|
24 hr ambulatory b/p monitor
|
$107.10 |
$107.10 |
$107.10 |
$313.04
|
|
2d tte w or without fol w/con,co
|
$891.60 |
$891.60 |
$891.60 |
$1,155.75
|
|
2nd order venous cath
|
$843.00 |
$843.00 |
$843.00 |
$1,543.85
|
|
3d ech img cgen car anomal
|
$560.10 |
$560.10 |
$560.10 |
$460.00
|
|
3-d radiotherapy plan
|
$5,227.80 |
$5,227.80 |
$5,227.80 |
$5,002.69
|
|
3d recon without postprocess indpndt
|
$198.90 |
$198.90 |
$198.90 |
$485.00
|
|
88334 ap bill cytologic exam each additional site
|
$46.50 |
$46.50 |
$46.50 |
$97.65
|
|
Abd aorta w/runoff s&i
|
$4,625.10 |
$4,625.10 |
$4,625.10 |
$3,569.56
|
|
Abd/low ext cath 1st
|
$2,782.80 |
$2,782.80 |
$2,782.80 |
$2,015.85
|
|
Abd/low ext cath 2nd
|
$2,782.80 |
$2,782.80 |
$2,782.80 |
$2,015.85
|
|
Abd/low ext cath 3rd
|
$1,366.20 |
$1,366.20 |
$1,366.20 |
$2,486.97
|
|
Abd/low ext cath addl
|
$732.30 |
$732.30 |
$732.30 |
$964.70
|
|
Abdominal CT scan (with and without contrast)
|
$4,433.10 |
$4,433.10 |
$4,433.10 |
$2,009.80
|
|
Abdominal CT scan (with contrast)
|
$4,084.20 |
$4,084.20 |
$4,084.20 |
$1,680.60
|
|
Abdominal CT scan (without contrast)
|
$3,010.50 |
$3,010.50 |
$3,010.50 |
$1,358.76
|
|
Abdominal MRI (with and without contrast)
|
$1,689.60 |
$1,689.60 |
$1,689.60 |
$3,015.94
|
|
Abdominal MRI (with contrast)
|
$2,479.20 |
$2,479.20 |
$2,479.20 |
$2,268.20
|
|
Abdominal MRI (without contrast)
|
$2,326.80 |
$2,326.80 |
$2,326.80 |
$2,050.14
|
|
Abdominal pad
|
$198.97 |
$198.97 |
$198.97 |
$151.32
|
|
Abdominal paracentesis w/image guidance
|
$4,085.32 |
$4,085.32 |
$4,085.32 |
$1,651.20
|
|
Abdominal Ultrasound (complete)
|
$1,893.30 |
$1,893.30 |
$1,893.30 |
$785.55
|
|
Abdominal Ultrasound (limited)
|
$924.00 |
$924.00 |
$924.00 |
$590.00
|
|
Abd paracentesis/w/o image guide 49082
|
$765.00 |
$765.00 |
$765.00 |
$1,145.40
|
|
Abduct control hip semi-flex
|
$507.15 |
$507.15 |
$507.15 |
$499.86
|
|
Abduction bar jointed adjust
|
$604.36 |
$604.36 |
$604.36 |
$595.67
|
|
Abduction rotation bar shoe
|
$213.72 |
$213.72 |
$213.72 |
$210.65
|
|
Abduct rotation bar without shoe
|
$195.43 |
$195.43 |
$195.43 |
$192.62
|
|
Abl1 gene
|
$496.20 |
$496.20 |
$496.20 |
$682.50
|
|
Ablate arrhythmia add on
|
$1,437.00 |
$1,437.00 |
$1,437.00 |
$6,898.92
|
|
Ablate bone tumor(s) cryo perq 20983
|
$5,087.40 |
$5,087.40 |
$5,087.40 |
$8,453.60
|
|
Ablate bone tumor(s) perq
|
$2,575.20 |
$2,575.20 |
$2,575.20 |
$9,350.33
|
|
Ablate heart dysrhythm focus
|
$4,761.90 |
$4,761.90 |
$4,761.90 |
$9,522.05
|
|
Ablate inf turbinate submuc 30802
|
$22,869.28 |
$22,869.28 |
$22,869.28 |
$1,752.89
|
|
Ablate inf turbinate superf 30801
|
$11,455.20 |
$11,455.20 |
$11,455.20 |
$1,944.80
|
|
Ablation cardiac vagal inputs atrium
|
$147.30 |
$147.30 |
$147.30 |
$1,960.80
|
|
Ablation of upper extremity nerves rf
|
$594.00 |
$594.00 |
$594.00 |
$802.99
|
|
Abscess drain retroperitoneal surg code
|
$1,895.40 |
$1,895.40 |
$1,895.40 |
$2,996.80
|
|
Access & clsr pq fem art endogft dlvry w/img uni
|
$390.30 |
$390.30 |
$390.30 |
$2,314.00
|
|
Acetaminophen level
|
$36.00 |
$36.00 |
$36.00 |
$107.62
|
|
Acetazolamide 500 mg solution for injection
|
$390.65 |
$390.65 |
$390.65 |
$122.55
|
|
Acetone qualitative
|
$44.70 |
$44.70 |
$44.70 |
$45.65
|
|
Acetylcholine receptor modulating antibody
|
$109.20 |
$109.20 |
$109.20 |
$64.50
|
|
Acetylcysteine 200 mg/ml (20 %) intravenous solution
|
$48.00 |
$48.00 |
$48.00 |
$216.00
|
|
Acetylcysteine non-comp unit
|
$104.51 |
$104.51 |
$104.51 |
$31.21
|
|
Acute hepatitis panel
|
$354.30 |
$354.30 |
$354.30 |
$291.00
|
|
Acyclovir 5 mg/ml in ns IV syringe (neo/ped) - cnr
|
$206.64 |
$206.64 |
$206.64 |
$63.48
|
|
Adapter b 8 channel 10cm
|
$10,180.73 |
$10,180.73 |
$10,180.73 |
$5,388.38
|
|
Add le poly knee custom kafo
|
$458.27 |
$458.27 |
$458.27 |
$451.68
|
|
Adenosine 3 mg/250 ml bag for osm
|
$53.87 |
$53.87 |
$53.87 |
$255.41
|
|
Admelog u-100 insulin lispro 100 unit/ml subcutaneous solution
|
$1,332.40 |
$1,332.40 |
$1,332.40 |
$181.12
|
|
Administration chemotherapy IV infusion each additional hour
|
$192.60 |
$192.60 |
$192.60 |
$230.35
|
|
Administration chemotherapy IV infusion each addl sequential infusion diff substance/drug >1 hr
|
$210.60 |
$210.60 |
$210.60 |
$294.00
|
|
Administration chemotherapy IV infusion up to 1 hour single/initial substance/drug
|
$408.60 |
$408.60 |
$408.60 |
$657.12
|
|
Administration chemotherapy subcutaneous/im anti neoplastic non hormonal
|
$131.10 |
$131.10 |
$131.10 |
$257.40
|
|
Administration immunization 1 vaccine
|
$952.00 |
$952.00 |
$952.00 |
$69.00
|
|
Administration immunization each additional vaccine
|
$179.10 |
$179.10 |
$179.10 |
$47.40
|
|
Administration vaccine influenza virus
|
$13.20 |
$13.20 |
$13.20 |
$50.43
|
|
Administration vaccine pneumococcal
|
$19.20 |
$19.20 |
$19.20 |
$50.43
|
|
Ado-trastuzumab emtansine 100 mg intravenous solution
|
$35,236.37 |
$35,236.37 |
$35,236.37 |
$11,350.31
|
|
_afb id by dna probe rflx ast
|
$87.60 |
$87.60 |
$87.60 |
$93.52
|
|
#afb mycobacteria suscep. #1
|
$61.50 |
$61.50 |
$61.50 |
$35.51
|
|
_afb org id by sequencing rflx ast-sendout
|
$315.00 |
$315.00 |
$315.00 |
$315.00
|
|
Afo molded ankle gauntlet
|
$1,083.56 |
$1,083.56 |
$1,083.56 |
$765.51
|
|
Afo molded plas rig ant tib
|
$2,473.49 |
$2,473.49 |
$2,473.49 |
$2,412.47
|
|
Afo molded to patient plasti
|
$1,034.59 |
$1,034.59 |
$1,034.59 |
$710.45
|
|
Afo rig ant tib tcf/= custom
|
$2,142.14 |
$2,142.14 |
$2,142.14 |
$1,868.94
|
|
Afo sing bar clasp attach sh
|
$673.24 |
$673.24 |
$673.24 |
$663.56
|
|
Afo sing solid stirrup calf
|
$969.28 |
$969.28 |
$969.28 |
$955.35
|
|
Afo sing upright with adjust s
|
$986.19 |
$986.19 |
$986.19 |
$696.71
|
|
Afo spiral molded to pt plas
|
$1,846.20 |
$1,846.20 |
$1,846.20 |
$1,450.86
|
|
Afo sprng wir drsflx calf bd
|
$684.90 |
$684.90 |
$684.90 |
$675.05
|
|
Afo supramalleolar custom
|
$1,350.85 |
$1,350.85 |
$1,350.85 |
$1,331.42
|
|
Afo tib fx cast plaster mold
|
$1,892.19 |
$1,892.19 |
$1,892.19 |
$1,864.98
|
|
Afo tibial fracture rigid
|
$1,850.28 |
$1,850.28 |
$1,850.28 |
$1,654.77
|
|
Afo tibial fracture soft
|
$1,211.12 |
$1,211.12 |
$1,211.12 |
$1,060.02
|
|
Afo, walk boot type, cus fab
|
$3,809.40 |
$3,809.40 |
$3,809.40 |
$2,903.60
|
|
Afo w/ankle joint, prefab
|
$1,533.60 |
$1,533.60 |
$1,533.60 |
$795.02
|
|
Ak/knee disartic pelvic band
|
$188.26 |
$188.26 |
$188.26 |
$185.56
|
|
Ak/knee disartic silesian ba
|
$234.14 |
$234.14 |
$234.14 |
$202.75
|
|
Ak sleeve susp neoprene/equa
|
$424.16 |
$424.16 |
$424.16 |
$275.52
|
|
Albumin body fluid quantitative each specimen
|
$39.30 |
$39.30 |
$39.30 |
$46.20
|
|
Albumin (human), 25%, 50ml
|
$458.05 |
$458.05 |
$458.05 |
$244.70
|
|
Albumin (human), 5%, 250 ml
|
$457.56 |
$457.56 |
$457.56 |
$243.59
|
|
Albumin (microalbumin) 24 hour urine quantitative
|
$57.00 |
$57.00 |
$57.00 |
$56.07
|
|
Albumin serum plasma or whole blood
|
$52.80 |
$52.80 |
$52.80 |
$40.45
|
|
Albuterol ipratrop non-comp
|
$6.00 |
$6.00 |
$6.00 |
$5.40
|
|
Albuterol non-comp con
|
$17.86 |
$17.86 |
$17.86 |
$6.07
|
|
Alcohol (ethanol) any specimen except urine/breath
|
$33.60 |
$33.60 |
$33.60 |
$93.60
|
|
Alkaline phosphatase
|
$56.70 |
$56.70 |
$56.70 |
$46.40
|
|
Allergen alpha lactalbumin ige
|
$70.80 |
$70.80 |
$70.80 |
$48.00
|
|
Allergen egg white ige
|
$22.50 |
$22.50 |
$22.50 |
$38.00
|
|
Allograft 160mg placental salera mini membrane
|
$6,707.64 |
$6,707.64 |
$6,707.64 |
$6,611.20
|
|
Allograft allowrap 4x4cm dry 16sqcm
|
$13,227.30 |
$13,227.30 |
$13,227.30 |
$5,401.92
|
|
Allograft amnioexcel plus 17mm disk
|
$16,597.84 |
$16,597.84 |
$16,597.84 |
$2,250.00
|
|
Allograft dermis 20x25x1mm decell w/matracell arthroflex
|
$10,322.51 |
$10,322.51 |
$10,322.51 |
$6,414.50
|
|
Allograft ecm allopatch hd dehydr thick 0.8-1.7mmx2x5cm-cost per sq cm
|
$46,859.15 |
$46,859.15 |
$46,859.15 |
$23,373.60
|
|
Allograft epieffect 2x3cm-q4186-cost per sq cm
|
$31,458.77 |
$31,458.77 |
$31,458.77 |
$877.10
|
|
Allograft graftjacket 2x12cm-q4107-cost per sq cm
|
$26,622.34 |
$26,622.34 |
$26,622.34 |
$4,677.40
|
|
Allograft membrn amnio 1x2cm hu ambriodry
|
$25,136.66 |
$25,136.66 |
$25,136.66 |
$4,725.00
|
|
Allograft umbil cord+amniotic membrane-q4148-cost per sq cm
|
$8,240.44 |
$8,240.44 |
$8,240.44 |
$4,561.83
|
