|
MRI breast c-+ w/cad uni
|
$939.16 |
$2,165.00 |
$3,132.30 |
|
|
MRI breast without cont bi
|
$608.30 |
$2,010.00 |
$4,191.00 |
|
|
MRI breast w IV cont bi
|
$1,506.26 |
$3,245.00 |
$4,475.32 |
|
|
MRI cardiac morph & func wo IV cont
|
$1,341.96 |
$2,130.00 |
$5,197.68 |
|
|
MRI cardiac morph & func wwo IV cont
|
$1,441.07 |
$2,593.80 |
$7,097.03 |
|
|
MRI cardiac morph & func wwo IV cont w/stress img
|
$2,510.00 |
$2,510.00 |
$2,510.00 |
|
|
MRI chest without contrast
|
$708.51 |
$2,110.00 |
$3,382.50 |
|
|
MRI chest without & w/contrast
|
$1,043.67 |
$3,036.00 |
$4,059.00 |
|
|
MRI chest w IV cont
|
$1,688.58 |
$2,210.00 |
$3,721.30 |
|
|
MRI compatible system
|
$2,923.03 |
$2,923.03 |
$2,923.03 |
|
|
MRI fetal ea addl gestation
|
$437.25 |
$1,505.23 |
$2,233.44 |
|
|
MRI fetal sngl/1st gestation
|
$1,020.25 |
$2,110.00 |
$2,251.70 |
|
|
MRI guid ndl plc s&i
|
$1,080.75 |
$1,082.26 |
$2,482.05 |
|
|
MRI loex nonjt w IV cont
|
$1,387.01 |
$2,210.00 |
$2,702.15 |
|
|
MRI lower extremity other than joint without contrast (both sides)
|
$609.33 |
$2,110.00 |
$4,975.80 |
|
|
MRI lower extremity other than joint without & w/contrast (both sides)
|
$1,080.72 |
$3,114.81 |
$6,434.73 |
|
|
MRI orbit fac&nck w IV cont
|
$1,741.85 |
$2,210.00 |
$2,556.72 |
|
|
MRI tmj
|
$543.21 |
$2,315.00 |
$3,107.94 |
|
|
MRI upper extremity other than joint without contrast (both sides)
|
$646.95 |
$2,110.00 |
$4,867.52 |
|
|
MRI upper extremity other than joint without & w/contrast (both sides)
|
$908.58 |
$3,223.55 |
$7,025.24 |
|
|
MRI upper extremity w/dye
|
$2,210.00 |
$2,303.95 |
$2,993.10 |
|
|
MRI w/cont, breast, bi
|
$2,165.00 |
$2,165.00 |
$4,948.90 |
|
|
MRI w/cont, breast, uni
|
$2,356.20 |
$2,356.20 |
$2,356.20 |
|
|
MRI without fol w/cont, breast
|
$2,571.80 |
$3,204.96 |
$5,394.40 |
|
|
MRI without fol w/cont, brst, un
|
$890.45 |
$2,474.45 |
$2,474.45 |
|
|
Mr safety determination physician/other qhp
|
$163.24 |
$260.00 |
$261.90 |
|
|
Mr safety implant elec prepj
|
$170.13 |
$462.50 |
$462.50 |
|
|
Mr safety implant&/fb assmt clin staff ea add 30
|
$25.00 |
$25.00 |
$146.23 |
|
|
Mr safety implt pos&/immoblj
|
$110.24 |
$705.00 |
$705.00 |
|
|
Mr sfty implt&/fb asmt stf 1
|
$45.58 |
$50.00 |
$73.12 |
|
|
Mr sfty med physics xm cstmz
|
$448.38 |
$1,095.00 |
$1,095.00 |
|
|
Mr spectroscopy
|
$264.55 |
$1,340.00 |
$2,352.24 |
|
|
Msh2 gene dup/delete variant
|
$554.40 |
$891.55 |
$1,625.80 |
|
|
Msh2 gene full seq
|
$1,023.00 |
$1,107.20 |
$1,626.35 |
|
|
Msh6 gene dup/delete variant
|
$607.20 |
$729.85 |
$1,023.00 |
|
|
Msh6 gene full seq
|
$729.85 |
$990.00 |
$1,212.80 |
|
|
Mthfr gene analy common variants
|
$97.50 |
$228.25 |
$928.40 |
|
|
Mucin synovial fluid
|
$18.55 |
$18.55 |
$30.00 |
|
|
Mucopolysaccharides
|
$54.59 |
$161.70 |
$555.06 |
|
|
Multi den insert direct form
|
$24.91 |
$24.91 |
$24.91 |
|
|
Multi family grp psychotherapy
|
$102.30 |
$102.30 |
$227.20 |
|
|
Multiple sleep latency test
|
$1,482.25 |
$2,545.00 |
$3,506.48 |
|
|
Mumps antibody igg
|
$41.04 |
$85.00 |
$283.43 |
|
|
Muscle-skin graft leg
|
$3,639.20 |
$3,639.20 |
$3,639.20 |
|
|
Muscle-skin graft trunk
|
$2,385.45 |
$2,385.45 |
$3,746.40 |
|
|
Muscle test cran nerv unilat
|
$70.49 |
$240.62 |
$439.45 |
|
|
Muscle test hemidiaphragm
|
$794.40 |
$794.40 |
$794.40 |
|
|
Muscle test larynx
|
$174.90 |
$188.65 |
$1,200.00 |
|
|
Muscle test one fiber
|
$58.83 |
$58.83 |
$592.68 |
|
|
Muscle transfers
|
$12,777.60 |
$12,777.60 |
$12,777.60 |
|
|
Muscle transfer shoulder/arm
|
$12,777.60 |
$12,777.60 |
$12,777.60 |
|
|
Musc/tdn transfer upr a/e 1
|
$5,002.40 |
$5,002.40 |
$5,002.40 |
|
|
Mycobacteria dna amp probe
|
$107.80 |
$635.00 |
$834.90 |
|
|
Mycophenolate mofetil 250 mg capsule
|
$1.36 |
$8.90 |
$270.17 |
|
|
Mycophenolic acid
|
$2.23 |
$4.99 |
$11.22 |
|
|
Mycoplasma antibody igm
|
$15.40 |
$79.20 |
$176.29 |
|
|
Myd88 gene p.leu265pro vrnt
|
$271.36 |
$437.50 |
$1,522.40 |
|
|
Myelogphy 2/> spine regions
|
$481.24 |
$1,389.13 |
$4,727.77 |
|
|
Myelography l-s spine
|
$409.69 |
$1,255.00 |
$4,964.16 |
|
|
Myelography neck spine
|
$420.82 |
$1,255.00 |
$4,964.16 |
|
|
Myelography thoracic spine
|
$409.69 |
$1,255.00 |
$4,964.16 |
|
|
Myelography via inj w/s&i 2+ regions
|
$939.69 |
$2,770.00 |
$5,001.04 |
|
|
Myelography via inj w/s&i cervical
|
$742.50 |
$1,850.00 |
$4,762.90 |
|
|
Myelography via inj w/s&i lumbosacral
|
$876.09 |
$1,850.00 |
$5,001.04 |
|
|
Myelography via inj w/s&i thoracic
|
$779.35 |
$1,850.00 |
$5,001.04 |
|
|
Myeloperoxidase ab multi step qualitative/semiquantitative
|
$62.13 |
$161.70 |
$505.00 |
|
|
Myocrd img pet 1std rst/strs
|
$3,558.50 |
$4,060.00 |
$4,789.40 |
|
|
Myocrd img pet 1 std w/ct
|
$1,150.26 |
$2,762.89 |
$4,060.00 |
|
|
Myocrd img pet 2rtracer
|
$4,880.00 |
$4,880.00 |
$4,880.00 |
|
|
Myocrd img pet 2rtracer CT
|
$5,370.00 |
$5,370.00 |
$5,370.00 |
|
|
Myocrd img pet mlt rst&strs
|
$4,060.00 |
$4,060.00 |
$4,060.00 |
|
|
Myocrd img pet rst&strs CT
|
$4,713.50 |
$4,713.50 |
$4,713.50 |
|
|
Myocrd img pet rst/strs w/ct
|
$4,314.20 |
$4,520.00 |
$4,520.00 |
|
|
Myomectomy abdom method
|
$8,940.25 |
$8,940.25 |
$8,940.25 |
|
|
Myringoplasty
|
$469.05 |
$469.05 |
$4,263.20 |
|
|
Nafcillin 2 gram solution for injection
|
$0.61 |
$0.61 |
$1.17 |
|
|
Nalbuphine 10 mg/ml injection solution
|
$6.39 |
$8.94 |
$73.88 |
|
|
Naloxone 0.4 mg/ml injection (wrapper)
|
$1.45 |
$1.93 |
$87.60 |
|
|
Naltrexone, depot form
|
$3.18 |
$4.02 |
$7.16 |
|
|
Narcosynthesis
|
$141.35 |
$141.35 |
$141.35 |
|
|
Nasal endoscopy dx uni/bi separate proc
|
$261.82 |
$323.95 |
$682.32 |
|
|
Nasal/sinus endoscopy surg
|
$4,429.60 |
$4,429.60 |
$4,429.60 |
|
|
Nasal/sinus endoscopy surg
|
$6,300.00 |
$6,300.00 |
$6,300.00 |
|
|
Nasal/sinus endoscopy surg
|
$6,632.00 |
$6,632.00 |
$6,632.00 |
|
|
Nasal/sinus endoscopy surg w/bx 31237
|
$276.66 |
$661.20 |
$4,175.20 |
|
|
Nasal/sinus endo spendt remove tiss 31288
|
$4,872.80 |
$4,872.80 |
$4,872.80 |
|
|
Nasal/sinus endo surg w/concha bullosa resct 31240
|
$2,535.20 |
$2,535.20 |
$2,535.20 |
|
|
Nasal/sinus endo w/ethmoidectomy part 31254
|
$4,489.60 |
$4,489.60 |
$4,489.60 |
|
|
Nasal/sinus endo w/ethmoidectomy tot 31255
|
$6,138.40 |
$6,138.40 |
$6,138.40 |
|
|
Nasal/sinus endo w/front sinus expl 31276
|
$5,316.80 |
$5,316.80 |
$5,316.80 |
|
|
Nasal/sinus maxillary endoscopy dx 31233
|
$292.03 |
$292.03 |
$1,900.80 |
|
|
Nasal/sinus sphenoid endoscopy dx 31235
|
$3,296.00 |
$3,296.00 |
$3,296.00 |
|
|
Nasal sinus therapy
|
$976.00 |
$976.00 |
$976.00 |
|
|
Nasopharyngoscopy w/endoscope
|
$118.25 |
$282.72 |
$716.44 |
|
|
Natalizumab 300 mg/15 ml intravenous solution
|
$38.58 |
$55.55 |
$15,962.89 |
|
|
Natriuretic peptide
|
$60.42 |
$111.30 |
$433.89 |
|
|
Natural killer cells total count
|
$90.06 |
$135.00 |
$312.95 |
|
|
Navigational bronchoscopy 31627
|
$2,903.87 |
$3,925.00 |
$3,925.00 |
|
|
Nav srv peer sup 60 min pr m
|
$302.40 |
$302.40 |
$302.40 |
|
|
N block inj hypogas plxs
|
$665.00 |
$665.00 |
$1,748.47 |
|
