|
2nd order venous cath
|
$1,006.20 |
$1,006.20 |
$1,006.20 |
$1,543.85
|
|
5' nucleotidase - sendout
|
$1,362.00 |
$1,362.00 |
$1,362.00 |
$50.40
|
|
Abatacept (with maltose) 250 mg intravenous solution
|
$5,723.40 |
$5,723.40 |
$5,723.40 |
$3,128.29
|
|
Abd aorta w/runoff s&i
|
$3,111.60 |
$3,111.60 |
$3,111.60 |
$3,569.56
|
|
Abd/low ext cath 1st
|
$1,258.80 |
$1,258.80 |
$1,258.80 |
$2,015.85
|
|
Abd/low ext cath 2nd
|
$792.00 |
$792.00 |
$792.00 |
$2,015.85
|
|
Abd/low ext cath 3rd
|
$1,309.20 |
$1,309.20 |
$1,309.20 |
$2,486.97
|
|
Abd/low ext cath addl
|
$160.80 |
$160.80 |
$160.80 |
$964.70
|
|
Abdominal CT scan (with and without contrast)
|
$2,446.80 |
$2,446.80 |
$2,446.80 |
$2,009.80
|
|
Abdominal CT scan (with contrast)
|
$2,048.40 |
$2,048.40 |
$2,048.40 |
$1,680.60
|
|
Abdominal CT scan (without contrast)
|
$1,663.20 |
$1,663.20 |
$1,663.20 |
$1,358.76
|
|
Abdominal MRI (with and without contrast)
|
$2,704.80 |
$2,704.80 |
$2,704.80 |
$3,015.94
|
|
Abdominal MRI (with contrast)
|
$2,704.80 |
$2,704.80 |
$2,704.80 |
$2,268.20
|
|
Abdominal MRI (without contrast)
|
$2,552.40 |
$2,552.40 |
$2,552.40 |
$2,050.14
|
|
Abdominal paracentesis w/image guidance
|
$1,428.00 |
$1,428.00 |
$1,428.00 |
$1,651.20
|
|
Abdominal Ultrasound (complete)
|
$933.00 |
$933.00 |
$933.00 |
$785.55
|
|
Abdominal Ultrasound (limited)
|
$565.20 |
$565.20 |
$565.20 |
$590.00
|
|
Abd paracentesis/w/o image guide 49082
|
$1,148.40 |
$1,148.40 |
$1,148.40 |
$1,145.40
|
|
Abl1 gene
|
$1,226.40 |
$1,226.40 |
$1,226.40 |
$682.50
|
|
Ablate inf turbinate submuc 30802
|
$730.80 |
$730.80 |
$730.80 |
$1,752.89
|
|
Ablate inf turbinate superf 30801
|
$334.80 |
$334.80 |
$334.80 |
$1,944.80
|
|
Ablation of upper extremity nerves rf
|
$341.40 |
$341.40 |
$341.40 |
$808.50
|
|
Abscess drain retroperitoneal surg code
|
$3,439.80 |
$3,439.80 |
$3,439.80 |
$2,957.17
|
|
Acetaminophen 10 mg/ml soln 100 ml glass cont
|
$49.20 |
$49.20 |
$49.20 |
$74.96
|
|
Acetaminophen 120 mg rectal suppository
|
$1,623.00 |
$1,623.00 |
$1,623.00 |
$75.09
|
|
Acetaminophen level
|
$34.20 |
$34.20 |
$34.20 |
$107.62
|
|
Acetazolamide 500 mg solution for injection
|
$150.00 |
$150.00 |
$150.00 |
$122.55
|
|
Acetone qualitative
|
$96.60 |
$96.60 |
$96.60 |
$45.65
|
|
Acetylcholine receptor modulating antibody
|
$1,156.80 |
$1,156.80 |
$1,156.80 |
$64.50
|
|
Aco annual medicare visit (awv), subsq g0439aco
|
$114.60 |
$114.60 |
$114.60 |
$167.04
|
|
Acute hepatitis panel
|
$348.60 |
$348.60 |
$348.60 |
$292.00
|
|
Acyclovir 5 mg/ml in ns IV syringe (neo/ped) - cnr
|
$70.80 |
$70.80 |
$70.80 |
$63.48
|
|
Adapter b 8 channel 10cm
|
$1,234.80 |
$1,234.80 |
$1,234.80 |
$5,695.04
|
|
Adenosine 3 mg/250 ml bag for osm
|
$426.00 |
$426.00 |
$426.00 |
$255.41
|
|
Admelog u-100 insulin lispro 100 unit/ml subcutaneous solution
|
$1.20 |
$1.20 |
$1.20 |
$181.12
|
|
Administration chemotherapy IV infusion each additional hour
|
$156.60 |
$156.60 |
$156.60 |
$230.35
|
|
Administration chemotherapy IV infusion each addl sequential infusion diff substance/drug >1 hr
|
$136.80 |
$136.80 |
$136.80 |
$294.00
|
|
Administration chemotherapy IV infusion up to 1 hour single/initial substance/drug
|
$477.00 |
$477.00 |
$477.00 |
$657.12
|
|
Administration chemotherapy IV push single/initial substance/drug
|
$223.20 |
$223.20 |
$223.20 |
$439.20
|
|
Administration chemotherapy subcutaneous/im anti neoplastic hormonal
|
$162.60 |
$162.60 |
$162.60 |
$211.09
|
|
Administration chemotherapy subcutaneous/im anti neoplastic non hormonal
|
$150.00 |
$150.00 |
$150.00 |
$257.40
|
|
Administration immunization 1 vaccine
|
$77.40 |
$77.40 |
$77.40 |
$69.21
|
|
Administration immunization each additional vaccine
|
$37.80 |
$37.80 |
$37.80 |
$47.40
|
|
Administration immunization first component each vaccine
|
$24.00 |
$24.00 |
$24.00 |
$46.40
|
|
Advance care planning each additional 30 min 99498
|
$99.00 |
$99.00 |
$99.00 |
$108.00
|
|
Air conduction bilat
|
$72.00 |
$72.00 |
$72.00 |
$133.00
|
|
Albumin body fluid quantitative each specimen
|
$5.40 |
$5.40 |
$5.40 |
$46.23
|
|
Albumin (human), 25%, 50ml
|
$294.00 |
$294.00 |
$294.00 |
$244.70
|
|
Albumin (microalbumin) 24 hour urine quantitative
|
$105.00 |
$105.00 |
$105.00 |
$57.00
|
|
Albumin serum plasma or whole blood
|
$96.60 |
$96.60 |
$96.60 |
$40.80
|
|
Alkaline phosphatase
|
$86.40 |
$86.40 |
$86.40 |
$46.40
|
|
Allergen alpha lactalbumin ige
|
$112.80 |
$112.80 |
$112.80 |
$48.00
|
|
Allergen egg white ige
|
$39.60 |
$39.60 |
$39.60 |
$38.00
|
|
Allergy injections; 2 or more 95117
|
$18.60 |
$18.60 |
$18.60 |
$43.75
|
|
Allergy injection; single 95115
|
$18.00 |
$18.00 |
$18.00 |
$42.75
|
|
Allograft allowrap 4x4cm dry 16sqcm
|
$635.04 |
$635.04 |
$635.04 |
$5,401.92
|
|
Allograft epieffect 2x3cm-q4186-cost per sq cm
|
$1,313.47 |
$1,313.47 |
$1,313.47 |
$874.65
|
|
Allograft graftjacket 2x12cm-q4107-cost per sq cm
|
$284.00 |
$284.00 |
$284.00 |
$4,677.40
|
|
Allograft umbilical epicord 15 sq cm-q4187-cost per sq cm
|
$380.73 |
$380.73 |
$380.73 |
$1,495.63
|
|
Alpha-1-proteinase inhibitor (human) 1,000 mg (+/-) IV solution
|
$3.60 |
$3.60 |
$3.60 |
$12.50
|
|
Alpha-fetoprotein afp-l3 frac & total
|
$370.80 |
$370.80 |
$370.80 |
$175.20
|
|
Alpha-fetoprotein tumor marker
|
$181.20 |
$181.20 |
$181.20 |
$106.00
|
|
Alteplase 100 mg infusion from pyxis vial
|
$32,310.00 |
$32,310.00 |
$32,310.00 |
$15,857.45
|
|
Alt/sgpt
|
$133.80 |
$133.80 |
$133.80 |
$47.45
|
|
Amantadine (symmetrel)-sendout
|
$129.00 |
$129.00 |
$129.00 |
$169.80
|
|
Aminophylline 25 mg/ml intravenous solution (wrapper)
|
$24.00 |
$24.00 |
$24.00 |
$45.02
|
|
Amiodarone 150 mg/100 ml (1.5 mg/ml) in dextrose, iso-osmotic IV
|
$154.80 |
$154.80 |
$154.80 |
$119.07
|
|
Amiodarone 50 mg/ml intravenous solution
|
$8.10 |
$8.10 |
$8.10 |
$55.86
|
|
Ammonia
|
$214.20 |
$214.20 |
$214.20 |
$119.70
|
|
Amphotericin b liposomal in d5w IV syringe 1 mg/ml (neo/ped) - cnr
|
$825.00 |
$825.00 |
$825.00 |
$543.85
|
|
Ampicillin 1 gram solution for injection
|
$49.20 |
$49.20 |
$49.20 |
$56.70
|
|
Ampicillin-sulbactam 1.5 gram solution for injection
|
$55.20 |
$55.20 |
$55.20 |
$53.86
|
|
Amp metatarsal w/toe single 28810
|
$750.00 |
$750.00 |
$750.00 |
$4,271.00
|
|
Amputate leg at thigh
|
$1,793.40 |
$1,793.40 |
$1,793.40 |
$2,854.80
|
|
Amputate thigh through femur 27590
|
$1,690.20 |
$1,690.20 |
$1,690.20 |
$3,342.87
|
|
Amputation leg thr tib/fib 27880
|
$1,643.40 |
$1,643.40 |
$1,643.40 |
$2,241.60
|
|
Amputation leg; tib/fib f/u 27886
|
$1,506.60 |
$1,506.60 |
$1,506.60 |
$1,461.89
|
|
Amputation of lower leg
|
$1,344.60 |
$1,344.60 |
$1,344.60 |
$1,417.20
|
|
Amputation thru metatarsal
|
$1,193.40 |
$1,193.40 |
$1,193.40 |
$3,839.54
|
|
Amputation toe interphalangeal joint
|
$765.00 |
$765.00 |
$765.00 |
$3,998.20
|
|
Amputation toe metatarsophalangeal joint
|
$780.60 |
$780.60 |
$780.60 |
$3,839.54
|
|
Amylase
|
$387.60 |
$387.60 |
$387.60 |
$89.04
|
|
Analysis complx cranial nerve pulse gen prgrmg 95977
|
$180.00 |
$180.00 |
$180.00 |
$338.40
|
|
Analysis gene f2 20210g>a variant
|
$327.60 |
$327.60 |
$327.60 |
$219.60
|
|
Analysis gene f5 leiden variant
|
$273.00 |
$273.00 |
$273.00 |
$230.40
|
|
Analysis; simple cranial nerv pulse gen prgrmg 95976
|
$150.00 |
$150.00 |
$150.00 |
$122.20
|
|
Analysis tumor
|
$264.60 |
$264.60 |
$264.60 |
$237.89
|
|
An fluoro guide for cvp
|
$361.80 |
$361.80 |
$361.80 |
$515.00
|
|
Angio balloon ctrl dialysis seg add-on
|
$4,294.80 |
$4,294.80 |
$4,294.80 |
$5,341.83
|
|
Angiotensin ii 0.5 mg/ml soln 1 ml vial
|
$51.00 |
$51.00 |
$51.00 |
$3,080.85
|
|
Angio trnslmnl balloon same artery ini
|
$8,550.60 |
$8,550.60 |
$8,550.60 |
$9,074.63
|
|
Angio trnslmnl balloon same vein ea addl
|
$4,072.20 |
$4,072.20 |
$4,072.20 |
$4,390.75
|
|
Angio trnslmnl balloon same vein ini
|
$8,884.80 |
$8,884.80 |
$8,884.80 |
$8,466.00
|
|
Ankle X-ray
|
$531.60 |
$531.60 |
$531.60 |
$353.60
|
|
Annual Physical, Established Patient (age 18-39)
|
$118.80 |
$118.80 |
$118.80 |
$141.00
|
|
Annual Physical, New Patient (age 18-39)
|
$115.80 |
$115.80 |
$115.80 |
$143.25
|
|
Annual Physical, New Patient (age 40-64)
|
$139.80 |
$139.80 |
$139.80 |
$165.10
|
|
Anora (draw only)
|
$19.20 |
$19.20 |
$19.20 |
$33.58
|
|
Ant colporrhaphy/rpr cyctocele 57240
|
$1,041.60 |
$1,041.60 |
$1,041.60 |
$5,463.96
|
|
Antibody bacterium, not elsewhere specified
|
$22.80 |
$22.80 |
$22.80 |
$57.81
|
