|
3d recon without postprocess indpndt
|
$31.50 |
$31.50 |
$31.50 |
$425.10
|
|
88334 ap bill cytologic exam each additional site
|
$107.52 |
$107.52 |
$107.52 |
$97.65
|
|
99381 initial comp preventive med less than 1 year new
|
$90.30 |
$90.30 |
$90.30 |
$151.20
|
|
99382 initial comp preventive med 1 to 4 years new
|
$94.08 |
$94.08 |
$94.08 |
$147.49
|
|
99383 initial comp preventive med 5 to 11 years new
|
$95.34 |
$95.34 |
$95.34 |
$162.00
|
|
99391 periodic comp preventive med less than 1 year est
|
$80.64 |
$80.64 |
$80.64 |
$135.00
|
|
99392 periodic comp preventive med 1 to 4 years est
|
$86.52 |
$86.52 |
$86.52 |
$135.00
|
|
99393 periodic comp preventive med 5 to 11 years est
|
$86.10 |
$86.10 |
$86.10 |
$129.00
|
|
99394 periodic comp preventive med 12 to 17 years est
|
$94.50 |
$94.50 |
$94.50 |
$147.92
|
|
99397 periodic comp preventive med 65+ years est
|
$102.90 |
$102.90 |
$102.90 |
$176.03
|
|
Abdominal CT scan (with and without contrast)
|
$884.52 |
$884.52 |
$884.52 |
$2,009.80
|
|
Abdominal CT scan (with contrast)
|
$836.22 |
$836.22 |
$836.22 |
$1,683.63
|
|
Abdominal CT scan (without contrast)
|
$509.88 |
$509.88 |
$509.88 |
$1,358.76
|
|
Abdominal MRI (with and without contrast)
|
$2,066.82 |
$2,066.82 |
$2,066.82 |
$2,933.60
|
|
Abdominal MRI (with contrast)
|
$2,024.82 |
$2,024.82 |
$2,024.82 |
$2,200.55
|
|
Abdominal MRI (without contrast)
|
$1,265.88 |
$1,265.88 |
$1,265.88 |
$1,975.74
|
|
Abdominal paracentesis w/image guidance
|
$1,227.24 |
$1,227.24 |
$1,227.24 |
$1,688.29
|
|
Abdominal Ultrasound (complete)
|
$270.06 |
$270.06 |
$270.06 |
$785.25
|
|
Abdominal Ultrasound (limited)
|
$270.06 |
$270.06 |
$270.06 |
$604.43
|
|
Abd paracentesis/w/o image guide 49082
|
$1,185.24 |
$1,185.24 |
$1,185.24 |
$1,248.00
|
|
Ablate inf turbinate superf 30801
|
$1,845.90 |
$1,845.90 |
$1,845.90 |
$2,122.56
|
|
Ablation cryo pq chest wall tumor(s) w/guid
|
$275.52 |
$275.52 |
$275.52 |
$339.18
|
|
Ablation of upper extremity nerves rf
|
$361.62 |
$361.62 |
$361.62 |
$825.60
|
|
Acetaminophen 10 mg/ml soln 100 ml glass cont
|
$62.91 |
$62.91 |
$62.91 |
$89.91
|
|
Acetone qualitative
|
$24.36 |
$24.36 |
$24.36 |
$48.00
|
|
Acetylcysteine 200 mg/ml (20 %) intravenous solution
|
$196.10 |
$196.10 |
$196.10 |
$306.22
|
|
Acetylcysteine non-comp unit
|
$131.58 |
$131.58 |
$131.58 |
$29.01
|
|
Acne surgery 10040
|
$240.24 |
$240.24 |
$240.24 |
$265.20
|
|
Aco annual medicare visit (awv), initial g0438aco
|
$141.12 |
$141.12 |
$141.12 |
$206.14
|
|
Aco annual medicare visit (awv), subsq g0439aco
|
$95.34 |
$95.34 |
$95.34 |
$160.50
|
|
Aco depression screen annual medicare g0444aco
|
$18.90 |
$18.90 |
$18.90 |
$32.97
|
|
Acute hepatitis panel
|
$493.92 |
$493.92 |
$493.92 |
$284.70
|
|
Acyclovir 5 mg/ml in ns IV syringe (neo/ped) - cnr
|
$139.46 |
$139.46 |
$139.46 |
$64.45
|
|
Adapter b 8 channel 10cm
|
$9,071.66 |
$9,071.66 |
$9,071.66 |
$6,875.44
|
|
Adding walker to prev cast
|
$193.62 |
$193.62 |
$193.62 |
$205.38
|
|
Adenosine 3 mg/250 ml bag for osm
|
$56.70 |
$56.70 |
$56.70 |
$217.04
|
|
Adjmt/revj ext fixj sys anes
|
$8,797.32 |
$8,797.32 |
$8,797.32 |
$7,907.11
|
|
Adj tis trans/see area/10.1-30sqcm 14041
|
$2,295.30 |
$2,295.30 |
$2,295.30 |
$2,837.09
|
|
Admelog u-100 insulin lispro 100 unit/ml subcutaneous solution
|
$139.60 |
$139.60 |
$139.60 |
$158.18
|
|
Administration immunization 1 vaccine
|
$76.86 |
$76.86 |
$76.86 |
$70.00
|
|
Administration immunization each additional vaccine
|
$18.48 |
$18.48 |
$18.48 |
$46.23
|
|
Administration immunization intranasal/oral route 1 vaccine
|
$5.78 |
$5.78 |
$5.78 |
$48.00
|
|
Administration immunization intranasal/oral route each additional vaccine
|
$5.78 |
$5.78 |
$5.78 |
$33.60
|
|
Administration rsv monoclonal ab seasonal dose im w/counseling
|
$5.78 |
$5.78 |
$5.78 |
$41.15
|
|
Administration vaccine rsv monoclonal ab seasonal dose im
|
$5.78 |
$5.78 |
$5.78 |
$41.00
|
|
Aep thrshld est mlt freq i&r
|
$976.50 |
$976.50 |
$976.50 |
$573.65
|
|
Air conduction bilat
|
$33.60 |
$33.60 |
$33.60 |
$116.22
|
|
Albumin body fluid quantitative each specimen
|
$42.00 |
$42.00 |
$42.00 |
$48.00
|
|
Albumin (human), 25%, 50ml
|
$271.23 |
$271.23 |
$271.23 |
$277.87
|
|
Albumin (microalbumin) 24 hour urine quantitative
|
$31.08 |
$31.08 |
$31.08 |
$58.00
|
|
Albumin serum plasma or whole blood
|
$26.46 |
$26.46 |
$26.46 |
$43.45
|
|
Albuterol ipratrop non-comp
|
$7.36 |
$7.36 |
$7.36 |
$9.93
|
|
Albuterol non-comp unit
|
$11.58 |
$11.58 |
$11.58 |
$9.43
|
|
Alkaline phosphatase
|
$27.72 |
$27.72 |
$27.72 |
$46.50
|
|
Allergen egg white ige
|
$40.32 |
$40.32 |
$40.32 |
$39.78
|
|
Allergy injections; 2 or more 95117
|
$24.36 |
$24.36 |
$24.36 |
$47.20
|
|
Allergy injection; single 95115
|
$7.14 |
$7.14 |
$7.14 |
$42.75
|
|
Allograft allowrap 4x4cm dry 16sqcm
|
$5,705.38 |
$5,705.38 |
$5,705.38 |
$5,579.34
|
|
Allograft amniotic activebarrier 200 2x2cm-q4100-cost per sheet
|
$28,035.16 |
$28,035.16 |
$28,035.16 |
$15,083.48
|
|
Allograft dermis 20x25x1mm decell w/matracell arthroflex
|
$11,021.04 |
$11,021.04 |
$11,021.04 |
$8,295.72
|
|
Allograft ecm allopatch hd dehydr thick 0.8-1.7mmx2x5cm-cost per sq cm
|
$29,442.76 |
$29,442.76 |
$29,442.76 |
$25,508.83
|
|
Allograft epieffect 2x3cm-q4186-cost per sq cm
|
$22,300.03 |
$22,300.03 |
$22,300.03 |
$3,621.72
|
|
Allograft graftjacket 2x12cm-q4107-cost per sq cm
|
$6,058.74 |
$6,058.74 |
$6,058.74 |
$4,898.43
|
|
Allograft membrn amnio 1x2cm hu ambriodry
|
$7,740.23 |
$7,740.23 |
$7,740.23 |
$5,381.40
|
|
Allograft umbil cord+amniotic membrane-q4148-cost per sq cm
|
$6,000.56 |
$6,000.56 |
$6,000.56 |
$5,538.22
|
|
Allograft umbilical epicord 15 sq cm-q4187-cost per sq cm
|
$6,587.41 |
$6,587.41 |
$6,587.41 |
$4,814.57
|
|
Alpha-fetoprotein tumor marker
|
$90.30 |
$90.30 |
$90.30 |
$103.60
|
|
Alteplase 100 mg infusion from pyxis vial
|
$45,243.16 |
$45,243.16 |
$45,243.16 |
$9,600.63
|
|
Alt/sgpt
|
$28.56 |
$28.56 |
$28.56 |
$49.00
|
|
Amikacin 4 mg/ml intravitreal injection - cnr
|
$56.70 |
$56.70 |
$56.70 |
$44.00
|
|
Amiodarone 50 mg/ml intravenous solution
|
$56.70 |
$56.70 |
$56.70 |
$50.85
|
|
Ammonia
|
$78.54 |
$78.54 |
$78.54 |
$123.48
|
|
Amniocentesisdiagnostic 59000
|
$1,307.04 |
$1,307.04 |
$1,307.04 |
$963.79
|
|
Amp f/th 1/2 jt/phalanx w/neurect local flap
|
$5,294.94 |
$5,294.94 |
$5,294.94 |
$3,969.00
|
|
Ampicillin 1 gram solution for injection
|
$56.70 |
$56.70 |
$56.70 |
$68.44
|
|
Ampicillin-sulbactam 1.5 gram solution for injection
|
$77.48 |
$77.48 |
$77.48 |
$57.38
|
|
Amplification real-time pcr dna markers infectious disease bacterial vaginosis and vaginitis
|
$206.64 |
$206.64 |
$206.64 |
$280.20
|
|
Amp metatarsal w/toe single 28810
|
$3,958.50 |
$3,958.50 |
$3,958.50 |
$3,839.54
|
|
Amputation toe interphalangeal joint
|
$3,958.50 |
$3,958.50 |
$3,958.50 |
$3,839.54
|
|
Amylase
|
$34.86 |
$34.86 |
$34.86 |
$93.00
|
|
An fluoro guide for cvp
|
$136.92 |
$136.92 |
$136.92 |
$509.60
|
|
Angiotensin ii 0.5 mg/ml soln 1 ml vial
|
$12,272.88 |
$12,272.88 |
$12,272.88 |
$6,048.00
|
|
Ankle X-ray
|
$147.00 |
$147.00 |
$147.00 |
$350.85
|
|
Annual Physical, Established Patient (age 18-39)
|
$96.60 |
$96.60 |
$96.60 |
$167.25
|
|
Annual Physical, Established Patient (age 40-64)
|
$102.90 |
$102.90 |
$102.90 |
$167.25
|
|
Annual Physical, New Patient (age 18-39)
|
$103.32 |
$103.32 |
$103.32 |
$167.25
|
|
Annual Physical, New Patient (age 40-64)
|
$121.38 |
$121.38 |
$121.38 |
$188.15
|
|
Anodyne therapy charges pt
|
$25.20 |
$25.20 |
$25.20 |
$41.02
|
|
Anogenital exam child w imag
|
$205.80 |
$205.80 |
$205.80 |
$238.06
|
|
Anoscopy control bleeding 46614
|
$1,252.44 |
$1,252.44 |
$1,252.44 |
$1,777.86
|
|
Anoscopy remove fb 46608
|
$960.96 |
$960.96 |
$960.96 |
$1,313.97
|
|
Antibody elution rbc reference
|
$155.40 |
$155.40 |
$155.40 |
$179.62
|
|
Antibody id rbc panel
|
$303.66 |
$303.66 |
$303.66 |
$291.75
|
|
Antibody screen rbc
|
$51.66 |
$51.66 |
$51.66 |
$105.00
|
|
Antinuclear antibodies
|
$92.82 |
$92.82 |
$92.82 |
$91.70
|
|
Antistreptolysin o titer
|
$11.76 |
$11.76 |
$11.76 |
$57.85
|
|
Antithrombin iii activity
|
$72.66 |
$72.66 |
$72.66 |
$106.85
|
|
App high cost ss t/a/l >100sq cm addl 100sq cm
|
$2,163.42 |
$2,163.42 |
$2,163.42 |
$1,300.71
|
|
Appl body cast sho to hips
|
$319.20 |
$319.20 |
$319.20 |
$390.73
|
|
Appl cast figure-of-eight
|
$319.20 |
$319.20 |
$319.20 |
$314.28
|