$3,370.00
|
|
Amputation leg thr tib/fib 27880
|
$2,057.67 |
$2,057.67 |
$2,057.67 |
$3,870.00
|
|
Amputation leg; tib/fib f/u 27886
|
$1,333.80 |
$1,333.80 |
$1,333.80 |
$2,605.20
|
|
Amputation of lower leg
|
$1,326.51 |
$1,326.51 |
$1,326.51 |
$2,545.40
|
|
Amputation of midtarsal 28800
|
$1,114.02 |
$1,114.02 |
$1,114.02 |
$2,285.40
|
|
Amputation thru metatarsal
|
$1,615.68 |
$1,615.68 |
$1,615.68 |
$3,839.54
|
|
Amputation toe interphalangeal joint
|
$604.80 |
$604.80 |
$604.80 |
$3,998.20
|
|
Amputation toe metatarsophalangeal joint
|
$1,071.09 |
$1,071.09 |
$1,071.09 |
$3,814.50
|
|
Analyze neurostimulator simple w/reprogramming 95971
|
$71.28 |
$71.28 |
$71.28 |
$411.45
|
|
An fluoro guide for cvp
|
$65.34 |
$65.34 |
$65.34 |
$515.34
|
|
Angiotensin ii 0.5 mg/ml soln 1 ml vial
|
$4,188.02 |
$4,188.02 |
$4,188.02 |
$3,755.70
|
|
Ankle X-ray
|
$205.74 |
$205.74 |
$205.74 |
$356.32
|
|
Annual Physical, Established Patient (age 18-39)
|
$144.18 |
$144.18 |
$144.18 |
$153.51
|
|
Annual Physical, Established Patient (age 40-64)
|
$158.76 |
$158.76 |
$158.76 |
$160.73
|
|
Annual Physical, New Patient (age 18-39)
|
$165.78 |
$165.78 |
$165.78 |
$154.80
|
|
Annual Physical, New Patient (age 40-64)
|
$194.40 |
$194.40 |
$194.40 |
$167.25
|
|
Anoscopy and biopsy
|
$403.92 |
$403.92 |
$403.92 |
$1,395.28
|
|
Anoscopy and dilation 46604
|
$231.39 |
$231.39 |
$231.39 |
$1,621.60
|
|
Anoscopy control bleeding 46614
|
$135.00 |
$135.00 |
$135.00 |
$2,030.25
|
|
Anoscopy remove fb 46608
|
$173.88 |
$173.88 |
$173.88 |
$1,457.76
|
|
Ant colporrhaphy/rpr cyctocele 57240
|
$1,427.49 |
$1,427.49 |
$1,427.49 |
$5,468.70
|
|
Anticoag mgmt pt warfarin
|
$17.82 |
$17.82 |
$17.82 |
$26.40
|
|
Ant/post colporrhap/enterocele rpr 57265
|
$2,227.50 |
$2,227.50 |
$2,227.50 |
$4,155.20
|
|
Appendectomy
|
$1,361.61 |
$1,361.61 |
$1,361.61 |
$5,681.93
|
|
Appendectomy add-on 44955
|
$177.12 |
$177.12 |
$177.12 |
$206.40
|
|
Appendectomy/open/rup/w/absc/peri 44960
|
$1,853.28 |
$1,853.28 |
$1,853.28 |
$1,644.60
|
|
Appendix Removal (Laparoscopic)
|
$1,265.49 |
$1,265.49 |
$1,265.49 |
$6,904.15
|
|
App high cost ss f/n/g/h/f <100sq cm addl <25sq cm
|
$51.30 |
$51.30 |
$51.30 |
$510.25
|
|
Application finger splntstatic 29130
|
$90.18 |
$90.18 |
$90.18 |
$208.50
|
|
Application long leg splint 29505
|
$197.10 |
$197.10 |
$197.10 |
$356.85
|
|
Application lower leg splint 29515
|
$157.14 |
$157.14 |
$157.14 |
$345.60
|
|
Application of forearm cast 29075
|
$191.16 |
$191.16 |
$191.16 |
$336.00
|
|
Application of long arm cast 29065
|
$210.06 |
$210.06 |
$210.06 |
$401.40
|
|
Application of long leg cast 29345
|
$291.60 |
$291.60 |
$291.60 |
$464.51
|
|
Application of paste boot 29580
|
$198.72 |
$198.72 |
$198.72 |
$328.20
|
|
Application short leg cast 29405
|
$124.20 |
$124.20 |
$124.20 |
$388.80
|
|
Application skin substitute graft face/scalp/neck/genit/hnd/ft <100 sq cm 1st 25 sq cm
|
$208.98 |
$208.98 |
$208.98 |
$2,164.64
|
|
Appl mltpln uni ext fixj sys
|
$2,378.16 |
$2,378.16 |
$2,378.16 |
$5,668.20
|