|
17-hydroxypregnenolone
|
$22.50 |
$22.50 |
$22.50 |
$89.25
|
|
1st hosp/birthing center care per day nml nb 99460
|
$92.50 |
$92.50 |
$92.50 |
$161.60
|
|
1st psyc collab care mgmt
|
$94.00 |
$94.00 |
$94.00 |
$109.46
|
|
1st/sbsq psyc collab care
|
$70.00 |
$70.00 |
$70.00 |
$111.20
|
|
3d recon without postprocess indpndt
|
$496.50 |
$496.50 |
$496.50 |
$485.00
|
|
5' nucleotidase - sendout
|
$8.00 |
$8.00 |
$8.00 |
$50.40
|
|
88334 ap bill cytologic exam each additional site
|
$38.50 |
$38.50 |
$38.50 |
$97.65
|
|
99381 initial comp preventive med less than 1 year new
|
$72.50 |
$72.50 |
$72.50 |
$132.00
|
|
99382 initial comp preventive med 1 to 4 years new
|
$77.50 |
$77.50 |
$77.50 |
$126.00
|
|
99383 initial comp preventive med 5 to 11 years new
|
$83.50 |
$83.50 |
$83.50 |
$111.00
|
|
99391 periodic comp preventive med less than 1 year est
|
$66.50 |
$66.50 |
$66.50 |
$107.10
|
|
99392 periodic comp preventive med 1 to 4 years est
|
$72.50 |
$72.50 |
$72.50 |
$115.50
|
|
99393 periodic comp preventive med 5 to 11 years est
|
$72.50 |
$72.50 |
$72.50 |
$113.40
|
|
99394 periodic comp preventive med 12 to 17 years est
|
$83.50 |
$83.50 |
$83.50 |
$127.20
|
|
99397 periodic comp preventive med 65+ years est
|
$97.50 |
$97.50 |
$97.50 |
$160.73
|
|
Abdominal CT scan (with and without contrast)
|
$1,021.50 |
$1,021.50 |
$1,021.50 |
$2,009.80
|
|
Abdominal CT scan (with contrast)
|
$851.50 |
$851.50 |
$851.50 |
$1,680.60
|
|
Abdominal CT scan (without contrast)
|
$714.50 |
$714.50 |
$714.50 |
$1,358.76
|
|
Abdominal MRI (with and without contrast)
|
$1,854.00 |
$1,854.00 |
$1,854.00 |
$3,015.94
|
|
Abdominal MRI (without contrast)
|
$1,205.50 |
$1,205.50 |
$1,205.50 |
$2,050.14
|
|
Abdominal paracentesis w/image guidance
|
$1,276.00 |
$1,276.00 |
$1,276.00 |
$1,651.20
|
|
Abdominal Ultrasound (complete)
|
$440.50 |
$440.50 |
$440.50 |
$785.55
|
|
Abdominal Ultrasound (limited)
|
$440.00 |
$440.00 |
$440.00 |
$590.00
|
|
Abd paracentesis/w/o image guide 49082
|
$1,150.00 |
$1,150.00 |
$1,150.00 |
$1,145.40
|
|
Ablate bone tumor(s) perq
|
$6,540.00 |
$6,540.00 |
$6,540.00 |
$9,350.33
|
|
Ablation of upper extremity nerves rf
|
$675.50 |
$675.50 |
$675.50 |
$808.50
|
|
Abobotulinumtoxina
|
$13.00 |
$13.00 |
$13.00 |
$1,541.21
|
|
Acetaminophen level
|
$15.50 |
$15.50 |
$15.50 |
$107.62
|
|
Acetazolamide 500 mg solution for injection
|
$15.50 |
$15.50 |
$15.50 |
$122.55
|
|
Acetylcholine receptor modulating antibody
|
$50.00 |
$50.00 |
$50.00 |
$64.50
|
|
Acne surgery 10040
|
$48.50 |
$48.50 |
$48.50 |
$260.49
|
|
Aco annual medicare visit (awv), initial g0438aco
|
$190.00 |
$190.00 |
$190.00 |
$243.00
|
|
Aco annual medicare visit (awv), subsq g0439aco
|
$149.50 |
$149.50 |
$149.50 |
$167.04
|
|
Aco ccm; at least 20 min 99490aco
|
$97.50 |
$97.50 |
$97.50 |
$102.38
|
|
Aco ccm; ea addl 20 min 99439aco
|
$64.50 |
$64.50 |
$64.50 |
$87.00
|
|
Aco cmplx chron care addl 20 min 99489aco
|
$76.50 |
$76.50 |
$76.50 |
$64.74
|
|
Aco cmplx chron care without pt visit, 60 min 99487aco
|
$170.50 |
$170.50 |
$170.50 |
$177.99
|
|
Aco cont gluc mnt phys/qhp eqp 95250aco
|
$153.00 |
$153.00 |
$153.00 |
$345.15
|
|
Aco depression screen annual medicare g0444aco
|
$26.00 |
$26.00 |
$26.00 |
$38.28
|
|
Acute hepatitis panel
|
$221.00 |
$221.00 |
$221.00 |
$292.00
|
|
#acylcarnitineprfl
|
$72.00 |
$72.00 |
$72.00 |
$125.40
|
|
Adenovirus antibody,serum - quest
|
$66.00 |
$66.00 |
$66.00 |
$63.00
|
|
Adh-sendout
|
$31.00 |
$31.00 |
$31.00 |
$109.28
|
|
Adj tis trans/see area/10.1-30sqcm 14041
|
$730.00 |
$730.00 |
$730.00 |
$3,146.85
|
|
Admelog u-100 insulin lispro 100 unit/ml subcutaneous solution
|
$4.00 |
$4.00 |
$4.00 |
$181.12
|
|
Admin ecg contrast agent
|
$37.00 |
$37.00 |
$37.00 |
$119.00
|
|
Administration chemotherapy IV infusion each additional hour
|
$148.50 |
$148.50 |
$148.50 |
$230.35
|
|
Administration chemotherapy IV infusion up to 1 hour single/initial substance/drug
|
$471.00 |
$471.00 |
$471.00 |
$657.12
|
|
Administration chemotherapy IV push single/initial substance/drug
|
$169.00 |
$169.00 |
$169.00 |
$439.20
|
|
Administration chemotherapy subcutaneous/im anti neoplastic hormonal
|
$40.00 |
$40.00 |
$40.00 |
$211.09
|
|
Administration immunization 1 vaccine
|
$40.00 |
$40.00 |
$40.00 |
$69.21
|
|
Administration immunization each additional component
|
$14.00 |
$14.00 |
$14.00 |
$27.95
|
|
Administration immunization each additional vaccine
|
$23.50 |
$23.50 |
$23.50 |
$47.40
|
|
Administration immunization first component each vaccine
|
$14.00 |
$14.00 |
$14.00 |
$46.40
|
|
Administration immunization intranasal/oral route 1 vaccine
|
$37.50 |
$37.50 |
$37.50 |
$48.00
|
|
Administration immunization intranasal/oral route each additional vaccine
|
$13.50 |
$13.50 |
$13.50 |
$30.24
|
|
Administration rsv monoclonal ab seasonal dose im w/counseling
|
$76.50 |
$76.50 |
$76.50 |
$41.45
|
|
Administration vaccine hepatitis b
|
$25.00 |
$25.00 |
$25.00 |
$54.40
|
|
Administration vaccine influenza virus
|
$25.00 |
$25.00 |
$25.00 |
$50.43
|
|
Administration vaccine pneumococcal
|
$25.00 |
$25.00 |
$25.00 |
$50.43
|
|
Administration vaccine rsv monoclonal ab seasonal dose im
|
$76.50 |
$76.50 |
$76.50 |
$41.00
|
|
Advance care planning each additional 30 min 99498
|
$72.00 |
$72.00 |
$72.00 |
$108.00
|
|
Aep hearing status deter i&r
|
$168.00 |
$168.00 |
$168.00 |
$305.73
|
|
Aflibercept injection
|
$847.00 |
$847.00 |
$847.00 |
$3,153.84
|
|
After cataract laser surgery
|
$296.00 |
$296.00 |
$296.00 |
$1,373.11
|
|
Air conduction bilat
|
$121.00 |
$121.00 |
$121.00 |
$133.00
|
|
Albumin body fluid quantitative each specimen
|
$31.50 |
$31.50 |
$31.50 |
$46.23
|
|
Albumin (human), 25%, 50ml
|
$52.50 |
$52.50 |
$52.50 |
$244.70
|
|
Albumin (microalbumin) 24 hour urine quantitative
|
$53.50 |
$53.50 |
$53.50 |
$57.00
|
|
Albumin serum plasma or whole blood
|
$30.50 |
$30.50 |
$30.50 |
$40.80
|
|
Albuterol ipratrop non-comp
|
$1.00 |
$1.00 |
$1.00 |
$5.40
|
|
Alcohol (ethanol) any specimen except urine/breath
|
$28.00 |
$28.00 |
$28.00 |
$93.60
|
|
Alcohol/subs interv 15-30mn
|
$36.00 |
$36.00 |
$36.00 |
$51.52
|
|
Alkaline phosphatase
|
$34.50 |
$34.50 |
$34.50 |
$46.40
|
|
Allergen alpha lactalbumin ige
|
$61.00 |
$61.00 |
$61.00 |
$48.00
|
|
Allergen egg white ige
|
$138.00 |
$138.00 |
$138.00 |
$38.00
|
|
Allergy injections; 2 or more 95117
|
$12.50 |
$12.50 |
$12.50 |
$43.75
|
|
Allergy injection; single 95115
|
$10.50 |
$10.50 |
$10.50 |
$42.75
|
|
Allergy Skin Testing
|
$4.00 |
$4.00 |
$4.00 |
$47.44
|
|
Allograft amnioexcel plus 17mm disk
|
$119.50 |
$119.50 |
$119.50 |
$2,250.00
|
|
Allograft amniotic activebarrier 200 2x2cm-q4100-cost per sheet
|
$0.01 |
$0.01 |
$0.01 |
$9,018.12
|
|
Allograft dermis 20x25x1mm decell w/matracell arthroflex
|
$85.00 |
$85.00 |
$85.00 |
$6,414.50
|
|
Allograft graftjacket 2x12cm-q4107-cost per sq cm
|
$119.50 |
$119.50 |
$119.50 |
$4,677.40
|
|
Alpha-fetoprotein amniotic
|
$28.50 |
$28.50 |
$28.50 |
$96.20
|
|
Alpha-fetoprotein tumor marker
|
$91.50 |
$91.50 |
$91.50 |
$106.00
|
|
Alprostadil for injection
|
$9.50 |
$9.50 |
$9.50 |
$519.93
|
|
Alteplase 100 mg infusion from pyxis vial
|
$128.00 |
$128.00 |
$128.00 |
$15,857.45
|
|
Alt/sgpt
|
$44.50 |
$44.50 |
$44.50 |
$47.45
|
|
Alys cplx sp/pn npgt w/prgrm
|
$91.50 |
$91.50 |
$91.50 |
$434.00
|
|
Amantadine (symmetrel)-sendout
|
$142.00 |
$142.00 |
$142.00 |
$169.80
|
|
Amikacin 4 mg/ml intravitreal injection - cnr
|
$1.00 |
$1.00 |
$1.00 |
$39.84
|
|
Aminolevulinic acid hcl top
|
$590.00 |
$590.00 |
$590.00 |
$640.56
|
|
Amitriptyline (elavil) -sendout
|
$11.00 |
$11.00 |
$11.00 |
$87.45
|
|
Ammonia
|
$98.50 |
$98.50 |
$98.50 |
$119.70
|
|
Amphetamine confirm urine -sendout
|
$20.00 |
$20.00 |
$20.00 |
$92.61
|
|
Ampicillin 1 gram solution for injection
|
$1.00 |
$1.00 |
$1.00 |
$56.70
|
|
Amputate metacarpal bone 26910
|
$807.00 |
$807.00 |
$807.00 |
$3,821.05
|
|
Amputation toe interphalangeal joint
|
$180.50 |
$180.50 |
$180.50 |
$3,998.20
|
|
Amputation toe metatarsophalangeal joint
|
$187.00 |
$187.00 |
$187.00 |
$3,839.54
|
|
Amylase
|
$237.00 |
$237.00 |
$237.00 |
$89.04
|
