|
Actigraphy testing
|
$244.80 |
$245.40 |
$728.40 |
|
|
Actinotherapy uv light
|
$49.50 |
$194.40 |
$390.40 |
|
|
Acup 1/> w/estim 1st 15 min
|
$15.00 |
$15.00 |
$36.50 |
|
|
Acup 1/> w/estim ea addl 15
|
$27.50 |
$27.50 |
$27.50 |
|
|
Acup 1/> without estim ea add 15
|
$35.00 |
$35.00 |
$35.00 |
|
|
Acup 1/> wo estim 1st 15 min
|
$36.50 |
$36.50 |
$36.50 |
|
|
Acute hepatitis panel
|
$198.40 |
$310.20 |
$976.80 |
|
|
Acute venous thrombus image
|
$479.40 |
$580.00 |
$1,350.60 |
|
|
Acyclovir 400 mg tablet
|
$13.20 |
$13.20 |
$13.80 |
|
|
Acyclovir 5 mg/ml in ns IV syringe (neo/ped) - cnr
|
$0.60 |
$39.00 |
$4,042.80 |
|
|
#acylcarnitineprfl
|
$36.00 |
$163.80 |
$1,687.20 |
|
|
Adalimumab injection
|
$1,089.60 |
$3,013.20 |
$7,692.60 |
|
|
Adapt behavior tx phys/qhp
|
$114.00 |
$114.00 |
$114.00 |
|
|
Adapter b 8 channel 10cm
|
$36.96 |
$1,629.60 |
$17,888.40 |
|
|
Adaptive behavior tx by tech
|
$114.00 |
$114.00 |
$114.00 |
|
|
Adenosine 3 mg/250 ml bag for osm
|
$6.00 |
$165.00 |
$3,166.80 |
|
|
Adenovirus ag ia
|
$24.00 |
$24.00 |
$199.20 |
|
|
Adenovirus antibody,serum - quest
|
$17.00 |
$91.80 |
$343.80 |
|
|
Adhesive, liquid or equal
|
$11.40 |
$1,256.40 |
$2,916.60 |
|
|
Adh-sendout
|
$36.00 |
$236.40 |
$3,237.00 |
|
|
Adj gastric band via subq port
|
$80.40 |
$1,952.40 |
$4,264.00 |
|
|
Adjmt/revj ext fixj sys anes
|
$4,493.40 |
$4,493.40 |
$4,493.40 |
|
|
Adj tis trans/see area/10.1-30sqcm 14041
|
$1,343.40 |
$3,491.40 |
$4,326.00 |
|
|
Adjustment gastric band
|
$118.00 |
$118.00 |
$118.00 |
|
|
Admelog u-100 insulin lispro 100 unit/ml subcutaneous solution
|
$1.20 |
$400.00 |
$3,000.00 |
|
|
Admin ecg contrast agent
|
$104.40 |
$297.60 |
$356.80 |
|
|
Administration chemotherapy IV infusion each additional hour
|
$93.00 |
$223.20 |
$684.60 |
|
|
Administration chemotherapy IV infusion each addl sequential infusion diff substance/drug >1 hr
|
$93.00 |
$322.20 |
$799.20 |
|
|
Administration chemotherapy IV infusion up to 1 hour single/initial substance/drug
|
$292.00 |
$790.20 |
$1,632.60 |
|
|
Administration chemotherapy IV push single/initial substance/drug
|
$173.60 |
$526.20 |
$1,159.80 |
|
|
Administration chemotherapy subcutaneous/im anti neoplastic hormonal
|
$94.80 |
$269.60 |
$568.20 |
|
|
Administration chemotherapy subcutaneous/im anti neoplastic non hormonal
|
$120.80 |
$285.00 |
$564.00 |
|
|
Administration immunization each additional component
|
$40.20 |
$48.60 |
$113.40 |
|
|
Administration immunization each additional vaccine
|
$12.00 |
$12.60 |
$80.00 |
|
|
Administration immunization first component each vaccine
|
$11.00 |
$170.40 |
$395.40 |
|
|
Administration immunization intranasal/oral route 1 vaccine
|
$12.00 |
$14.40 |
$37.00 |
|
|
Administration immunization intranasal/oral route each additional vaccine
|
$12.50 |
$12.50 |
$18.40 |
|
|
Administration rsv monoclonal ab seasonal dose im w/counseling
|
$24.00 |
$25.20 |
$91.00 |
|
|
Administration vaccine hepatitis b
|
$12.00 |
$12.00 |
$99.00 |
|
|
Administration vaccine influenza virus
|
$12.00 |
$12.00 |
$205.60 |
|
|
Administration vaccine pneumococcal
|
$12.00 |
$12.00 |
$205.60 |
|
|
Administration vaccine rsv monoclonal ab seasonal dose im
|
$24.00 |
$91.00 |
$283.20 |
|
|
Ado-trastuzumab emtansine 100 mg intravenous solution
|
$97.80 |
$139.20 |
$15,894.60 |
|
|
Adrenal cortex & medulla img
|
$1,703.40 |
$4,242.60 |
$8,015.40 |
|
|
Adrenalin epinephrine inject
|
$0.60 |
$89.40 |
$736.20 |
|
|
Advance care planning each additional 30 min 99498
|
$232.00 |
$464.40 |
$572.40 |
|
|
Aep hearing status deter i&r
|
$154.40 |
$336.60 |
$1,386.60 |
|
|
Aep neurodiagnostic i&r
|
$243.60 |
$583.80 |
$1,635.60 |
|
|
Aep thrshld est mlt freq i&r
|
$261.00 |
$831.60 |
$1,635.60 |
|
|
Afamelanotide implant, 1 mg
|
$6,227.40 |
$6,529.20 |
$140,689.80 |
|
|
_afb id by dna probe rflx ast
|
$111.60 |
$170.40 |
$1,349.40 |
|
|
#afb mycobacteria suscep. #1
|
$30.40 |
$41.40 |
$218.40 |
|
|
_afb org id by sequencing rflx ast-sendout
|
$364.00 |
$642.60 |
$1,939.20 |
|
|
Aff2 gen aly detc abnl allel
|
$1,539.00 |
$1,539.00 |
$1,539.00 |
|
|
Aflibercept injection
|
$2,185.50 |
$2,185.50 |
$6,024.00 |
|
|
After cataract laser surgery
|
$799.00 |
$799.00 |
$799.00 |
|
|
Agalsidase beta 35 mg intravenous solution
|
$955.20 |
$4,783.20 |
$47,027.60 |
|
|
Air conduction bilat
|
$12.00 |
$117.00 |
$133.00 |
|
|
Air injection into abdomen 49400
|
$829.60 |
$1,285.20 |
$6,051.00 |
|
|
Airway resistance by impulse oscillometry 94728
|
$315.50 |
$315.50 |
$315.50 |
|
|
Albumin body fluid quantitative each specimen
|
$15.00 |
$40.20 |
$151.20 |
|
|
Albumin (human), 25%, 50ml
|
$44.40 |
$304.00 |
$1,898.40 |
|
|
Albumin, human 25 % intravenous solution
|
$204.00 |
$204.00 |
$406.80 |
|
|
Albumin (human), 5%, 250 ml
|
$63.00 |
$618.60 |
$1,429.60 |
|
|
Albumin, human 5 % intravenous solution
|
$183.60 |
$292.80 |
$396.00 |
|
|
Albumin (microalbumin) 24 hour urine quantitative
|
$24.00 |
$36.00 |
$606.00 |
|
|
Albumin serum plasma or whole blood
|
$20.80 |
$32.00 |
$165.00 |
|
|
Albuterol comp unit
|
$1.20 |
$1.20 |
$1.20 |
|
|
Albuterol ipratrop non-comp
|
$0.60 |
$11.60 |
$27.80 |
|
|
Albuterol non-comp con
|
$0.80 |
$5.00 |
$370.80 |
|
|
Albuterol non-comp unit
|
$3.20 |
$8.40 |
$34.00 |
|
|
Alcohol (ethanol) any specimen except urine/breath
|
$147.50 |
$147.50 |
$147.50 |
|
|
Alcohol/subs interv 15-30mn
|
$43.00 |
$382.20 |
$393.00 |
|
|
Alcohol/subs interv >30 min
|
$550.80 |
$550.80 |
$550.80 |
|
|
Aldesleukin injection
|
$3,330.60 |
$3,330.60 |
$8,184.00 |
|
|
Alefacept
|
$214.20 |
$214.20 |
$214.20 |
|
|
Alemtuzumab 12 mg/1.2 ml intravenous solution
|
$55.50 |
$8,173.80 |
$51,339.60 |
|
|
Alginate dressing <=16 sq in
|
$13.00 |
$78.60 |
$105.00 |
|
|
Alginate drsg >16 <=48 sq in
|
$96.00 |
$139.80 |
$189.00 |
|
|
Alginate drsg wound filler
|
$81.00 |
$128.00 |
$210.00 |
|
|
Alkaline phosphatase
|
$19.50 |
$34.80 |
$259.20 |
|
|
Allergen alpha lactalbumin ige
|
$21.00 |
$75.20 |
$498.00 |
|
|
Allergen egg white ige
|
$19.80 |
$39.00 |
$1,347.00 |
|
|
Allergy injections; 2 or more 95117
|
$6.80 |
$24.60 |
$52.20 |
|
|
Allergy injection; single 95115
|
$10.20 |
$24.60 |
$52.20 |
|
|
Allergy Skin Testing
|
$16.20 |
$16.20 |
$122.40 |
|
|
Allg patch or app # of tests 95044
|
$32.40 |
$32.40 |
$55.20 |
|
|
Allgrft implnt knee w/scope
|
$2,334.60 |
$2,334.60 |
$2,334.60 |
|
|
Allograft allowrap 4x4cm dry 16sqcm
|
$7,558.80 |
$7,558.80 |
$7,558.80 |
|
|
Allograft amnioexcel plus 17mm disk
|
$143.50 |
$143.50 |
$143.50 |
|
|
Allograft amniotic activebarrier 200 2x2cm-q4100-cost per sheet
|
$0.01 |
$4,449.60 |
$33,312.60 |
|
|
Allograft dermis 20x25x1mm decell w/matracell arthroflex
|
$2,027.40 |
$9,274.20 |
$16,546.20 |
|
|
Allograft ecm allopatch hd dehydr thick 0.8-1.7mmx2x5cm-cost per sq cm
|
$7,353.60 |
$24,912.00 |
$67,982.40 |
|
|
Allograft epieffect 2x3cm-q4186-cost per sq cm
|
$676.20 |
$4,721.40 |
$8,304.60 |
|
|
Allograft graftjacket 2x12cm-q4107-cost per sq cm
|
$151.50 |
$4,781.60 |
$5,527.20 |
|
|
Allograft membrn amnio 1x2cm hu ambriodry
|
$825.00 |
$2,235.00 |
$9,430.20 |
|
|
Allograft umbilical epicord 15 sq cm-q4187-cost per sq cm
|
$8,445.00 |
$8,445.00 |
$8,445.00 |
|
|
All tstg perq&iq drugs/biol
|
$50.50 |
$102.60 |
$146.40 |
|
|
All tstg perq&iq w/venoms
|
$42.00 |
$42.00 |
$146.40 |
|
|
Alpha-1-proteinase inhibitor (human) 1,000 mg (+/-) IV solution
|
$1.20 |
$51.00 |
$2,080.00 |
|
