|
Brain MRI (with and without contrast)
|
$405.00 |
$405.00 |
$405.00 |
$2,854.80
|
|
Brain MRI (with contrast)
|
$315.90 |
$315.90 |
$315.90 |
$2,267.23
|
|
Brain MRI (without contrast)
|
$262.44 |
$262.44 |
$262.44 |
$1,946.40
|
|
Breast Biopsy (ultrasound-guided, percutaneous)
|
$485.46 |
$485.46 |
$485.46 |
$3,012.38
|
|
Breast punct aspir cyst, bil
|
$277.56 |
$277.56 |
$277.56 |
$845.40
|
|
Brief chkin by md/qhp, 11-20
|
$35.10 |
$35.10 |
$35.10 |
$31.93
|
|
Br punct aspir ea add, l
|
$235.98 |
$235.98 |
$235.98 |
$356.50
|
|
Bumetanide in d5w IV syringe 0.04 mg/ml (neo/ped) - cnr
|
$9.79 |
$9.79 |
$9.79 |
$24.00
|
|
Bundled special stain group 1 microorganisms
|
$93.42 |
$93.42 |
$93.42 |
$160.80
|
|
Bundled special stain group 2
|
$52.38 |
$52.38 |
$52.38 |
$173.95
|
|
Bupivacaine 0.1 % epidural pca - 1 hour dose limit
|
$24.32 |
$24.32 |
$24.32 |
$33.08
|
|
Buprenorphine 2 mg-naloxone 0.5 mg sublingual tablet
|
$10.61 |
$10.61 |
$10.61 |
$11.72
|
|
Buprenorphine 8 mg-naloxone 2 mg sublingual tablet
|
$18.99 |
$18.99 |
$18.99 |
$14.27
|
|
Buprenorphine oral 1mg
|
$5.35 |
$5.35 |
$5.35 |
$10.50
|
|
Buprenorphine X-ray over 100 mg
|
$3,773.10 |
$3,773.10 |
$3,773.10 |
$3,702.22
|
|
Buprenorph X-ray 100 mg or less
|
$3,773.10 |
$3,773.10 |
$3,773.10 |
$3,864.00
|
|
Bx bone trocar/ndl deep
|
$406.62 |
$406.62 |
$406.62 |
$2,271.01
|
|
Bx breast 1st lesion strtctc
|
$807.57 |
$807.57 |
$807.57 |
$3,601.35
|
|
Bx breast add lesion strtctc
|
$167.94 |
$167.94 |
$167.94 |
$1,790.95
|
|
Bx breast add lesion Ultrasound imag
|
$241.38 |
$241.38 |
$241.38 |
$1,670.79
|
|
Bx breast perq without image 19100
|
$408.24 |
$408.24 |
$408.24 |
$1,312.15
|
|
Bx/curett of cervix w/scope 57454
|
$351.00 |
$351.00 |
$351.00 |
$515.50
|
|
Bx/exc lymph node/open/deep cervic 38510
|
$1,085.40 |
$1,085.40 |
$1,085.40 |
$4,531.42
|
|
Bx/exc lymph node/open/superfic 38500
|
$677.70 |
$677.70 |
$677.70 |
$4,184.94
|
|
Bx liver with other
|
$235.98 |
$235.98 |
$235.98 |
$543.40
|
|
Bx muscle
|
$197.10 |
$197.10 |
$197.10 |
$1,917.33
|
|
Bx of breast open 19101
|
$694.44 |
$694.44 |
$694.44 |
$4,531.42
|
|
Bx of cervix w/scope leep 57460
|
$643.14 |
$643.14 |
$643.14 |
$3,876.00
|
|
Bx pancreas pq ndl
|
$660.42 |
$660.42 |
$660.42 |
$1,610.05
|
|
Bx perianal mass
|
$374.22 |
$374.22 |
$374.22 |
$1,540.50
|
|
Bx pleura pq ndl
|
$265.68 |
$265.68 |
$265.68 |
$1,617.00
|
|
Bx prostate trnsrctl u/s guid
|
$411.48 |
$411.48 |
$411.48 |
$4,050.75
|
|
Bx skin incisnl ea sep/add l les
|
$147.42 |
$147.42 |
$147.42 |
$249.60
|
|
Bx skin punch ea sep/ addl les
|
$124.74 |
$124.74 |
$124.74 |
$227.13
|
|
Bx skin tangential ea sep/ addl les
|
$103.68 |
$103.68 |
$103.68 |
$203.00
|
|
Bx soft tissue back/flank supf 21920
|
$532.98 |
$532.98 |
$532.98 |
$1,917.33
|
|
Bx thyroid/percutan core needle 60100
|
$230.04 |
$230.04 |
$230.04 |
$964.62
|
|
Bx vag mucos smpl (sep proc)
|
$214.92 |
$214.92 |
$214.92 |
$1,059.90
|
|
Bx vulva or perineum/1 lesion 56605
|
$199.80 |
$199.80 |
$199.80 |
$1,148.20
|
|
Bx vulva or perineum/ea add lesion 56606
|
$172.53 |
$172.53 |
$172.53 |
$465.09
|
|
Bypass temp external fem-fem
|
$658.80 |
$658.80 |
$658.80 |
$1,780.35
|
|
Cabazitaxel 10 mg/ml (first dilution) intravenous solution
|
$145.80 |
$145.80 |
$145.80 |
$27,723.08
|
|
Calcium chloride 100 mg/ml (10 %) intravenous syringe
|
$46.52 |
$46.52 |
$46.52 |
$45.49
|
|
Calcium gluconate 100 mg/ml (10 %) intravenous solution
|
$23.05 |
$23.05 |
$23.05 |
$64.08
|
|
Calcium gluconate 2 gram/100 ml in sodium chloride,iso-osm IV solution
|
$90.87 |
$90.87 |
$90.87 |
$91.60
|
|
Caloric vstblr test w/rec
|
$42.12 |
$42.12 |
$42.12 |
$299.11
|
|
Capsulotomy mpj ea joint (sep proc)
|
$715.50 |
$715.50 |
$715.50 |
$3,591.33
|
|
Carboplatin 10 mg/ml desensitization
|
$45.36 |
$45.36 |
$45.36 |
$186.12
|
|
Cardiac perf spect sgl/ef/wm rst/strs
|
$238.14 |
$238.14 |
$238.14 |
$2,576.60
|
|
Cardioversion elective electrical conversion arrhythmia external
|
$287.01 |
$287.01 |
$287.01 |
$1,411.20
|
|
Carfilzomib 10 mg intravenous solution
|
$4,584.20 |
$4,584.20 |
$4,584.20 |
$6,877.19
|
|
Carotid Artery Ultrasound (Duplex)
|
$133.92 |
$133.92 |
$133.92 |
$997.10
|
|
Carpal Tunnel Release Surgery
|
$933.12 |
$933.12 |
$933.12 |
$3,639.20
|
|
Caspofungin acetate
|
$19.44 |
$19.44 |
$19.44 |
$615.86
|
|
Catheter insert artery
|
$268.65 |
$268.65 |
$268.65 |
$388.85
|
|
Catheterization collection of specimen single patient all places of service
|
$333.72 |
$333.72 |
$333.72 |
$40.95
|
|
Cathj umbilical vein dx/ther nb
|
$143.64 |
$143.64 |
$143.64 |
$254.80
|
|
Cath/saline/contrast/sis/hysteosal 58340
|
$176.04 |
$176.04 |
$176.04 |
$468.48
|
|
Cauterization chemical granulation tissue
|
$178.20 |
$178.20 |
$178.20 |
$338.80
|
|
Cciiv4 vac no prsv 0.5 ml im
|
$27.54 |
$27.54 |
$27.54 |
$34.80
|
|
Cefazolin 10 mg/10 ml (dilution #2) IV desensitization - cnr
|
$21.06 |
$21.06 |
$21.06 |
$37.70
|
|
Cefepime 1 gram solution for injection
|
$76.19 |
$76.19 |
$76.19 |
$44.03
|
|
Cefoxitin 1 gram intravenous solution
|
$27.22 |
$27.22 |
$27.22 |
$74.82
|
|
Ceftriaxone 1 gram solution for injection
|
$21.06 |
$21.06 |
$21.06 |
$84.15
|
|
Certolizumab pegol 400 mg (200 mg x 2 vials) subcutaneous kit
|
$23.76 |
$23.76 |
$23.76 |
$10,872.46
|
|
Cervical or vaginal cancer screening g0101
|
$51.30 |
$51.30 |
$51.30 |
$109.46
|
|
Cesarean section delivery only 59514
|
$1,926.45 |
$1,926.45 |
$1,926.45 |
$2,194.65
|
|
Cetuximab 100 mg/50 ml intravenous solution
|
$62.64 |
$62.64 |
$62.64 |
$3,028.20
|
|
Change cystostomy tube; complex 51710
|
$331.29 |
$331.29 |
$331.29 |
$1,470.75
|
|
Change cystostomy tube simple
|
$301.32 |
$301.32 |
$301.32 |
$451.00
|
|
Change of windpipe airway 31502
|
$83.16 |
$83.16 |
$83.16 |
$388.00
|
|
Chemodenerv eccrine glands 64650
|
$183.60 |
$183.60 |
$183.60 |
$521.82
|
|
Chemodenerv musc migraine 64615
|
$311.04 |
$311.04 |
$311.04 |
$540.80
|
|
Chest 2 vws w oblique
|
$55.08 |
$55.08 |
$55.08 |
$373.60
|
|
Chest apical lordotic proj
|
$49.14 |
$49.14 |
$49.14 |
$303.56
|
|
Chest CT scan (with and without contrast)
|
$220.32 |
$220.32 |
$220.32 |
$1,963.50
|
|
Chest CT scan (with contrast)
|
$206.28 |
$206.28 |
$206.28 |
$1,669.00
|
|
Chest CT scan (without contrast)
|
$191.16 |
$191.16 |
$191.16 |
$1,350.03
|
|
Chest X-ray
|
$124.74 |
$124.74 |
$124.74 |
$294.06
|
|
Chest X-ray (single view)
|
$108.54 |
$108.54 |
$108.54 |
$239.04
|
|
Chlnggrphy intraop addl s&i
|
$37.80 |
$37.80 |
$37.80 |
$281.18
|
|
Chloroprocaine hcl injection
|
$51.48 |
$51.48 |
$51.48 |
$61.38
|
|
Cholangiography and/or pancreatography intraoperative supervision & interpretation
|
$52.11 |
$52.11 |
$52.11 |
$602.40
|
|
Cholecystectomy w/cholangiography 47605
|
$2,311.20 |
$2,311.20 |
$2,311.20 |
$1,963.37
|
|
Ciprofloxacin 400 mg/200 ml in 5 % dextrose intravenous piggyback
|
$21.48 |
$21.48 |
$21.48 |
$35.00
|
|
Circum 28 days or older
|
$415.80 |
$415.80 |
$415.80 |
$3,860.64
|
|
Circumcise/surg/28 days or < 54160
|
$487.62 |
$487.62 |
$487.62 |
$1,219.20
|
|
Circumcision (newborn)
|
$309.96 |
$309.96 |
$309.96 |
$1,375.52
|
|
Cladribine 10 mg/10 ml intravenous solution
|
$54.54 |
$54.54 |
$54.54 |
$572.12
|
|
Claviculectomy partial
|
$1,250.64 |
$1,250.64 |
$1,250.64 |
$3,594.44
|
|
Clindamycin 600 mg/50 ml in 5 % dextrose intravenous piggyback
|
$30.02 |
$30.02 |
$30.02 |
$55.20
|
|
Closed carpo/metacarpal disl thumb w/manip
|
$834.30 |
$834.30 |
$834.30 |
$508.45
|
|
Closed carpo/metacarpal fx disl thumb w/manip
|
$858.06 |
$858.06 |
$858.06 |
$1,806.01
|
|
Closed tx humerus fx with manip 23605
|
$922.32 |
$922.32 |
$922.32 |
$2,211.05
|
|
Closed tx humerus fx without manip 23600
|
$736.02 |
$736.02 |
$736.02 |
$494.15
|
|
Closed tx humerus fx w/manip 24505
|
$975.24 |
$975.24 |
$975.24 |
$1,520.36
|
|
Closed tx metatarsophalangeal jnt disl without anes
|
$235.44 |
$235.44 |
$235.44 |
$386.40
|
|
Closed tx post hip arthroplasty disloc w/anes 27266
|
$1,332.18 |
$1,332.18 |
$1,332.18 |
$2,527.50
|
|
Closed tx septal&nose fx
|
$642.60 |
$642.60 |
$642.60 |
$3,624.40
|
|
Closed tx sesamoid fx 28530
|
$227.34 |
$227.34 |
$227.34 |
$445.00
|
