|
17-ketosteroids
|
$8.05 |
$8.05 |
$8.05 |
$44.00
|
|
2nd order venous cath
|
$643.65 |
$643.65 |
$643.65 |
$1,809.60
|
|
3-d radiotherapy plan
|
$2,140.60 |
$2,140.60 |
$2,140.60 |
$4,886.50
|
|
3d recon without postprocess indpndt
|
$94.50 |
$94.50 |
$94.50 |
$427.34
|
|
5' nucleotidase - sendout
|
$36.40 |
$36.40 |
$36.40 |
$50.05
|
|
88334 ap bill cytologic exam each additional site
|
$74.73 |
$74.73 |
$74.73 |
$97.65
|
|
99397 periodic comp preventive med 65+ years est
|
$23.10 |
$23.10 |
$23.10 |
$176.03
|
|
Abatacept (with maltose) 250 mg intravenous solution
|
$191.58 |
$191.58 |
$191.58 |
$3,634.61
|
|
Abd aorta w/runoff s&i
|
$1,913.63 |
$1,913.63 |
$1,913.63 |
$3,667.71
|
|
Abd/low ext cath 1st
|
$1,251.78 |
$1,251.78 |
$1,251.78 |
$2,608.45
|
|
Abd/low ext cath 2nd
|
$1,544.38 |
$1,544.38 |
$1,544.38 |
$2,517.20
|
|
Abd/low ext cath 3rd
|
$1,837.68 |
$1,837.68 |
$1,837.68 |
$3,050.58
|
|
Abd/low ext cath addl
|
$1,080.98 |
$1,080.98 |
$1,080.98 |
$1,009.00
|
|
Abdominal CT scan (with and without contrast)
|
$793.80 |
$793.80 |
$793.80 |
$2,049.00
|
|
Abdominal CT scan (with contrast)
|
$746.20 |
$746.20 |
$746.20 |
$1,683.63
|
|
Abdominal CT scan (without contrast)
|
$666.93 |
$666.93 |
$666.93 |
$1,358.76
|
|
Abdominal MRI (with and without contrast)
|
$1,289.23 |
$1,289.23 |
$1,289.23 |
$2,916.21
|
|
Abdominal MRI (with contrast)
|
$1,160.43 |
$1,160.43 |
$1,160.43 |
$2,187.60
|
|
Abdominal MRI (without contrast)
|
$747.78 |
$747.78 |
$747.78 |
$1,972.66
|
|
Abdominal paracentesis w/image guidance
|
$637.70 |
$637.70 |
$637.70 |
$1,666.30
|
|
Abdominal Ultrasound (complete)
|
$310.45 |
$310.45 |
$310.45 |
$759.57
|
|
Abdominal Ultrasound (limited)
|
$231.70 |
$231.70 |
$231.70 |
$603.33
|
|
Abd paracentesis/w/o image guide 49082
|
$497.35 |
$497.35 |
$497.35 |
$1,170.28
|
|
Ablate arrhythmia add on
|
$4,098.33 |
$4,098.33 |
$4,098.33 |
$7,417.15
|
|
Ablate heart dysrhythm focus
|
$3,467.80 |
$3,467.80 |
$3,467.80 |
$10,008.58
|
|
Ablate inf turbinate submuc 30802
|
$69.13 |
$69.13 |
$69.13 |
$1,747.81
|
|
Ablate inf turbinate superf 30801
|
$50.05 |
$50.05 |
$50.05 |
$1,849.50
|
|
Ablation cardiac vagal inputs atrium
|
$1,175.48 |
$1,175.48 |
$1,175.48 |
$3,587.65
|
|
Ablation cryo abd perit om
|
$57.58 |
$57.58 |
$57.58 |
$2,555.80
|
|
Ablation of upper extremity nerves rf
|
$184.63 |
$184.63 |
$184.63 |
$987.60
|
|
Abscess drain retroperitoneal surg code
|
$943.08 |
$943.08 |
$943.08 |
$3,053.18
|
|
Access & clsr pq fem art endogft dlvry w/img uni
|
$58.63 |
$58.63 |
$58.63 |
$3,263.74
|
|
Acetaminophen level
|
$67.90 |
$67.90 |
$67.90 |
$117.01
|
|
Acetazolamide 500 mg solution for injection
|
$1.79 |
$1.79 |
$1.79 |
$133.60
|
|
Acetone qualitative
|
$10.33 |
$10.33 |
$10.33 |
$47.45
|
|
Acetylcysteine 200 mg/ml (20 %) intravenous solution
|
$5.05 |
$5.05 |
$5.05 |
$323.77
|
|
Acetylcysteine non-comp unit
|
$1.09 |
$1.09 |
$1.09 |
$29.01
|
|
Acne surgery 10040
|
$22.75 |
$22.75 |
$22.75 |
$235.13
|
|
Aco annual medicare visit (awv), initial g0438aco
|
$41.30 |
$41.30 |
$41.30 |
$206.14
|
|
Aco annual medicare visit (awv), subsq g0439aco
|
$27.83 |
$27.83 |
$27.83 |
$158.50
|
|
Aco depression screen annual medicare g0444aco
|
$4.20 |
$4.20 |
$4.20 |
$33.00
|
|
Aco med nutria tx/group, ea 30 min 97804aco
|
$8.40 |
$8.40 |
$8.40 |
$42.28
|
|
Acoustic refl threshold tst
|
$3.68 |
$3.68 |
$3.68 |
$83.79
|
|
Actinotherapy uv light
|
$15.75 |
$15.75 |
$15.75 |
$89.05
|
|
Acute hepatitis panel
|
$131.78 |
$131.78 |
$131.78 |
$284.70
|
|
Acyclovir 400 mg tablet
|
$11.13 |
$11.13 |
$11.13 |
$654.96
|
|
Acyclovir 5 mg/ml in ns IV syringe (neo/ped) - cnr
|
$3.29 |
$3.29 |
$3.29 |
$50.70
|
|
Adapter b 8 channel 10cm
|
$4,169.73 |
$4,169.73 |
$4,169.73 |
$1,638.00
|
|
Adenosine 3 mg/250 ml bag for osm
|
$3.96 |
$3.96 |
$3.96 |
$219.86
|
|
Adenovirus assay w/optic
|
$3.68 |
$3.68 |
$3.68 |
$30.03
|
|
Adh-sendout
|
$40.25 |
$40.25 |
$40.25 |
$109.28
|
|
Adj gastric band via subq port
|
$77.70 |
$77.70 |
$77.70 |
$1,874.60
|
|
Adj tis trans/see area/10.1-30sqcm 14041
|
$207.20 |
$207.20 |
$207.20 |
$2,786.55
|
|
Admelog u-100 insulin lispro 100 unit/ml subcutaneous solution
|
$49.63 |
$49.63 |
$49.63 |
$124.70
|
|
Administration chemotherapy IV infusion each additional hour
|
$88.55 |
$88.55 |
$88.55 |
$230.35
|
|
Administration chemotherapy IV infusion each addl sequential infusion diff substance/drug >1 hr
|
$120.05 |
$120.05 |
$120.05 |
$308.10
|
|
Administration chemotherapy IV infusion up to 1 hour single/initial substance/drug
|
$256.03 |
$256.03 |
$256.03 |
$672.03
|
|
Administration chemotherapy IV push single/initial substance/drug
|
$229.95 |
$229.95 |
$229.95 |
$440.00
|
|
Administration chemotherapy subcutaneous/im anti neoplastic hormonal
|
$64.40 |
$64.40 |
$64.40 |
$220.00
|
|
Administration chemotherapy subcutaneous/im anti neoplastic non hormonal
|
$82.43 |
$82.43 |
$82.43 |
$264.00
|
|
Administration immunization 1 vaccine
|
$30.45 |
$30.45 |
$30.45 |
$70.52
|
|
Administration immunization each additional component
|
$5.95 |
$5.95 |
$5.95 |
$27.20
|
|
Administration immunization each additional vaccine
|
$15.23 |
$15.23 |
$15.23 |
$46.23
|
|
Administration immunization first component each vaccine
|
$5.95 |
$5.95 |
$5.95 |
$45.50
|
|
Administration immunization intranasal/oral route 1 vaccine
|
$5.78 |
$5.78 |
$5.78 |
$48.00
|
|
Administration immunization intranasal/oral route each additional vaccine
|
$2.98 |
$2.98 |
$2.98 |
$33.60
|
|
Administration vaccine hepatitis b
|
$18.20 |
$18.20 |
$18.20 |
$51.35
|
|
Ado-trastuzumab emtansine 100 mg intravenous solution
|
$857.54 |
$857.54 |
$857.54 |
$11,874.55
|
|
Adrenal cortex & medulla img
|
$282.98 |
$282.98 |
$282.98 |
$1,780.19
|
|
Aep hearing status deter i&r
|
$54.95 |
$54.95 |
$54.95 |
$305.73
|
|
_afb id by dna probe rflx ast
|
$40.25 |
$40.25 |
$40.25 |
$105.00
|
|
Air conduction bilat
|
$7.53 |
$7.53 |
$7.53 |
$106.50
|
|
Airway resistance by impulse oscillometry 94728
|
$8.40 |
$8.40 |
$8.40 |
$276.66
|
|
Albumin body fluid quantitative each specimen
|
$31.50 |
$31.50 |
$31.50 |
$48.00
|
|
Albumin (human), 25%, 50ml
|
$18.20 |
$18.20 |
$18.20 |
$295.80
|
|
Albumin (human), 5%, 250 ml
|
$18.20 |
$18.20 |
$18.20 |
$295.80
|
|
Albumin (microalbumin) 24 hour urine quantitative
|
$24.68 |
$24.68 |
$24.68 |
$57.60
|
|
Albumin serum plasma or whole blood
|
$26.95 |
$26.95 |
$26.95 |
$43.50
|
|
Albuterol ipratrop non-comp
|
$7.35 |
$7.35 |
$7.35 |
$22.45
|
|
Albuterol non-comp con
|
$0.06 |
$0.06 |
$0.06 |
$15.00
|
|
Albuterol non-comp unit
|
$2.28 |
$2.28 |
$2.28 |
$9.59
|
|
Alkaline phosphatase
|
$22.23 |
$22.23 |
$22.23 |
$46.20
|
|
Allergy injections; 2 or more 95117
|
$2.45 |
$2.45 |
$2.45 |
$51.07
|
|
Allergy injection; single 95115
|
$2.63 |
$2.63 |
$2.63 |
$42.75
|
|
Allergy Skin Testing
|
$1.58 |
$1.58 |
$1.58 |
$47.44
|
|
Allograft amniotic activebarrier 200 2x2cm-q4100-cost per sheet
|
$13,389.43 |
$13,389.43 |
$13,389.43 |
$6,555.62
|
|
Allograft dermis 20x25x1mm decell w/matracell arthroflex
|
$6,788.78 |
$6,788.78 |
$6,788.78 |
$6,285.56
|
|
Allograft epieffect 2x3cm-q4186-cost per sq cm
|
$1,645.35 |
$1,645.35 |
$1,645.35 |
$905.18
|
|
Allograft graftjacket 2x12cm-q4107-cost per sq cm
|
$4,898.43 |
$4,898.43 |
$4,898.43 |
$2,513.00
|
|
Allograft membrn amnio 1x2cm hu ambriodry
|
$1,698.03 |
$1,698.03 |
$1,698.03 |
$2,198.85
|
|
Allograft umbil cord+amniotic membrane-q4148-cost per sq cm
|
$93.63 |
$93.63 |
$93.63 |
$4,101.14
|
|
Alpha-fetoprotein tumor marker
|
$50.93 |
$50.93 |
$50.93 |
$99.00
|
|
Alprostadil for injection
|
$20.07 |
$20.07 |
$20.07 |
$533.06
|
|
Alteplase 100 mg infusion from pyxis vial
|
$1,501.57 |
$1,501.57 |
$1,501.57 |
$2,600.22
|
|
Alt/sgpt
|
$22.05 |
$22.05 |
$22.05 |
$49.00
|
|
Alys cplx sp/pn npgt w/prgrm
|
$160.83 |
$160.83 |
$160.83 |
$437.50
|
|
Amikacin 4 mg/ml intravitreal injection - cnr
|
$1.48 |
$1.48 |
$1.48 |
$36.30
|
|
Aminophylline 25 mg/ml intravenous solution (wrapper)
|
$1.91 |
$1.91 |
$1.91 |
$41.59
|
|
Amiodarone 150 mg/100 ml (1.5 mg/ml) in dextrose, iso-osmotic IV
|
$3.83 |
$3.83 |
$3.83 |
$202.10
|
|
Amiodarone 50 mg/ml intravenous solution
|
$2.06 |
$2.06 |
$2.06 |
$47.44
|
