|
17-hydroxypregnenolone
|
$109.50 |
$109.50 |
$109.50 |
$89.25
|
|
1st psyc collab care mgmt
|
$116.50 |
$116.50 |
$116.50 |
$109.46
|
|
2d tee w or without fol w/con,in
|
$889.00 |
$889.00 |
$889.00 |
$1,624.70
|
|
2nd order venous cath
|
$208.00 |
$208.00 |
$208.00 |
$1,543.85
|
|
3d recon without postprocess indpndt
|
$218.50 |
$218.50 |
$218.50 |
$485.00
|
|
88334 ap bill cytologic exam each additional site
|
$54.00 |
$54.00 |
$54.00 |
$97.65
|
|
99381 initial comp preventive med less than 1 year new
|
$93.00 |
$93.00 |
$93.00 |
$132.00
|
|
99382 initial comp preventive med 1 to 4 years new
|
$85.00 |
$85.00 |
$85.00 |
$126.00
|
|
99383 initial comp preventive med 5 to 11 years new
|
$77.50 |
$77.50 |
$77.50 |
$111.00
|
|
99391 periodic comp preventive med less than 1 year est
|
$80.00 |
$80.00 |
$80.00 |
$107.10
|
|
99392 periodic comp preventive med 1 to 4 years est
|
$103.50 |
$103.50 |
$103.50 |
$115.50
|
|
99393 periodic comp preventive med 5 to 11 years est
|
$77.50 |
$77.50 |
$77.50 |
$113.40
|
|
99394 periodic comp preventive med 12 to 17 years est
|
$109.00 |
$109.00 |
$109.00 |
$127.20
|
|
99397 periodic comp preventive med 65+ years est
|
$140.00 |
$140.00 |
$140.00 |
$160.73
|
|
Abd aorta w/runoff s&i
|
$2,772.50 |
$2,772.50 |
$2,772.50 |
$3,569.56
|
|
Abd/low ext cath 1st
|
$1,249.00 |
$1,249.00 |
$1,249.00 |
$2,015.85
|
|
Abd/low ext cath 2nd
|
$1,488.50 |
$1,488.50 |
$1,488.50 |
$2,015.85
|
|
Abd/low ext cath 3rd
|
$1,745.00 |
$1,745.00 |
$1,745.00 |
$2,486.97
|
|
Abdominal CT scan (with and without contrast)
|
$639.50 |
$639.50 |
$639.50 |
$2,009.80
|
|
Abdominal CT scan (with contrast)
|
$639.50 |
$639.50 |
$639.50 |
$1,680.60
|
|
Abdominal CT scan (without contrast)
|
$296.00 |
$296.00 |
$296.00 |
$1,358.76
|
|
Abdominal MRI (with and without contrast)
|
$1,781.00 |
$1,781.00 |
$1,781.00 |
$3,015.94
|
|
Abdominal MRI (with contrast)
|
$1,054.50 |
$1,054.50 |
$1,054.50 |
$2,268.20
|
|
Abdominal MRI (without contrast)
|
$747.50 |
$747.50 |
$747.50 |
$2,050.14
|
|
Abdominal paracentesis w/image guidance
|
$1,880.00 |
$1,880.00 |
$1,880.00 |
$1,651.20
|
|
Abdominal Ultrasound (complete)
|
$289.00 |
$289.00 |
$289.00 |
$785.55
|
|
Abdominal Ultrasound (limited)
|
$303.50 |
$303.50 |
$303.50 |
$590.00
|
|
Ablation cardiac vagal inputs atrium
|
$272.00 |
$272.00 |
$272.00 |
$1,960.80
|
|
Ablation of upper extremity nerves rf
|
$620.50 |
$620.50 |
$620.50 |
$808.50
|
|
Abobotulinumtoxina
|
$9.00 |
$9.00 |
$9.00 |
$1,541.21
|
|
Abscess drain retroperitoneal surg code
|
$3,411.50 |
$3,411.50 |
$3,411.50 |
$2,957.17
|
|
Access & clsr pq fem art endogft dlvry w/img uni
|
$455.50 |
$455.50 |
$455.50 |
$2,314.00
|
|
Acetaminophen 10 mg/ml soln 100 ml glass cont
|
$14.18 |
$14.18 |
$14.18 |
$74.96
|
|
Acetaminophen 120 mg rectal suppository
|
$15.80 |
$15.80 |
$15.80 |
$75.09
|
|
Acetaminophen level
|
$103.50 |
$103.50 |
$103.50 |
$107.62
|
|
Acetazolamide 500 mg solution for injection
|
$23.50 |
$23.50 |
$23.50 |
$122.55
|
|
Acetone qualitative
|
$21.50 |
$21.50 |
$21.50 |
$45.65
|
|
Acetylcholine receptor modulating antibody
|
$50.00 |
$50.00 |
$50.00 |
$64.50
|
|
Acne surgery 10040
|
$230.50 |
$230.50 |
$230.50 |
$260.49
|
|
Aco ccm; at least 20 min 99490aco
|
$30.50 |
$30.50 |
$30.50 |
$102.38
|
|
Aco cont gluc mnt phys/qhp eqp 95250aco
|
$103.50 |
$103.50 |
$103.50 |
$345.15
|
|
Acute hepatitis panel
|
$221.00 |
$221.00 |
$221.00 |
$292.00
|
|
#acylcarnitineprfl
|
$22.00 |
$22.00 |
$22.00 |
$125.40
|
|
Adapter b 8 channel 10cm
|
$507.00 |
$507.00 |
$507.00 |
$5,695.04
|
|
Adenosine 3 mg/250 ml bag for osm
|
$28.43 |
$28.43 |
$28.43 |
$255.41
|
|
Adh-sendout
|
$222.00 |
$222.00 |
$222.00 |
$109.28
|
|
Adj gastric band via subq port
|
$2,300.00 |
$2,300.00 |
$2,300.00 |
$1,609.80
|
|
Admelog u-100 insulin lispro 100 unit/ml subcutaneous solution
|
$5.50 |
$5.50 |
$5.50 |
$181.12
|
|
Administration chemotherapy IV infusion each additional hour
|
$429.00 |
$429.00 |
$429.00 |
$230.35
|
|
Administration chemotherapy IV infusion each addl sequential infusion diff substance/drug >1 hr
|
$153.50 |
$153.50 |
$153.50 |
$294.00
|
|
Administration chemotherapy IV infusion up to 1 hour single/initial substance/drug
|
$772.00 |
$772.00 |
$772.00 |
$657.12
|
|
Administration chemotherapy IV push single/initial substance/drug
|
$504.50 |
$504.50 |
$504.50 |
$439.20
|
|
Administration chemotherapy subcutaneous/im anti neoplastic hormonal
|
$153.50 |
$153.50 |
$153.50 |
$211.09
|
|
Administration chemotherapy subcutaneous/im anti neoplastic non hormonal
|
$153.50 |
$153.50 |
$153.50 |
$257.40
|
|
Administration immunization 1 vaccine
|
$176.50 |
$176.50 |
$176.50 |
$69.21
|
|
Administration immunization each additional component
|
$10.50 |
$10.50 |
$10.50 |
$27.95
|
|
Administration immunization each additional vaccine
|
$85.50 |
$85.50 |
$85.50 |
$47.40
|
|
Administration immunization first component each vaccine
|
$17.50 |
$17.50 |
$17.50 |
$46.40
|
|
Administration immunization intranasal/oral route 1 vaccine
|
$37.00 |
$37.00 |
$37.00 |
$48.00
|
|
Administration immunization intranasal/oral route each additional vaccine
|
$10.50 |
$10.50 |
$10.50 |
$30.24
|
|
Administration vaccine influenza virus
|
$23.50 |
$23.50 |
$23.50 |
$50.43
|
|
Administration vaccine pneumococcal
|
$21.50 |
$21.50 |
$21.50 |
$50.43
|
|
Adrenalin epinephrine inject
|
$4.28 |
$4.28 |
$4.28 |
$229.69
|
|
Aep hearing status deter i&r
|
$350.50 |
$350.50 |
$350.50 |
$305.73
|
|
#afb mycobacteria suscep. #1
|
$24.00 |
$24.00 |
$24.00 |
$35.51
|
|
_afb org id by sequencing rflx ast-sendout
|
$743.00 |
$743.00 |
$743.00 |
$315.00
|
|
Aflibercept injection
|
$2,185.50 |
$2,185.50 |
$2,185.50 |
$3,153.84
|
|
After cataract laser surgery
|
$1,208.50 |
$1,208.50 |
$1,208.50 |
$1,373.11
|
|
Air conduction bilat
|
$23.50 |
$23.50 |
$23.50 |
$133.00
|
|
Albumin body fluid quantitative each specimen
|
$26.00 |
$26.00 |
$26.00 |
$46.23
|
|
Albumin (human), 25%, 50ml
|
$587.25 |
$587.25 |
$587.25 |
$244.70
|
|
Albumin (human), 5%, 250 ml
|
$97.88 |
$97.88 |
$97.88 |
$243.59
|
|
Albumin (microalbumin) 24 hour urine quantitative
|
$31.50 |
$31.50 |
$31.50 |
$57.00
|
|
Albumin serum plasma or whole blood
|
$52.50 |
$52.50 |
$52.50 |
$40.80
|
|
Albuterol ipratrop non-comp
|
$1.00 |
$1.00 |
$1.00 |
$5.40
|
|
Alcohol (ethanol) any specimen except urine/breath
|
$48.50 |
$48.50 |
$48.50 |
$93.60
|
|
Alkaline phosphatase
|
$34.00 |
$34.00 |
$34.00 |
$46.40
|
|
Allergen alpha lactalbumin ige
|
$32.50 |
$32.50 |
$32.50 |
$48.00
|
|
Allergen egg white ige
|
$7,030.00 |
$7,030.00 |
$7,030.00 |
$38.00
|
|
Allergy injections; 2 or more 95117
|
$14.00 |
$14.00 |
$14.00 |
$43.75
|
|
Allergy injection; single 95115
|
$10.00 |
$10.00 |
$10.00 |
$42.75
|
|
Allg patch or app # of tests 95044
|
$4.00 |
$4.00 |
$4.00 |
$445.00
|
|
Allograft amnioexcel plus 17mm disk
|
$143.50 |
$143.50 |
$143.50 |
$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
|
$143.50 |
$143.50 |
$143.50 |
$4,677.40
|
|
Alpha-fetoprotein amniotic
|
$28.50 |
$28.50 |
$28.50 |
$96.20
|
|
Alpha-fetoprotein tumor marker
|
$93.00 |
$93.00 |
$93.00 |
$106.00
|
|
Alprostadil for injection
|
$14.00 |
$14.00 |
$14.00 |
$519.93
|
|
Alteplase 100 mg infusion from pyxis vial
|
$191.50 |
$191.50 |
$191.50 |
$15,857.45
|
|
Alt/sgpt
|
$42.00 |
$42.00 |
$42.00 |
$47.45
|
|
Alys cplx sp/pn npgt w/prgrm
|
$77.50 |
$77.50 |
$77.50 |
$434.00
|
|
Amantadine (symmetrel)-sendout
|
$142.00 |
$142.00 |
$142.00 |
$169.80
|
|
Amikacin 4 mg/ml intravitreal injection - cnr
|
$1.50 |
$1.50 |
$1.50 |
$39.84
|
|
Amiodarone 50 mg/ml intravenous solution
|
$1.56 |
$1.56 |
$1.56 |
$55.86
|
|
Amitriptyline (elavil) -sendout
|
$357.00 |
$357.00 |
$357.00 |
$87.45
|
|
Ammonia
|
$74.00 |
$74.00 |
$74.00 |
$119.70
|
|
Amphetamine confirm urine -sendout
|
$79.00 |
$79.00 |
$79.00 |
$92.61
|
|
Amphetamines 5 or more
|
$29.00 |
$29.00 |
$29.00 |
$82.96
|
|
Ampicillin 1 gram solution for injection
|
$17.52 |
$17.52 |
$17.52 |
$56.70
|
|
Ampicillin-sulbactam 1.5 gram solution for injection
|
$7.17 |
$7.17 |
$7.17 |
$53.86
|
