|
11-desoxycortisol - sendout
|
$597.60 |
$597.60 |
$597.60 |
$91.85
|
|
17-hydroxypregnenolone
|
$372.00 |
$372.00 |
$372.00 |
$92.65
|
|
17-ketosteroids
|
$415.20 |
$415.20 |
$415.20 |
$55.00
|
|
24 hr ambulatory b/p monitor
|
$460.80 |
$460.80 |
$460.80 |
$313.04
|
|
2d tee w or without fol w/con,in
|
$1,026.40 |
$1,026.40 |
$1,026.40 |
$1,724.25
|
|
2d tte w or without fol w/con,co
|
$1,026.40 |
$1,026.40 |
$1,026.40 |
$1,284.00
|
|
3d ech img cgen car anomal
|
$1,716.80 |
$1,716.80 |
$1,716.80 |
$511.60
|
|
3d recon without postprocess indpndt
|
$843.20 |
$843.20 |
$843.20 |
$508.13
|
|
5' nucleotidase - sendout
|
$294.40 |
$294.40 |
$294.40 |
$50.05
|
|
88334 ap bill cytologic exam each additional site
|
$110.40 |
$110.40 |
$110.40 |
$100.10
|
|
99381 initial comp preventive med less than 1 year new
|
$134.40 |
$134.40 |
$134.40 |
$135.00
|
|
99382 initial comp preventive med 1 to 4 years new
|
$143.40 |
$143.40 |
$143.40 |
$135.00
|
|
99383 initial comp preventive med 5 to 11 years new
|
$151.20 |
$151.20 |
$151.20 |
$131.00
|
|
99391 periodic comp preventive med less than 1 year est
|
$122.40 |
$122.40 |
$122.40 |
$117.72
|
|
99392 periodic comp preventive med 1 to 4 years est
|
$134.40 |
$134.40 |
$134.40 |
$132.30
|
|
99393 periodic comp preventive med 5 to 11 years est
|
$134.40 |
$134.40 |
$134.40 |
$120.25
|
|
99394 periodic comp preventive med 12 to 17 years est
|
$151.20 |
$151.20 |
$151.20 |
$137.15
|
|
99397 periodic comp preventive med 65+ years est
|
$178.80 |
$178.80 |
$178.80 |
$164.73
|
|
Abatacept (with maltose) 250 mg intravenous solution
|
$4,845.00 |
$4,845.00 |
$4,845.00 |
$3,138.72
|
|
#a/b/c/c/h pnl-candida albicans ab
|
$140.00 |
$140.00 |
$140.00 |
$53.95
|
|
Abciximab injection
|
$6,244.80 |
$6,244.80 |
$6,244.80 |
$2,443.52
|
|
Abdominal and Pelvic Blood Vessel Ultrasound (complete)
|
$1,530.40 |
$1,530.40 |
$1,530.40 |
$988.00
|
|
Abdominal and Pelvic Blood Vessel Ultrasound (limited)
|
$1,262.40 |
$1,262.40 |
$1,262.40 |
$662.40
|
|
Abdominal CT scan (with and without contrast)
|
$4,204.00 |
$4,204.00 |
$4,204.00 |
$1,976.94
|
|
Abdominal CT scan (with contrast)
|
$3,352.80 |
$3,352.80 |
$3,352.80 |
$1,667.60
|
|
Abdominal CT scan (without contrast)
|
$2,630.40 |
$2,630.40 |
$2,630.40 |
$1,353.32
|
|
Abdominal MRI (with and without contrast)
|
$4,850.40 |
$4,850.40 |
$4,850.40 |
$2,967.00
|
|
Abdominal MRI (with contrast)
|
$3,689.60 |
$3,689.60 |
$3,689.60 |
$2,240.00
|
|
Abdominal MRI (without contrast)
|
$3,040.00 |
$3,040.00 |
$3,040.00 |
$2,048.36
|
|
Abdominal paracentesis w/image guidance
|
$1,689.00 |
$1,689.00 |
$1,689.00 |
$1,632.96
|
|
Abdominal Ultrasound (complete)
|
$1,108.80 |
$1,108.80 |
$1,108.80 |
$783.00
|
|
Abdominal Ultrasound (limited)
|
$835.20 |
$835.20 |
$835.20 |
$586.43
|
|
Abdominal X-ray (2 views)
|
$395.20 |
$395.20 |
$395.20 |
$318.20
|
|
Abdominal X-ray Series (acute, with chest view)
|
$609.60 |
$609.60 |
$609.60 |
$418.63
|
|
Abdominal X-ray (single view)
|
$650.40 |
$650.40 |
$650.40 |
$260.00
|
|
Abd paracentesis/w/o image guide 49082
|
$1,175.20 |
$1,175.20 |
$1,175.20 |
$1,148.40
|
|
Ablation cryo thigh/knee
|
$507.20 |
$507.20 |
$507.20 |
$531.95
|
|
Ablation of upper extremity nerves rf
|
$998.40 |
$998.40 |
$998.40 |
$832.50
|
|
Abobotulinumtoxina
|
$4,582.80 |
$4,582.80 |
$4,582.80 |
$1,541.21
|
|
Abscess drain retroperitoneal surg code
|
$5,596.80 |
$5,596.80 |
$5,596.80 |
$3,050.40
|
|
Absorpt drg > 48 sq in without b
|
$4.00 |
$4.00 |
$4.00 |
$7.76
|
|
Acetaminophen 10 mg/ml soln 100 ml glass cont
|
$168.60 |
$168.60 |
$168.60 |
$72.74
|
|
Acetazolamide 500 mg solution for injection
|
$256.80 |
$256.80 |
$256.80 |
$122.55
|
|
Acetone qualitative
|
$72.40 |
$72.40 |
$72.40 |
$46.80
|
|
Acetylcholine receptor modulating antibody
|
$388.20 |
$388.20 |
$388.20 |
$67.50
|
|
Acetylcysteine 200 mg/ml (20 %) intravenous solution
|
$1,044.60 |
$1,044.60 |
$1,044.60 |
$218.79
|
|
Acetylcysteine non-comp unit
|
$92.80 |
$92.80 |
$92.80 |
$31.21
|
|
Aco annual medicare visit (awv), initial g0438aco
|
$121.80 |
$121.80 |
$121.80 |
$243.00
|
|
Aco annual medicare visit (awv), subsq g0439aco
|
$141.00 |
$141.00 |
$141.00 |
$160.69
|
|
Acute hepatitis panel
|
$921.60 |
$921.60 |
$921.60 |
$284.95
|
|
Acute venous thrombus image
|
$580.00 |
$580.00 |
$580.00 |
$1,426.73
|
|
Acyclovir 5 mg/ml in ns IV syringe (neo/ped) - cnr
|
$74.40 |
$74.40 |
$74.40 |
$64.45
|
|
#acylcarnitineprfl
|
$268.80 |
$268.80 |
$268.80 |
$121.55
|
|
Adalimumab injection
|
$7,692.60 |
$7,692.60 |
$7,692.60 |
$6,853.40
|
|
Adenosine 3 mg/250 ml bag for osm
|
$382.20 |
$382.20 |
$382.20 |
$271.98
|
|
Adenovirus ag ia
|
$196.00 |
$196.00 |
$196.00 |
$53.95
|
|
Adenovirus antibody,serum - quest
|
$111.20 |
$111.20 |
$111.20 |
$58.00
|
|
Adhesive, liquid or equal
|
$2,828.00 |
$2,828.00 |
$2,828.00 |
$14.40
|
|
Adh-sendout
|
$375.20 |
$375.20 |
$375.20 |
$118.79
|
|
Adj gastric band via subq port
|
$4,264.00 |
$4,264.00 |
$4,264.00 |
$1,666.86
|
|
Admelog u-100 insulin lispro 100 unit/ml subcutaneous solution
|
$120.00 |
$120.00 |
$120.00 |
$193.40
|
|
Admin ecg contrast agent
|
$356.80 |
$356.80 |
$356.80 |
$120.78
|
|
Administration chemotherapy IV infusion each additional hour
|
$269.60 |
$269.60 |
$269.60 |
$230.35
|
|
Administration chemotherapy IV infusion each addl sequential infusion diff substance/drug >1 hr
|
$269.60 |
$269.60 |
$269.60 |
$298.98
|
|
Administration chemotherapy IV infusion up to 1 hour single/initial substance/drug
|
$977.60 |
$977.60 |
$977.60 |
$668.98
|
|
Administration chemotherapy IV push single/initial substance/drug
|
$615.20 |
$615.20 |
$615.20 |
$439.20
|
|
Administration chemotherapy subcutaneous/im anti neoplastic hormonal
|
$269.60 |
$269.60 |
$269.60 |
$212.80
|
|
Administration chemotherapy subcutaneous/im anti neoplastic non hormonal
|
$223.20 |
$223.20 |
$223.20 |
$256.49
|
|
Administration immunization each additional component
|
$58.80 |
$58.80 |
$58.80 |
$29.20
|
|
Administration immunization each additional vaccine
|
$16.00 |
$16.00 |
$16.00 |
$47.40
|
|
Administration immunization first component each vaccine
|
$283.20 |
$283.20 |
$283.20 |
$46.40
|
|
Administration immunization intranasal/oral route 1 vaccine
|
$18.40 |
$18.40 |
$18.40 |
$48.00
|
|
Administration immunization intranasal/oral route each additional vaccine
|
$18.40 |
$18.40 |
$18.40 |
$30.24
|
|
Administration rsv monoclonal ab seasonal dose im w/counseling
|
$25.20 |
$25.20 |
$25.20 |
$44.80
|
|
Administration vaccine hepatitis b
|
$16.00 |
$16.00 |
$16.00 |
$53.00
|
|
Administration vaccine influenza virus
|
$16.00 |
$16.00 |
$16.00 |
$51.07
|
|
Administration vaccine pneumococcal
|
$16.00 |
$16.00 |
$16.00 |
$49.68
|
|
Administration vaccine rsv monoclonal ab seasonal dose im
|
$25.20 |
$25.20 |
$25.20 |
$41.45
|
|
Ado-trastuzumab emtansine 100 mg intravenous solution
|
$139.20 |
$139.20 |
$139.20 |
$11,350.31
|
|
Aep hearing status deter i&r
|
$154.40 |
$154.40 |
$154.40 |
$303.00
|
|
Aep neurodiagnostic i&r
|
$295.20 |
$295.20 |
$295.20 |
$583.80
|
|
Aep thrshld est mlt freq i&r
|
$295.20 |
$295.20 |
$295.20 |
$635.00
|
|
_afb id by dna probe rflx ast
|
$170.40 |
$170.40 |
$170.40 |
$104.50
|
|
_afb org id by sequencing rflx ast-sendout
|
$1,823.20 |
$1,823.20 |
$1,823.20 |
$300.00
|
|
Agalsidase beta 35 mg intravenous solution
|
$27,295.80 |
$27,295.80 |
$27,295.80 |
$14,475.20
|
|
Albumin body fluid quantitative each specimen
|
$76.60 |
$76.60 |
$76.60 |
$47.45
|
|
Albumin (human), 25%, 50ml
|
$304.00 |
$304.00 |
$304.00 |
$244.70
|
|
Albumin (human), 5%, 250 ml
|
$682.40 |
$682.40 |
$682.40 |
$252.77
|
|
Albumin (microalbumin) 24 hour urine quantitative
|
$422.40 |
$422.40 |
$422.40 |
$58.17
|
|
Albumin serum plasma or whole blood
|
$80.80 |
$80.80 |
$80.80 |
$43.00
|
|
Albuterol ipratrop non-comp
|
$13.80 |
$13.80 |
$13.80 |
$5.67
|
|
Albuterol non-comp con
|
$5.00 |
$5.00 |
$5.00 |
$6.07
|
|
Albuterol non-comp unit
|
$10.00 |
$10.00 |
$10.00 |
$5.40
|
|
Aldesleukin injection
|
$6,538.20 |
$6,538.20 |
$6,538.20 |
$9,030.11
|
|
Alemtuzumab 12 mg/1.2 ml intravenous solution
|
$8,173.80 |
$8,173.80 |
$8,173.80 |
$47,974.31
|
|
Alginate dressing <=16 sq in
|
$13.00 |
$13.00 |
$13.00 |
$16.56
|
|
Alginate drsg >16 <=48 sq in
|
$168.80 |
$168.80 |
$168.80 |
$43.72
|
|
Alginate drsg wound filler
|
$128.00 |
$128.00 |
$128.00 |
$15.79
|
|
Alkaline phosphatase
|
$158.40 |
$158.40 |
$158.40 |
$46.80
|
|
Allergen alpha lactalbumin ige
|
$31.80 |
$31.80 |
$31.80 |
$48.57
|
