|
11-desoxycortisol - sendout
|
$120.60 |
$120.60 |
$120.60 |
$84.56
|
|
17-hydroxypregnenolone
|
$151.20 |
$151.20 |
$151.20 |
$88.20
|
|
2d tte w or without fol w/con,co
|
$1,284.00 |
$1,284.00 |
$1,284.00 |
$1,155.75
|
|
3d recon without postprocess indpndt
|
$378.60 |
$378.60 |
$378.60 |
$469.20
|
|
5' nucleotidase - sendout
|
$70.20 |
$70.20 |
$70.20 |
$50.05
|
|
88334 ap bill cytologic exam each additional site
|
$175.80 |
$175.80 |
$175.80 |
$97.65
|
|
99381 initial comp preventive med less than 1 year new
|
$224.40 |
$224.40 |
$224.40 |
$132.00
|
|
99383 initial comp preventive med 5 to 11 years new
|
$224.40 |
$224.40 |
$224.40 |
$111.00
|
|
99391 periodic comp preventive med less than 1 year est
|
$224.40 |
$224.40 |
$224.40 |
$107.10
|
|
99392 periodic comp preventive med 1 to 4 years est
|
$224.40 |
$224.40 |
$224.40 |
$115.50
|
|
99393 periodic comp preventive med 5 to 11 years est
|
$224.40 |
$224.40 |
$224.40 |
$113.40
|
|
Abatacept (with maltose) 250 mg intravenous solution
|
$8,463.00 |
$8,463.00 |
$8,463.00 |
$3,128.29
|
|
Abd aorta w/runoff s&i
|
$4,077.60 |
$4,077.60 |
$4,077.60 |
$3,569.56
|
|
Abd/low ext cath 2nd
|
$2,457.00 |
$2,457.00 |
$2,457.00 |
$2,015.85
|
|
Abd/low ext cath 3rd
|
$1,764.00 |
$1,764.00 |
$1,764.00 |
$2,486.97
|
|
Abdominal CT scan (with and without contrast)
|
$2,323.20 |
$2,323.20 |
$2,323.20 |
$1,992.00
|
|
Abdominal CT scan (with contrast)
|
$2,604.00 |
$2,604.00 |
$2,604.00 |
$1,669.00
|
|
Abdominal CT scan (without contrast)
|
$1,969.20 |
$1,969.20 |
$1,969.20 |
$1,358.76
|
|
Abdominal MRI (with and without contrast)
|
$4,324.80 |
$4,324.80 |
$4,324.80 |
$2,999.67
|
|
Abdominal MRI (with contrast)
|
$3,663.00 |
$3,663.00 |
$3,663.00 |
$2,210.00
|
|
Abdominal MRI (without contrast)
|
$2,527.20 |
$2,527.20 |
$2,527.20 |
$2,048.36
|
|
Abdominal pad
|
$388.52 |
$388.52 |
$388.52 |
$151.32
|
|
Abdominal paracentesis w/image guidance
|
$3,315.00 |
$3,315.00 |
$3,315.00 |
$1,655.36
|
|
Abdominal Ultrasound (complete)
|
$2,041.20 |
$2,041.20 |
$2,041.20 |
$785.55
|
|
Abdominal Ultrasound (limited)
|
$1,583.40 |
$1,583.40 |
$1,583.40 |
$581.94
|
|
Abdominoplasty 15830
|
$43,273.32 |
$43,273.32 |
$43,273.32 |
$6,442.80
|
|
Abd paracentesis/w/o image guide 49082
|
$688.80 |
$688.80 |
$688.80 |
$1,145.00
|
|
Abduct control hip semi-flex
|
$990.31 |
$990.31 |
$990.31 |
$499.86
|
|
Abduction bar jointed adjust
|
$1,180.12 |
$1,180.12 |
$1,180.12 |
$595.67
|
|
Abduction rotation bar shoe
|
$417.32 |
$417.32 |
$417.32 |
$210.65
|
|
Abduct rotation bar without shoe
|
$381.61 |
$381.61 |
$381.61 |
$192.62
|
|
Abl1 gene
|
$992.40 |
$992.40 |
$992.40 |
$668.85
|
|
Ablate arrhythmia add on
|
$2,534.40 |
$2,534.40 |
$2,534.40 |
$6,898.92
|
|
Ablate bone tumor(s) perq
|
$5,150.40 |
$5,150.40 |
$5,150.40 |
$9,350.33
|
|
Ablate heart dysrhythm focus
|
$9,523.80 |
$9,523.80 |
$9,523.80 |
$9,522.05
|
|
Ablate inf turbinate submuc 30802
|
$24,686.02 |
$24,686.02 |
$24,686.02 |
$1,752.89
|
|
Ablate inf turbinate superf 30801
|
$24,125.17 |
$24,125.17 |
$24,125.17 |
$1,944.80
|
|
Ablation cardiac vagal inputs atrium
|
$294.60 |
$294.60 |
$294.60 |
$1,960.80
|
|
Ablation cryo abd perit om
|
$14,683.24 |
$14,683.24 |
$14,683.24 |
$2,312.80
|
|
Ablation cryo thigh/knee
|
$4,870.80 |
$4,870.80 |
$4,870.80 |
$531.95
|
|
Ablation of upper extremity nerves rf
|
$58,883.95 |
$58,883.95 |
$58,883.95 |
$808.50
|
|
Abscess drain retroperitoneal surg code
|
$6,546.00 |
$6,546.00 |
$6,546.00 |
$2,996.80
|
|
Acetaminophen level
|
$72.00 |
$72.00 |
$72.00 |
$103.75
|
|
Acetazolamide 500 mg solution for injection
|
$416.85 |
$416.85 |
$416.85 |
$122.55
|
|
Acetone qualitative
|
$89.40 |
$89.40 |
$89.40 |
$45.65
|
|
Acetylcholine receptor modulating antibody
|
$218.40 |
$218.40 |
$218.40 |
$62.50
|
|
Acetylcysteine 200 mg/ml (20 %) intravenous solution
|
$48.00 |
$48.00 |
$48.00 |
$216.00
|
|
Acetylcysteine non-comp unit
|
$131.04 |
$131.04 |
$131.04 |
$31.21
|
|
Acne surgery 10040
|
$555.00 |
$555.00 |
$555.00 |
$260.49
|
|
Acute hepatitis panel
|
$327.60 |
$327.60 |
$327.60 |
$286.05
|
|
Acyclovir 5 mg/ml in ns IV syringe (neo/ped) - cnr
|
$48.00 |
$48.00 |
$48.00 |
$63.47
|
|
#acylcarnitineprfl
|
$60.00 |
$60.00 |
$60.00 |
$125.00
|
|
Adapter b 8 channel 10cm
|
$19,879.67 |
$19,879.67 |
$19,879.67 |
$5,695.04
|
|
Adding walker to prev cast
|
$237.00 |
$237.00 |
$237.00 |
$216.00
|
|
Add le poly knee custom kafo
|
$894.85 |
$894.85 |
$894.85 |
$451.68
|
|
Adenosine 3 mg/250 ml bag for osm
|
$57.49 |
$57.49 |
$57.49 |
$235.74
|
|
Adh-sendout
|
$153.60 |
$153.60 |
$153.60 |
$109.28
|
|
Admelog u-100 insulin lispro 100 unit/ml subcutaneous solution
|
$1,195.24 |
$1,195.24 |
$1,195.24 |
$183.76
|
|
Administration chemotherapy IV infusion each additional hour
|
$376.80 |
$376.80 |
$376.80 |
$230.35
|
|
Administration chemotherapy IV infusion up to 1 hour single/initial substance/drug
|
$817.20 |
$817.20 |
$817.20 |
$657.12
|
|
Administration chemotherapy subcutaneous/im anti neoplastic non hormonal
|
$262.20 |
$262.20 |
$262.20 |
$257.40
|
|
Administration immunization 1 vaccine
|
$57.60 |
$57.60 |
$57.60 |
$69.00
|
|
Administration immunization each additional vaccine
|
$37.20 |
$37.20 |
$37.20 |
$46.80
|
|
Administration immunization intranasal/oral route each additional vaccine
|
$19.20 |
$19.20 |
$19.20 |
$30.24
|
|
Administration vaccine influenza virus
|
$25.20 |
$25.20 |
$25.20 |
$49.50
|
|
Administration vaccine pneumococcal
|
$38.40 |
$38.40 |
$38.40 |
$49.17
|
|
Ado-trastuzumab emtansine 100 mg intravenous solution
|
$36,385.38 |
$36,385.38 |
$36,385.38 |
$11,350.31
|
|
_afb id by dna probe rflx ast
|
$118.80 |
$118.80 |
$118.80 |
$93.52
|
|
#afb mycobacteria suscep. #1
|
$24.60 |
$24.60 |
$24.60 |
$35.51
|
|
_afb org id by sequencing rflx ast-sendout
|
$630.00 |
$630.00 |
$630.00 |
$300.22
|
|
Afo molded ankle gauntlet
|
$2,115.84 |
$2,115.84 |
$2,115.84 |
$1,067.98
|
|
Afo molded plas rig ant tib
|
$4,829.92 |
$4,829.92 |
$4,829.92 |
$2,412.47
|
|
Afo molded to patient plasti
|
$2,020.23 |
$2,020.23 |
$2,020.23 |
$710.45
|
|
Afo rig ant tib tcf/= custom
|
$4,182.91 |
$4,182.91 |
$4,182.91 |
$1,654.77
|
|
Afo sing bar clasp attach sh
|
$1,314.62 |
$1,314.62 |
$1,314.62 |
$663.56
|
|
Afo sing solid stirrup calf
|
$1,892.69 |
$1,892.69 |
$1,892.69 |
$955.35
|
|
Afo sing upright with adjust s
|
$1,925.71 |
$1,925.71 |
$1,925.71 |
$696.71
|
|
Afo spiral molded to pt plas
|
$3,605.04 |
$3,605.04 |
$3,605.04 |
$1,450.86
|
|
Afo sprng wir drsflx calf bd
|
$1,337.39 |
$1,337.39 |
$1,337.39 |
$675.05
|
|
Afo supramalleolar custom
|
$2,637.76 |
$2,637.76 |
$2,637.76 |
$1,331.42
|
|
Afo tib fx cast plaster mold
|
$3,694.82 |
$3,694.82 |
$3,694.82 |
$1,864.98
|
|
Afo tibial fracture rigid
|
$3,613.00 |
$3,613.00 |
$3,613.00 |
$1,654.77
|
|
Afo tibial fracture soft
|
$2,364.92 |
$2,364.92 |
$2,364.92 |
$1,060.02
|
|
Afo, walk boot type, cus fab
|
$7,438.52 |
$7,438.52 |
$7,438.52 |
$2,903.60
|
|
Afo w/ankle joint, prefab
|
$2,994.62 |
$2,994.62 |
$2,994.62 |
$795.02
|
|
Ak/knee disartic pelvic band
|
$367.62 |
$367.62 |
$367.62 |
$185.56
|
|
Ak/knee disartic silesian ba
|
$457.20 |
$457.20 |
$457.20 |
$202.75
|
|
Ak sleeve susp neoprene/equa
|
$828.25 |
$828.25 |
$828.25 |
$275.52
|
|
Albumin body fluid quantitative each specimen
|
$78.60 |
$78.60 |
$78.60 |
$45.18
|
|
Albumin (human), 25%, 50ml
|
$735.00 |
$735.00 |
$735.00 |
$244.70
|
|
Albumin (human), 5%, 250 ml
|
$771.75 |
$771.75 |
$771.75 |
$245.11
|
|
Albumin (microalbumin) 24 hour urine quantitative
|
$118.20 |
$118.20 |
$118.20 |
$55.90
|
|
Albumin serum plasma or whole blood
|
$110.40 |
$110.40 |
$110.40 |
$40.00
|
|
Albuterol ipratrop non-comp
|
$6.00 |
$6.00 |
$6.00 |
$5.40
|
|
Albuterol non-comp con
|
$900.05 |
$900.05 |
$900.05 |
$6.07
|
|
Albuterol non-comp unit
|
$9.97 |
$9.97 |
$9.97 |
$5.61
|
|
Alcohol (ethanol) any specimen except urine/breath
|
$67.20 |
$67.20 |
$67.20 |
$91.00
|
|
Alkaline phosphatase
|
$37.20 |
$37.20 |
$37.20 |
$45.75
|
|
Allergen alpha lactalbumin ige
|
$45.60 |
$45.60 |
$45.60 |
$47.65
|
|
Allergen egg white ige
|
$45.00 |
$45.00 |
$45.00 |
$37.05
|
