|
17-hydroxypregnenolone
|
$88.80 |
$88.80 |
$88.80 |
$89.25
|
|
1st hosp/birthing center care per day nml nb 99460
|
$161.60 |
$161.60 |
$161.60 |
$161.60
|
|
1st psyc collab care mgmt
|
$150.40 |
$150.40 |
$150.40 |
$109.46
|
|
1st/sbsq psyc collab care
|
$112.00 |
$112.00 |
$112.00 |
$111.20
|
|
2nd order venous cath
|
$293.60 |
$293.60 |
$293.60 |
$1,543.85
|
|
3d recon without postprocess indpndt
|
$515.20 |
$515.20 |
$515.20 |
$485.00
|
|
5' nucleotidase - sendout
|
$47.20 |
$47.20 |
$47.20 |
$50.40
|
|
88334 ap bill cytologic exam each additional site
|
$61.60 |
$61.60 |
$61.60 |
$97.65
|
|
99381 initial comp preventive med less than 1 year new
|
$184.80 |
$184.80 |
$184.80 |
$132.00
|
|
99382 initial comp preventive med 1 to 4 years new
|
$124.00 |
$124.00 |
$124.00 |
$126.00
|
|
99383 initial comp preventive med 5 to 11 years new
|
$170.40 |
$170.40 |
$170.40 |
$111.00
|
|
99391 periodic comp preventive med less than 1 year est
|
$131.20 |
$131.20 |
$131.20 |
$107.10
|
|
99392 periodic comp preventive med 1 to 4 years est
|
$146.40 |
$146.40 |
$146.40 |
$115.50
|
|
99393 periodic comp preventive med 5 to 11 years est
|
$145.60 |
$145.60 |
$145.60 |
$113.40
|
|
99394 periodic comp preventive med 12 to 17 years est
|
$160.80 |
$160.80 |
$160.80 |
$127.20
|
|
99397 periodic comp preventive med 65+ years est
|
$177.60 |
$177.60 |
$177.60 |
$160.73
|
|
#a/b/c/c/h pnl-candida albicans ab
|
$132.80 |
$132.80 |
$132.80 |
$53.95
|
|
Abd exp/postop hem/throm/infec 35840
|
$2,123.20 |
$2,123.20 |
$2,123.20 |
$2,659.14
|
|
Abd/low ext cath 1st
|
$395.20 |
$395.20 |
$395.20 |
$2,015.85
|
|
Abd/low ext cath 2nd
|
$428.00 |
$428.00 |
$428.00 |
$2,015.85
|
|
Abd/low ext cath 3rd
|
$493.60 |
$493.60 |
$493.60 |
$2,486.97
|
|
Abdominal CT scan (with and without contrast)
|
$766.40 |
$766.40 |
$766.40 |
$2,009.80
|
|
Abdominal CT scan (with contrast)
|
$766.40 |
$766.40 |
$766.40 |
$1,680.60
|
|
Abdominal CT scan (without contrast)
|
$472.00 |
$472.00 |
$472.00 |
$1,358.76
|
|
Abdominal MRI (with and without contrast)
|
$1,588.80 |
$1,588.80 |
$1,588.80 |
$3,015.94
|
|
Abdominal MRI (with contrast)
|
$2,206.40 |
$2,206.40 |
$2,206.40 |
$2,268.20
|
|
Abdominal MRI (without contrast)
|
$969.60 |
$969.60 |
$969.60 |
$2,050.14
|
|
Abdominal paracentesis w/image guidance
|
$1,651.20 |
$1,651.20 |
$1,651.20 |
$1,651.20
|
|
Abdominal Ultrasound (complete)
|
$260.00 |
$260.00 |
$260.00 |
$785.55
|
|
Abdominal Ultrasound (limited)
|
$257.60 |
$257.60 |
$257.60 |
$590.00
|
|
Abdominoplasty 15830
|
$1,948.00 |
$1,948.00 |
$1,948.00 |
$6,442.80
|
|
Abd paracentesis/w/o image guide 49082
|
$1,389.60 |
$1,389.60 |
$1,389.60 |
$1,145.40
|
|
Ablate bone tumor(s) perq
|
$604.00 |
$604.00 |
$604.00 |
$9,350.33
|
|
Ablation cryo thigh/knee
|
$1,996.80 |
$1,996.80 |
$1,996.80 |
$531.95
|
|
Ablation of upper extremity nerves rf
|
$4,185.60 |
$4,185.60 |
$4,185.60 |
$808.50
|
|
Abobotulinumtoxina
|
$20.80 |
$20.80 |
$20.80 |
$1,541.21
|
|
Abscess drain retroperitoneal surg code
|
$311.20 |
$311.20 |
$311.20 |
$2,957.17
|
|
Acetaminophen 10 mg/ml soln 100 ml glass cont
|
$28.80 |
$28.80 |
$28.80 |
$74.96
|
|
Acetaminophen level
|
$24.80 |
$24.80 |
$24.80 |
$107.62
|
|
Acetazolamide 500 mg solution for injection
|
$24.80 |
$24.80 |
$24.80 |
$122.55
|
|
Acetone qualitative
|
$4.00 |
$4.00 |
$4.00 |
$45.65
|
|
Acetylcholine receptor modulating antibody
|
$80.00 |
$80.00 |
$80.00 |
$64.50
|
|
Acetylcysteine 200 mg/ml (20 %) intravenous solution
|
$72.63 |
$72.63 |
$72.63 |
$216.00
|
|
Acetylcysteine non-comp unit
|
$27.79 |
$27.79 |
$27.79 |
$31.21
|
|
Acne surgery 10040
|
$77.60 |
$77.60 |
$77.60 |
$260.49
|
|
Aco annual medicare visit (awv), initial g0438aco
|
$304.00 |
$304.00 |
$304.00 |
$243.00
|
|
Aco annual medicare visit (awv), subsq g0439aco
|
$239.20 |
$239.20 |
$239.20 |
$167.04
|
|
Aco ccm; at least 20 min 99490aco
|
$156.00 |
$156.00 |
$156.00 |
$102.38
|
|
Aco ccm; ea addl 20 min 99439aco
|
$56.00 |
$56.00 |
$56.00 |
$87.00
|
|
Aco cmplx chron care addl 20 min 99489aco
|
$80.00 |
$80.00 |
$80.00 |
$64.74
|
|
Aco cmplx chron care without pt visit, 60 min 99487aco
|
$291.20 |
$291.20 |
$291.20 |
$177.99
|
|
Aco cont gluc mnt phys/qhp eqp 95250aco
|
$244.80 |
$244.80 |
$244.80 |
$345.15
|
|
Aco depression screen annual medicare g0444aco
|
$36.00 |
$36.00 |
$36.00 |
$38.28
|
|
Acromp/acromionectomy prtl
|
$1,056.00 |
$1,056.00 |
$1,056.00 |
$3,839.54
|
|
Acute hepatitis panel
|
$60.00 |
$60.00 |
$60.00 |
$292.00
|
|
Acyclovir 5 mg/ml in ns IV syringe (neo/ped) - cnr
|
$5.97 |
$5.97 |
$5.97 |
$63.48
|
|
#acylcarnitineprfl
|
$28.00 |
$28.00 |
$28.00 |
$125.40
|
|
Adenosine 3 mg/250 ml bag for osm
|
$26.42 |
$26.42 |
$26.42 |
$255.41
|
|
Adh-sendout
|
$172.00 |
$172.00 |
$172.00 |
$109.28
|
|
Adj tis trans/see area/10.1-30sqcm 14041
|
$1,168.00 |
$1,168.00 |
$1,168.00 |
$3,146.85
|
|
Admelog u-100 insulin lispro 100 unit/ml subcutaneous solution
|
$42.94 |
$42.94 |
$42.94 |
$181.12
|
|
Admin ecg contrast agent
|
$59.20 |
$59.20 |
$59.20 |
$119.00
|
|
Administration chemotherapy IV infusion each additional hour
|
$372.00 |
$372.00 |
$372.00 |
$230.35
|
|
Administration chemotherapy IV infusion each addl sequential infusion diff substance/drug >1 hr
|
$248.00 |
$248.00 |
$248.00 |
$294.00
|
|
Administration chemotherapy IV infusion up to 1 hour single/initial substance/drug
|
$652.80 |
$652.80 |
$652.80 |
$657.12
|
|
Administration chemotherapy IV push single/initial substance/drug
|
$407.20 |
$407.20 |
$407.20 |
$439.20
|
|
Administration chemotherapy subcutaneous/im anti neoplastic hormonal
|
$130.40 |
$130.40 |
$130.40 |
$211.09
|
|
Administration chemotherapy subcutaneous/im anti neoplastic non hormonal
|
$248.00 |
$248.00 |
$248.00 |
$257.40
|
|
Administration immunization 1 vaccine
|
$60.80 |
$60.80 |
$60.80 |
$69.21
|
|
Administration immunization each additional vaccine
|
$39.20 |
$39.20 |
$39.20 |
$47.40
|
|
Administration immunization intranasal/oral route 1 vaccine
|
$59.20 |
$59.20 |
$59.20 |
$48.00
|
|
Administration immunization intranasal/oral route each additional vaccine
|
$18.40 |
$18.40 |
$18.40 |
$30.24
|
|
Administration rsv monoclonal ab seasonal dose im w/counseling
|
$62.40 |
$62.40 |
$62.40 |
$41.45
|
|
Administration vaccine hepatitis b
|
$40.80 |
$40.80 |
$40.80 |
$54.40
|
|
Administration vaccine influenza virus
|
$40.80 |
$40.80 |
$40.80 |
$50.43
|
|
Administration vaccine pneumococcal
|
$60.80 |
$60.80 |
$60.80 |
$50.43
|
|
Ado-trastuzumab emtansine 100 mg intravenous solution
|
$15,093.74 |
$15,093.74 |
$15,093.74 |
$11,350.31
|
|
Adrenalin epinephrine inject
|
$271.80 |
$271.80 |
$271.80 |
$229.69
|
|
Advance care planning each additional 30 min 99498
|
$115.20 |
$115.20 |
$115.20 |
$108.00
|
|
_afb id by dna probe rflx ast
|
$232.00 |
$232.00 |
$232.00 |
$93.52
|
|
Aflibercept injection
|
$1,355.20 |
$1,355.20 |
$1,355.20 |
$3,153.84
|
|
After cataract laser surgery
|
$473.60 |
$473.60 |
$473.60 |
$1,373.11
|
|
Air conduction bilat
|
$193.60 |
$193.60 |
$193.60 |
$133.00
|
|
Albumin body fluid quantitative each specimen
|
$20.00 |
$20.00 |
$20.00 |
$46.23
|
|
Albumin (human), 25%, 50ml
|
$98.40 |
$98.40 |
$98.40 |
$244.70
|
|
Albumin (microalbumin) 24 hour urine quantitative
|
$19.20 |
$19.20 |
$19.20 |
$57.00
|
|
Albumin serum plasma or whole blood
|
$11.20 |
$11.20 |
$11.20 |
$40.80
|
|
Albuterol ipratrop non-comp
|
$1.60 |
$1.60 |
$1.60 |
$5.40
|
|
Alcohol (ethanol) any specimen except urine/breath
|
$44.80 |
$44.80 |
$44.80 |
$93.60
|
|
Alcohol/subs interv 15-30mn
|
$57.60 |
$57.60 |
$57.60 |
$51.52
|
|
Alkaline phosphatase
|
$28.80 |
$28.80 |
$28.80 |
$46.40
|
|
Allergen alpha lactalbumin ige
|
$74.40 |
$74.40 |
$74.40 |
$48.00
|
|
Allergen egg white ige
|
$220.80 |
$220.80 |
$220.80 |
$38.00
|
|
Allergen specific ige qual multi scrn ea
|
$26.40 |
$26.40 |
$26.40 |
$24.01
|
|
Allergy injections; 2 or more 95117
|
$50.40 |
$50.40 |
$50.40 |
$43.75
|
|
Allergy injection; single 95115
|
$38.40 |
$38.40 |
$38.40 |
$42.75
|
|
Allergy Skin Testing
|
$6.40 |
$6.40 |
$6.40 |
$47.44
|
|
Allograft amnioexcel plus 17mm disk
|
$191.20 |
$191.20 |
$191.20 |
$2,250.00
|
|
Allograft amniotic activebarrier 200 2x2cm-q4100-cost per sheet
|
$0.01 |
$0.01 |
$0.01 |
$9,018.12
|
|
Allograft graftjacket 2x12cm-q4107-cost per sq cm
|
$191.20 |
$191.20 |
$191.20 |
$4,677.40
|
