|
17-hydroxypregnenolone
|
$33.60 |
$33.60 |
$33.60 |
$89.25
|
|
2d tee w or without fol w/con,in
|
$1,650.00 |
$1,650.00 |
$1,650.00 |
$1,624.70
|
|
2d tte w or without fol w/con,co
|
$1,535.40 |
$1,535.40 |
$1,535.40 |
$1,155.75
|
|
2nd order venous cath
|
$2,158.80 |
$2,158.80 |
$2,158.80 |
$1,543.85
|
|
3d ech img cgen car anomal
|
$664.80 |
$664.80 |
$664.80 |
$460.00
|
|
3-d radiotherapy plan
|
$6,159.60 |
$6,159.60 |
$6,159.60 |
$5,002.69
|
|
5' nucleotidase - sendout
|
$78.60 |
$78.60 |
$78.60 |
$50.40
|
|
88334 ap bill cytologic exam each additional site
|
$184.20 |
$184.20 |
$184.20 |
$97.65
|
|
99391 periodic comp preventive med less than 1 year est
|
$83.40 |
$83.40 |
$83.40 |
$107.10
|
|
99392 periodic comp preventive med 1 to 4 years est
|
$83.40 |
$83.40 |
$83.40 |
$115.50
|
|
99393 periodic comp preventive med 5 to 11 years est
|
$83.40 |
$83.40 |
$83.40 |
$113.40
|
|
99394 periodic comp preventive med 12 to 17 years est
|
$83.40 |
$83.40 |
$83.40 |
$127.20
|
|
99397 periodic comp preventive med 65+ years est
|
$83.40 |
$83.40 |
$83.40 |
$160.73
|
|
Abatacept (with maltose) 250 mg intravenous solution
|
$5,812.50 |
$5,812.50 |
$5,812.50 |
$3,128.29
|
|
#a/b/c/c/h pnl-candida albicans ab
|
$65.40 |
$65.40 |
$65.40 |
$53.95
|
|
Abd aorta w/runoff s&i
|
$3,386.40 |
$3,386.40 |
$3,386.40 |
$3,569.56
|
|
Abd/low ext cath 1st
|
$3,106.80 |
$3,106.80 |
$3,106.80 |
$2,015.85
|
|
Abd/low ext cath 2nd
|
$2,704.80 |
$2,704.80 |
$2,704.80 |
$2,015.85
|
|
Abd/low ext cath 3rd
|
$3,150.00 |
$3,150.00 |
$3,150.00 |
$2,486.97
|
|
Abd/low ext cath addl
|
$1,409.40 |
$1,409.40 |
$1,409.40 |
$964.70
|
|
Abdominal CT scan (with and without contrast)
|
$3,406.80 |
$3,406.80 |
$3,406.80 |
$2,009.80
|
|
Abdominal CT scan (with contrast)
|
$2,822.40 |
$2,822.40 |
$2,822.40 |
$1,680.60
|
|
Abdominal CT scan (without contrast)
|
$2,628.60 |
$2,628.60 |
$2,628.60 |
$1,358.76
|
|
Abdominal MRI (with and without contrast)
|
$6,756.60 |
$6,756.60 |
$6,756.60 |
$3,015.94
|
|
Abdominal MRI (with contrast)
|
$2,506.20 |
$2,506.20 |
$2,506.20 |
$2,268.20
|
|
Abdominal MRI (without contrast)
|
$4,209.00 |
$4,209.00 |
$4,209.00 |
$2,050.14
|
|
Abdominal pad
|
$322.61 |
$322.61 |
$322.61 |
$151.32
|
|
Abdominal paracentesis w/image guidance
|
$1,890.60 |
$1,890.60 |
$1,890.60 |
$1,651.20
|
|
Abdominal Ultrasound (complete)
|
$1,350.60 |
$1,350.60 |
$1,350.60 |
$785.55
|
|
Abdominal Ultrasound (limited)
|
$620.40 |
$620.40 |
$620.40 |
$590.00
|
|
Abd paracentesis/w/o image guide 49082
|
$18,272.03 |
$18,272.03 |
$18,272.03 |
$1,145.40
|
|
Abduct control hip semi-flex
|
$822.30 |
$822.30 |
$822.30 |
$499.86
|
|
Abduction bar jointed adjust
|
$979.91 |
$979.91 |
$979.91 |
$595.67
|
|
Abduction rotation bar shoe
|
$346.52 |
$346.52 |
$346.52 |
$210.65
|
|
Abduct rotation bar without shoe
|
$316.87 |
$316.87 |
$316.87 |
$192.62
|
|
Abl1 gene
|
$992.40 |
$992.40 |
$992.40 |
$682.50
|
|
Ablate arrhythmia add on
|
$2,427.00 |
$2,427.00 |
$2,427.00 |
$6,898.92
|
|
Ablate bone tumor(s) perq
|
$7,856.40 |
$7,856.40 |
$7,856.40 |
$9,350.33
|
|
Ablate heart dysrhythm focus
|
$11,382.00 |
$11,382.00 |
$11,382.00 |
$9,522.05
|
|
Ablation cryo abd perit om
|
$62,756.84 |
$62,756.84 |
$62,756.84 |
$2,312.80
|
|
Ablation cryo thigh/knee
|
$30,764.36 |
$30,764.36 |
$30,764.36 |
$531.95
|
|
Ablation of upper extremity nerves rf
|
$600.60 |
$600.60 |
$600.60 |
$802.99
|
|
Abscess drain retroperitoneal surg code
|
$3,889.80 |
$3,889.80 |
$3,889.80 |
$2,996.80
|
|
Acetaminophen level
|
$72.00 |
$72.00 |
$72.00 |
$107.62
|
|
Acetazolamide 500 mg solution for injection
|
$254.87 |
$254.87 |
$254.87 |
$122.55
|
|
Acetylcholine receptor modulating antibody
|
$218.40 |
$218.40 |
$218.40 |
$64.50
|
|
Acetylcholinesterase assay
|
$61.80 |
$61.80 |
$61.80 |
$113.00
|
|
Acetylcysteine 200 mg/ml (20 %) intravenous solution
|
$38.52 |
$38.52 |
$38.52 |
$216.00
|
|
Acetylcysteine non-comp unit
|
$92.00 |
$92.00 |
$92.00 |
$31.21
|
|
Acne surgery 10040
|
$475.20 |
$475.20 |
$475.20 |
$260.49
|
|
Acute hepatitis panel
|
$295.20 |
$295.20 |
$295.20 |
$291.00
|
|
Acyclovir 5 mg/ml in ns IV syringe (neo/ped) - cnr
|
$134.82 |
$134.82 |
$134.82 |
$63.48
|
|
#acylcarnitineprfl
|
$162.00 |
$162.00 |
$162.00 |
$125.40
|
|
Adapter b 8 channel 10cm
|
$16,507.13 |
$16,507.13 |
$16,507.13 |
$5,388.38
|
|
Add le poly knee custom kafo
|
$743.04 |
$743.04 |
$743.04 |
$451.68
|
|
Adenosine 3 mg/250 ml bag for osm
|
$24.00 |
$24.00 |
$24.00 |
$255.41
|
|
Adh-sendout
|
$229.20 |
$229.20 |
$229.20 |
$109.28
|
|
Adj gastric band via subq port
|
$48,673.09 |
$48,673.09 |
$48,673.09 |
$1,609.80
|
|
Adj tis trans/see area/10.1-30sqcm 14041
|
$15,461.39 |
$15,461.39 |
$15,461.39 |
$3,146.85
|
|
Admelog u-100 insulin lispro 100 unit/ml subcutaneous solution
|
$2,067.12 |
$2,067.12 |
$2,067.12 |
$181.12
|
|
Administration chemotherapy IV infusion each additional hour
|
$377.40 |
$377.40 |
$377.40 |
$230.35
|
|
Administration chemotherapy IV infusion each addl sequential infusion diff substance/drug >1 hr
|
$625.20 |
$625.20 |
$625.20 |
$294.00
|
|
Administration chemotherapy IV infusion up to 1 hour single/initial substance/drug
|
$1,281.60 |
$1,281.60 |
$1,281.60 |
$657.12
|
|
Administration chemotherapy IV push single/initial substance/drug
|
$411.60 |
$411.60 |
$411.60 |
$439.20
|
|
Administration chemotherapy subcutaneous/im anti neoplastic hormonal
|
$364.80 |
$364.80 |
$364.80 |
$211.09
|
|
Administration chemotherapy subcutaneous/im anti neoplastic non hormonal
|
$95.40 |
$95.40 |
$95.40 |
$257.40
|
|
Administration immunization 1 vaccine
|
$84.60 |
$84.60 |
$84.60 |
$69.00
|
|
Administration immunization each additional vaccine
|
$63.00 |
$63.00 |
$63.00 |
$47.40
|
|
Administration vaccine hepatitis b
|
$29.40 |
$29.40 |
$29.40 |
$54.40
|
|
Administration vaccine influenza virus
|
$26.40 |
$26.40 |
$26.40 |
$50.43
|
|
Administration vaccine pneumococcal
|
$40.20 |
$40.20 |
$40.20 |
$50.43
|
|
_afb id by dna probe rflx ast
|
$112.80 |
$112.80 |
$112.80 |
$93.52
|
|
#afb mycobacteria suscep. #1
|
$31.80 |
$31.80 |
$31.80 |
$35.51
|
|
_afb org id by sequencing rflx ast-sendout
|
$657.60 |
$657.60 |
$657.60 |
$315.00
|
|
Afo molded ankle gauntlet
|
$1,756.89 |
$1,756.89 |
$1,756.89 |
$765.51
|
|
Afo molded plas rig ant tib
|
$4,010.54 |
$4,010.54 |
$4,010.54 |
$2,412.47
|
|
Afo molded to patient plasti
|
$1,677.50 |
$1,677.50 |
$1,677.50 |
$710.45
|
|
Afo rig ant tib tcf/= custom
|
$3,473.29 |
$3,473.29 |
$3,473.29 |
$1,868.94
|
|
Afo sing bar clasp attach sh
|
$1,091.60 |
$1,091.60 |
$1,091.60 |
$663.56
|
|
Afo sing solid stirrup calf
|
$1,571.60 |
$1,571.60 |
$1,571.60 |
$955.35
|
|
Afo sing upright with adjust s
|
$1,599.02 |
$1,599.02 |
$1,599.02 |
$696.71
|
|
Afo spiral molded to pt plas
|
$2,993.45 |
$2,993.45 |
$2,993.45 |
$1,450.86
|
|
Afo sprng wir drsflx calf bd
|
$1,110.50 |
$1,110.50 |
$1,110.50 |
$675.05
|
|
Afo supramalleolar custom
|
$2,190.28 |
$2,190.28 |
$2,190.28 |
$1,331.42
|
|
Afo tib fx cast plaster mold
|
$3,068.00 |
$3,068.00 |
$3,068.00 |
$1,864.98
|
|
Afo tibial fracture rigid
|
$3,000.05 |
$3,000.05 |
$3,000.05 |
$1,654.77
|
|
Afo tibial fracture soft
|
$1,963.72 |
$1,963.72 |
$1,963.72 |
$1,060.02
|
|
Afo, walk boot type, cus fab
|
$6,176.59 |
$6,176.59 |
$6,176.59 |
$2,903.60
|
|
Afo w/ankle joint, prefab
|
$2,486.59 |
$2,486.59 |
$2,486.59 |
$795.02
|
|
Ak/knee disartic pelvic band
|
$305.26 |
$305.26 |
$305.26 |
$185.56
|
|
Ak/knee disartic silesian ba
|
$379.64 |
$379.64 |
$379.64 |
$202.75
|
|
Ak sleeve susp neoprene/equa
|
$687.74 |
$687.74 |
$687.74 |
$275.52
|
|
Albumin body fluid quantitative each specimen
|
$68.40 |
$68.40 |
$68.40 |
$46.20
|
|
Albumin (human), 25%, 50ml
|
$577.80 |
$577.80 |
$577.80 |
$244.70
|
|
Albumin (human), 5%, 250 ml
|
$577.80 |
$577.80 |
$577.80 |
$243.59
|
|
Albumin, human 5 % intravenous solution
|
$577.80 |
$577.80 |
$577.80 |
$296.32
|
|
Albumin (microalbumin) 24 hour urine quantitative
|
$73.80 |
$73.80 |
$73.80 |
$56.07
|
|
Albumin serum plasma or whole blood
|
$64.80 |
$64.80 |
$64.80 |
$40.45
|
|
Albuterol ipratrop non-comp
|
$9.00 |
$9.00 |
$9.00 |
$5.40
|
|
Albuterol non-comp con
|
$55.30 |
$55.30 |
$55.30 |
$6.07
|
