|
11-desoxycortisol - sendout
|
$42.40 |
$42.40 |
$42.40 |
$87.50
|
|
17-ketosteroids
|
$129.20 |
$129.20 |
$129.20 |
$55.00
|
|
2nd order venous cath
|
$3,554.00 |
$3,554.00 |
$3,554.00 |
$1,497.85
|
|
3d ech img cgen car anomal
|
$540.00 |
$540.00 |
$540.00 |
$490.50
|
|
3-d radiotherapy plan
|
$1,952.80 |
$1,952.80 |
$1,952.80 |
$4,965.20
|
|
3d recon without postprocess indpndt
|
$12.80 |
$12.80 |
$12.80 |
$505.05
|
|
Abatacept (with maltose) 250 mg intravenous solution
|
$101.73 |
$101.73 |
$101.73 |
$3,128.29
|
|
#a/b/c/c/h pnl-candida albicans ab
|
$53.60 |
$53.60 |
$53.60 |
$53.90
|
|
Abd aorta w/runoff s&i
|
$3,375.20 |
$3,375.20 |
$3,375.20 |
$3,587.50
|
|
Abd/low ext cath 1st
|
$7,252.80 |
$7,252.80 |
$7,252.80 |
$2,015.85
|
|
Abd/low ext cath 2nd
|
$7,252.80 |
$7,252.80 |
$7,252.80 |
$2,015.85
|
|
Abd/low ext cath 3rd
|
$7,252.80 |
$7,252.80 |
$7,252.80 |
$2,428.44
|
|
Abd/low ext cath addl
|
$7,252.80 |
$7,252.80 |
$7,252.80 |
$963.76
|
|
Abdominal CT scan (with and without contrast)
|
$1,901.20 |
$1,901.20 |
$1,901.20 |
$1,976.00
|
|
Abdominal CT scan (with contrast)
|
$1,667.60 |
$1,667.60 |
$1,667.60 |
$1,664.40
|
|
Abdominal CT scan (without contrast)
|
$1,084.00 |
$1,084.00 |
$1,084.00 |
$1,358.76
|
|
Abdominal MRI (with and without contrast)
|
$1,469.20 |
$1,469.20 |
$1,469.20 |
$2,960.16
|
|
Abdominal MRI (with contrast)
|
$1,469.20 |
$1,469.20 |
$1,469.20 |
$2,222.40
|
|
Abdominal MRI (without contrast)
|
$793.20 |
$793.20 |
$793.20 |
$2,010.62
|
|
Abdominal paracentesis w/image guidance
|
$1,150.80 |
$1,150.80 |
$1,150.80 |
$1,636.80
|
|
Abdominal Ultrasound (complete)
|
$468.80 |
$468.80 |
$468.80 |
$783.00
|
|
Abdominal Ultrasound (limited)
|
$363.20 |
$363.20 |
$363.20 |
$580.80
|
|
Abd paracentesis/w/o image guide 49082
|
$1,150.80 |
$1,150.80 |
$1,150.80 |
$1,145.00
|
|
Abduction bar jointed adjust
|
$196.80 |
$196.80 |
$196.80 |
$529.14
|
|
Abduction bar-straight
|
$96.00 |
$96.00 |
$96.00 |
$173.60
|
|
Abduction rotation bar shoe
|
$54.40 |
$54.40 |
$54.40 |
$164.98
|
|
Abduct rotation bar without shoe
|
$49.60 |
$49.60 |
$49.60 |
$176.01
|
|
Abl1 gene
|
$346.40 |
$346.40 |
$346.40 |
$683.20
|
|
Ablate arrhythmia add on
|
$1,244.80 |
$1,244.80 |
$1,244.80 |
$6,828.51
|
|
Ablate heart dysrhythm focus
|
$7,926.00 |
$7,926.00 |
$7,926.00 |
$9,398.62
|
|
Ablation cardiac vagal inputs atrium
|
$160.80 |
$160.80 |
$160.80 |
$2,260.30
|
|
Ablation cryo retro lymph node
|
$314.40 |
$314.40 |
$314.40 |
$826.80
|
|
Ablation of upper extremity nerves rf
|
$1,807.60 |
$1,807.60 |
$1,807.60 |
$832.50
|
|
Abscess drain retroperitoneal surg code
|
$436.00 |
$436.00 |
$436.00 |
$2,999.34
|
|
Absorpt drg <=16 sq in w/bdr
|
$20.80 |
$20.80 |
$20.80 |
$5.18
|
|
Access & clsr pq fem art endogft dlvry w/img uni
|
$2,370.40 |
$2,370.40 |
$2,370.40 |
$2,338.44
|
|
Acetaminophen 10 mg/ml soln 100 ml glass cont
|
$1.09 |
$1.09 |
$1.09 |
$73.25
|
|
Acetaminophen 120 mg rectal suppository
|
$3.20 |
$3.20 |
$3.20 |
$75.09
|
|
Acetaminophen level
|
$11.60 |
$11.60 |
$11.60 |
$111.00
|
|
Acetazolamide 500 mg solution for injection
|
$89.18 |
$89.18 |
$89.18 |
$120.90
|
|
Acetone qualitative
|
$24.40 |
$24.40 |
$24.40 |
$46.80
|
|
Acetylcysteine 200 mg/ml (20 %) intravenous solution
|
$9.76 |
$9.76 |
$9.76 |
$226.00
|
|
Aco annual medicare visit (awv), initial g0438aco
|
$130.00 |
$130.00 |
$130.00 |
$243.00
|
|
Aco annual medicare visit (awv), subsq g0439aco
|
$88.00 |
$88.00 |
$88.00 |
$160.69
|
|
Aco ccm; at least 20 min 99490aco
|
$91.60 |
$91.60 |
$91.60 |
$101.09
|
|
Aco cont gluc mnt phys/qhp eqp 95250aco
|
$173.60 |
$173.60 |
$173.60 |
$344.10
|
|
Actinotherapy uv light
|
$126.00 |
$126.00 |
$126.00 |
$105.60
|
|
Acute hepatitis panel
|
$215.20 |
$215.20 |
$215.20 |
$284.00
|
|
Acyclovir 400 mg tablet
|
$1,034.92 |
$1,034.92 |
$1,034.92 |
$54.77
|
|
Acyclovir 5 mg/ml in ns IV syringe (neo/ped) - cnr
|
$2.46 |
$2.46 |
$2.46 |
$64.15
|
|
#acylcarnitineprfl
|
$18.80 |
$18.80 |
$18.80 |
$115.50
|
|
Adapter b 8 channel 10cm
|
$22,405.60 |
$22,405.60 |
$22,405.60 |
$6,142.50
|
|
Add le poly knee custom kafo
|
$118.80 |
$118.80 |
$118.80 |
$409.30
|
|
Adenosine 3 mg/250 ml bag for osm
|
$40.70 |
$40.70 |
$40.70 |
$272.57
|
|
Adh-sendout
|
$71.20 |
$71.20 |
$71.20 |
$109.71
|
|
Admelog u-100 insulin lispro 100 unit/ml subcutaneous solution
|
$41.84 |
$41.84 |
$41.84 |
$197.05
|
|
Administration chemotherapy IV infusion each additional hour
|
$91.20 |
$91.20 |
$91.20 |
$230.35
|
|
Administration chemotherapy IV infusion each addl sequential infusion diff substance/drug >1 hr
|
$138.80 |
$138.80 |
$138.80 |
$298.13
|
|
Administration chemotherapy IV infusion up to 1 hour single/initial substance/drug
|
$434.40 |
$434.40 |
$434.40 |
$646.80
|
|
Administration chemotherapy IV push single/initial substance/drug
|
$282.40 |
$282.40 |
$282.40 |
$437.19
|
|
Administration chemotherapy subcutaneous/im anti neoplastic hormonal
|
$144.40 |
$144.40 |
$144.40 |
$207.94
|
|
Administration chemotherapy subcutaneous/im anti neoplastic non hormonal
|
$144.40 |
$144.40 |
$144.40 |
$254.40
|
|
Administration immunization 1 vaccine
|
$84.40 |
$84.40 |
$84.40 |
$67.60
|
|
Administration immunization each additional vaccine
|
$51.60 |
$51.60 |
$51.60 |
$46.89
|
|
Administration immunization intranasal/oral route 1 vaccine
|
$86.00 |
$86.00 |
$86.00 |
$48.00
|
|
Administration immunization intranasal/oral route each additional vaccine
|
$15.20 |
$15.20 |
$15.20 |
$30.24
|
|
Administration rsv monoclonal ab seasonal dose im w/counseling
|
$283.20 |
$283.20 |
$283.20 |
$42.00
|
|
Administration vaccine hepatitis b
|
$84.40 |
$84.40 |
$84.40 |
$51.80
|
|
Administration vaccine influenza virus
|
$22.00 |
$22.00 |
$22.00 |
$48.73
|
|
Administration vaccine pneumococcal
|
$84.40 |
$84.40 |
$84.40 |
$48.73
|
|
Administration vaccine rsv monoclonal ab seasonal dose im
|
$283.20 |
$283.20 |
$283.20 |
$41.45
|
|
Ado-trastuzumab emtansine 100 mg intravenous solution
|
$57.98 |
$57.98 |
$57.98 |
$11,350.31
|
|
Adrenalin epinephrine inject
|
$4.54 |
$4.54 |
$4.54 |
$206.20
|
|
_afb id by dna probe rflx ast
|
$44.80 |
$44.80 |
$44.80 |
$103.37
|
|
#afb mycobacteria suscep. #1
|
$11.60 |
$11.60 |
$11.60 |
$34.74
|
|
_afb org id by sequencing rflx ast-sendout
|
$70.00 |
$70.00 |
$70.00 |
$293.02
|
|
Afo rig ant tib tcf/= custom
|
$830.80 |
$830.80 |
$830.80 |
$1,875.66
|
|
Afo tib fx semi-rigid l2114
|
$347.60 |
$347.60 |
$347.60 |
$817.60
|
|
Afo tibial fracture rigid
|
$417.20 |
$417.20 |
$417.20 |
$1,489.57
|
|
Afo tibial fracture soft
|
$283.20 |
$283.20 |
$283.20 |
$1,060.02
|
|
Afo, walk boot type, cus fab
|
$935.60 |
$935.60 |
$935.60 |
$2,859.19
|
|
Afo w/ankle joint, prefab
|
$286.80 |
$286.80 |
$286.80 |
$741.72
|
|
Albumin body fluid quantitative each specimen
|
$21.60 |
$21.60 |
$21.60 |
$46.41
|
|
Albumin (human), 25%, 50ml
|
$97.48 |
$97.48 |
$97.48 |
$235.92
|
|
Albumin (human), 5%, 250 ml
|
$69.40 |
$69.40 |
$69.40 |
$251.66
|
|
Albumin (microalbumin) 24 hour urine quantitative
|
$37.60 |
$37.60 |
$37.60 |
$57.20
|
|
Albumin serum plasma or whole blood
|
$32.40 |
$32.40 |
$32.40 |
$42.00
|
|
Albuterol ipratrop non-comp
|
$6.38 |
$6.38 |
$6.38 |
$5.28
|
|
Albuterol non-comp unit
|
$6.28 |
$6.28 |
$6.28 |
$5.61
|
|
Alcohol (ethanol) any specimen except urine/breath
|
$114.40 |
$114.40 |
$114.40 |
$94.90
|
|
Alginate drsg >16 <=48 sq in
|
$35.60 |
$35.60 |
$35.60 |
$43.72
|
|
Alkaline phosphatase
|
$24.80 |
$24.80 |
$24.80 |
$46.80
|
|
Allergen alpha lactalbumin ige
|
$36.80 |
$36.80 |
$36.80 |
$48.57
|
|
Allergen egg white ige
|
$3.20 |
$3.20 |
$3.20 |
$37.05
|
|
Allergy injections; 2 or more 95117
|
$44.80 |
$44.80 |
$44.80 |
$43.75
|
|
Allergy injection; single 95115
|
$44.80 |
$44.80 |
$44.80 |
$45.00
|
|
Allograft dermis 20x25x1mm decell w/matracell arthroflex
|
$3,338.00 |
$3,338.00 |
$3,338.00 |
$6,414.50
|
|
Allograft epieffect 2x3cm-q4186-cost per sq cm
|
$13,892.80 |
$13,892.80 |
$13,892.80 |
$874.65
|
|
Allograft membrn amnio 1x2cm hu ambriodry
|
$4,268.80 |
$4,268.80 |
$4,268.80 |
$5,096.00
|
|
Alpha-1-proteinase inhibitor (human) 1,000 mg (+/-) IV solution
|
$10.46 |
$10.46 |
$10.46 |
$12.50
|
