|
2d tee w or without fol w/con,in
|
$2,252.40 |
$2,252.40 |
$2,252.40 |
$1,624.70
|
|
2nd order venous cath
|
$1,558.80 |
$1,558.80 |
$1,558.80 |
$1,543.85
|
|
3d ech img cgen car anomal
|
$422.40 |
$422.40 |
$422.40 |
$460.00
|
|
3d recon without postprocess indpndt
|
$422.40 |
$422.40 |
$422.40 |
$469.20
|
|
88334 ap bill cytologic exam each additional site
|
$87.60 |
$87.60 |
$87.60 |
$97.65
|
|
Abatacept (with maltose) 250 mg intravenous solution
|
$6,510.00 |
$6,510.00 |
$7,440.00 |
$3,128.29
|
|
Abd aorta w/runoff s&i
|
$4,657.20 |
$4,657.20 |
$4,657.20 |
$3,569.56
|
|
Abd/low ext cath 1st
|
$1,989.00 |
$1,989.00 |
$1,989.00 |
$2,015.85
|
|
Abd/low ext cath 2nd
|
$2,206.80 |
$2,206.80 |
$2,206.80 |
$2,015.85
|
|
Abd/low ext cath 3rd
|
$4,269.60 |
$4,269.60 |
$4,269.60 |
$2,486.97
|
|
Abd/low ext cath addl
|
$1,801.80 |
$1,801.80 |
$1,801.80 |
$964.70
|
|
Abdominal CT scan (with and without contrast)
|
$1,705.80 |
$1,705.80 |
$1,705.80 |
$1,992.00
|
|
Abdominal CT scan (with contrast)
|
$1,408.20 |
$1,408.20 |
$1,408.20 |
$1,669.00
|
|
Abdominal CT scan (without contrast)
|
$1,189.80 |
$1,189.80 |
$1,189.80 |
$1,358.76
|
|
Abdominal MRI (with and without contrast)
|
$2,029.20 |
$2,029.20 |
$2,029.20 |
$2,999.67
|
|
Abdominal MRI (without contrast)
|
$1,913.40 |
$1,913.40 |
$1,913.40 |
$2,048.36
|
|
Abdominal pad
|
$468.56 |
$468.56 |
$468.56 |
$151.32
|
|
Abdominal paracentesis w/image guidance
|
$1,933.20 |
$1,933.20 |
$2,981.79 |
$1,655.36
|
|
Abdominal Ultrasound (complete)
|
$1,092.00 |
$1,092.00 |
$1,092.00 |
$785.55
|
|
Abdominal Ultrasound (limited)
|
$517.20 |
$517.20 |
$517.20 |
$581.94
|
|
Abdominoplasty 15830
|
$34,624.24 |
$34,624.24 |
$34,624.24 |
$6,442.80
|
|
Abd paracentesis/w/o image guide 49082
|
$1,611.60 |
$1,611.60 |
$3,572.29 |
$1,145.00
|
|
Abduct control hip semi-flex
|
$1,194.31 |
$1,194.31 |
$1,194.31 |
$499.86
|
|
Abduction bar jointed adjust
|
$1,423.23 |
$1,423.23 |
$1,423.23 |
$595.67
|
|
Abduction rotation bar shoe
|
$503.29 |
$503.29 |
$503.29 |
$210.65
|
|
Abduct rotation bar without shoe
|
$460.22 |
$460.22 |
$460.22 |
$192.62
|
|
Ablate arrhythmia add on
|
$36,853.20 |
$36,853.20 |
$36,853.20 |
$6,898.92
|
|
Ablate bone tumor(s) cryo perq 20983
|
$17,145.00 |
$17,145.00 |
$17,145.00 |
$8,453.60
|
|
Ablate bone tumor(s) perq
|
$82,793.37 |
$82,793.37 |
$82,793.37 |
$9,350.33
|
|
Ablate heart dysrhythm focus
|
$11,494.80 |
$11,494.80 |
$11,494.80 |
$9,522.05
|
|
Ablate inf turbinate submuc 30802
|
$16,047.65 |
$16,047.65 |
$16,047.65 |
$1,752.89
|
|
Ablate pulm tumor perq crybl
|
$23,538.60 |
$23,538.60 |
$23,538.60 |
$9,591.75
|
|
Ablation cardiac vagal inputs atrium
|
$357.00 |
$357.00 |
$357.00 |
$1,960.80
|
|
Ablation of upper extremity nerves rf
|
$865.80 |
$865.80 |
$15,400.52 |
$808.50
|
|
Abscess drain retroperitoneal surg code
|
$3,815.40 |
$3,815.40 |
$3,815.40 |
$2,996.80
|
|
Access & clsr pq fem art endogft dlvry w/img uni
|
$2,371.80 |
$2,371.80 |
$2,371.80 |
$2,314.00
|
|
Acetaminophen level
|
$59.40 |
$59.40 |
$59.40 |
$103.75
|
|
Acetazolamide 500 mg solution for injection
|
$261.77 |
$261.77 |
$292.95 |
$122.55
|
|
Acetylcholine receptor modulating antibody
|
$208.20 |
$208.20 |
$208.20 |
$62.50
|
|
Acetylcholinesterase assay
|
$112.80 |
$112.80 |
$112.80 |
$107.63
|
|
Acetylcysteine 200 mg/ml (20 %) intravenous solution
|
$45.00 |
$45.00 |
$45.00 |
$216.00
|
|
Acetylcysteine non-comp unit
|
$151.30 |
$151.30 |
$188.74 |
$31.21
|
|
Acne surgery 10040
|
$603.60 |
$603.60 |
$603.60 |
$260.49
|
|
Acute hepatitis panel
|
$471.00 |
$471.00 |
$471.00 |
$286.05
|
|
Acyclovir 5 mg/ml in ns IV syringe (neo/ped) - cnr
|
$174.51 |
$174.51 |
$195.30 |
$63.47
|
|
#acylcarnitineprfl
|
$301.80 |
$301.80 |
$301.80 |
$125.00
|
|
Adapter b 8 channel 10cm
|
$23,974.91 |
$23,974.91 |
$23,974.91 |
$5,695.04
|
|
Add le poly knee custom kafo
|
$1,079.19 |
$1,079.19 |
$1,079.19 |
$451.68
|
|
Adenosine 3 mg/250 ml bag for osm
|
$45.00 |
$45.00 |
$45.00 |
$235.74
|
|
Adj gastric band via subq port
|
$44,802.41 |
$44,802.41 |
$44,802.41 |
$1,666.86
|
|
Admelog u-100 insulin lispro 100 unit/ml subcutaneous solution
|
$925.34 |
$925.34 |
$1,388.02 |
$183.76
|
|
Administration chemotherapy IV infusion each additional hour
|
$415.20 |
$415.20 |
$415.20 |
$230.35
|
|
Administration chemotherapy IV infusion each addl sequential infusion diff substance/drug >1 hr
|
$443.40 |
$443.40 |
$443.40 |
$298.11
|
|
Administration chemotherapy IV infusion up to 1 hour single/initial substance/drug
|
$1,008.00 |
$1,008.00 |
$1,008.00 |
$657.12
|
|
Administration chemotherapy IV push single/initial substance/drug
|
$556.20 |
$556.20 |
$556.20 |
$439.20
|
|
Administration chemotherapy subcutaneous/im anti neoplastic non hormonal
|
$243.60 |
$243.60 |
$243.60 |
$257.40
|
|
Administration immunization 1 vaccine
|
$94.80 |
$94.80 |
$94.80 |
$69.00
|
|
Administration immunization each additional vaccine
|
$40.80 |
$40.80 |
$40.80 |
$46.80
|
|
Administration vaccine influenza virus
|
$127.20 |
$127.20 |
$127.20 |
$49.50
|
|
Ado-trastuzumab emtansine 100 mg intravenous solution
|
$31,789.33 |
$31,789.33 |
$36,385.38 |
$11,350.31
|
|
_afb id by dna probe rflx ast
|
$132.00 |
$132.00 |
$132.00 |
$93.52
|
|
#afb mycobacteria suscep. #1
|
$67.80 |
$67.80 |
$67.80 |
$35.51
|
|
_afb org id by sequencing rflx ast-sendout
|
$489.00 |
$489.00 |
$489.00 |
$300.22
|
|
Afo molded ankle gauntlet
|
$2,551.70 |
$2,551.70 |
$2,551.70 |
$1,067.98
|
|
Afo molded plas rig ant tib
|
$5,824.89 |
$5,824.89 |
$5,824.89 |
$2,412.47
|
|
Afo molded to patient plasti
|
$2,436.40 |
$2,436.40 |
$2,436.40 |
$710.45
|
|
Afo rig ant tib tcf/= custom
|
$5,044.59 |
$5,044.59 |
$5,044.59 |
$1,654.77
|
|
Afo sing bar clasp attach sh
|
$1,585.43 |
$1,585.43 |
$1,585.43 |
$663.56
|
|
Afo sing solid stirrup calf
|
$2,282.59 |
$2,282.59 |
$2,282.59 |
$955.35
|
|
Afo sing upright with adjust s
|
$2,322.41 |
$2,322.41 |
$2,322.41 |
$696.71
|
|
Afo spiral molded to pt plas
|
$4,347.68 |
$4,347.68 |
$4,347.68 |
$1,450.86
|
|
Afo sprng wir drsflx calf bd
|
$1,612.90 |
$1,612.90 |
$1,612.90 |
$675.05
|
|
Afo supramalleolar custom
|
$3,181.15 |
$3,181.15 |
$3,181.15 |
$1,331.42
|
|
Afo tib fx cast plaster mold
|
$4,455.97 |
$4,455.97 |
$4,455.97 |
$1,864.98
|
|
Afo tibial fracture rigid
|
$4,357.27 |
$4,357.27 |
$4,357.27 |
$1,654.77
|
|
Afo tibial fracture soft
|
$2,852.10 |
$2,852.10 |
$2,852.10 |
$1,060.02
|
|
Afo, walk boot type, cus fab
|
$8,970.86 |
$8,970.86 |
$8,970.86 |
$2,903.60
|
|
Afo w/ankle joint, prefab
|
$3,611.52 |
$3,611.52 |
$3,611.52 |
$795.02
|
|
After cataract laser surgery
|
$11,982.16 |
$11,982.16 |
$11,982.16 |
$1,373.11
|
|
Ak/knee disartic pelvic band
|
$443.35 |
$443.35 |
$443.35 |
$185.56
|
|
Ak/knee disartic silesian ba
|
$551.38 |
$551.38 |
$551.38 |
$202.75
|
|
Ak sleeve susp neoprene/equa
|
$998.87 |
$998.87 |
$998.87 |
$275.52
|
|
Albumin body fluid quantitative each specimen
|
$52.20 |
$52.20 |
$52.20 |
$45.18
|
|
Albumin (human), 25%, 50ml
|
$386.83 |
$386.83 |
$432.92 |
$244.70
|
|
Albumin (human), 5%, 250 ml
|
$610.79 |
$610.79 |
$683.55 |
$245.11
|
|
Albumin (microalbumin) 24 hour urine quantitative
|
$84.60 |
$84.60 |
$84.60 |
$55.90
|
|
Albumin serum plasma or whole blood
|
$47.40 |
$47.40 |
$47.40 |
$40.00
|
|
Albuterol ipratrop non-comp
|
$27.00 |
$27.00 |
$27.00 |
$5.40
|
|
Albuterol non-comp con
|
$27.00 |
$27.00 |
$27.00 |
$6.07
|
|
Albuterol non-comp unit
|
$27.00 |
$27.00 |
$27.00 |
$5.61
|
|
Alcohol (ethanol) any specimen except urine/breath
|
$54.60 |
$54.60 |
$54.60 |
$91.00
|
|
Alemtuzumab 12 mg/1.2 ml intravenous solution
|
$89,232.73 |
$89,232.73 |
$89,232.73 |
$47,974.31
|
|
Alkaline phosphatase
|
$49.20 |
$49.20 |
$49.20 |
$45.75
|
|
Allograft 160mg placental salera mini membrane
|
$15,796.01 |
$15,796.01 |
$15,796.01 |
$6,611.20
|
|
Allograft allowrap 4x4cm dry 16sqcm
|
$31,149.36 |
$31,149.36 |
$31,149.36 |
$5,401.92
|
|
Allograft amnioexcel plus 17mm disk
|
$39,086.74 |
$39,086.74 |
$39,086.74 |
$2,386.00
|
|
Allograft dermis 20x25x1mm decell w/matracell arthroflex
|
$24,308.79 |
$24,308.79 |
$24,308.79 |
$6,414.50
|
|
Allograft ecm allopatch hd dehydr thick 0.8-1.7mmx2x5cm-cost per sq cm
|
$110,350.00 |
$110,350.00 |
$110,350.00 |
$23,373.60
|
|
Allograft epieffect 2x3cm-q4186-cost per sq cm
|
$74,083.19 |
$74,083.19 |
$74,083.19 |
$989.09
|
|
Allograft graftjacket 2x12cm-q4107-cost per sq cm
|
$62,693.73 |
$62,693.73 |
$62,693.73 |
$4,677.40
|
