|
Administration chemotherapy IV infusion each addl sequential infusion diff substance/drug >1 hr
|
$15.54 |
$103.15 |
$416.27 |
|
|
Administration chemotherapy IV infusion up to 1 hour single/initial substance/drug
|
$31.56 |
$219.31 |
$1,041.34 |
|
|
Administration chemotherapy IV push single/initial substance/drug
|
$67.61 |
$208.68 |
$458.40 |
|
|
Administration chemotherapy subcutaneous/im anti neoplastic hormonal
|
$67.69 |
$114.24 |
$279.25 |
|
|
Administration chemotherapy subcutaneous/im anti neoplastic non hormonal
|
$63.21 |
$237.26 |
$492.27 |
|
|
Administration immunization each additional component
|
$23.01 |
$23.01 |
$23.01 |
|
|
Administration immunization each additional vaccine
|
$4.39 |
$11.35 |
$153.60 |
|
|
Administration immunization first component each vaccine
|
$40.07 |
$40.07 |
$40.07 |
|
|
Administration immunization intranasal/oral route 1 vaccine
|
$18.65 |
$25.23 |
$53.48 |
|
|
Administration immunization intranasal/oral route each additional vaccine
|
$17.81 |
$17.81 |
$53.48 |
|
|
Administration vaccine hepatitis b
|
$8.71 |
$21.06 |
$73.82 |
|
|
Administration vaccine influenza virus
|
$8.71 |
$21.52 |
$73.82 |
|
|
Administration vaccine pneumococcal
|
$8.71 |
$21.52 |
$73.82 |
|
|
Ado-trastuzumab emtansine 100 mg intravenous solution
|
$8,766.14 |
$8,766.14 |
$11,122.58 |
|
|
Adrenal cortex & medulla img
|
$486.59 |
$605.15 |
$2,499.80 |
|
|
Adrenalin epinephrine inject
|
$0.01 |
$37.80 |
$1,822.40 |
|
|
Advance care planning each additional 30 min 99498
|
$110.56 |
$110.56 |
$110.56 |
|
|
Aep hearing status deter i&r
|
$107.48 |
$345.15 |
$842.06 |
|
|
Aep neurodiagnostic i&r
|
$213.41 |
$303.50 |
$845.75 |
|
|
Aep thrshld est mlt freq i&r
|
$213.41 |
$409.43 |
$1,140.95 |
|
|
Afamitresgene autoleucel
|
$907,514.78 |
$907,514.78 |
$1,829,146.46 |
|
|
_afb id by dna probe rflx ast
|
$11.90 |
$18.47 |
$163.24 |
|
|
#afb mycobacteria suscep. #1
|
$10.27 |
$14.74 |
$55.01 |
|
|
_afb org id by sequencing rflx ast-sendout
|
$56.91 |
$94.04 |
$471.17 |
|
|
Afo rig ant tib tcf/= custom
|
$1,877.15 |
$1,877.15 |
$1,877.15 |
|
|
Agalsidase beta 35 mg intravenous solution
|
$10,383.91 |
$10,383.91 |
$27,675.86 |
|
|
Air conduction bilat
|
$30.75 |
$33.50 |
$157.93 |
|
|
Air injection into abdomen 49400
|
$113.85 |
$145.49 |
$665.58 |
|
|
Airway resistance by impulse oscillometry 94728
|
$10.08 |
$75.74 |
$199.58 |
|
|
Albumin body fluid quantitative each specimen
|
$4.87 |
$9.63 |
$86.08 |
|
|
Albumin (human), 25%, 50ml
|
$16.70 |
$350.37 |
$500.85 |
|
|
Albumin (human), 5%, 250 ml
|
$2.61 |
$231.00 |
$304.97 |
|
|
Albumin, human 5 % intravenous solution
|
$19.91 |
$86.10 |
$233.73 |
|
|
Albumin (microalbumin) 24 hour urine quantitative
|
$5.71 |
$10.61 |
$91.27 |
|
|
Albumin serum plasma or whole blood
|
$9.16 |
$19.91 |
$73.24 |
|
|
Alcohol/subs interv 15-30mn
|
$31.84 |
$34.34 |
$40.20 |
|
|
Alcohol/subs interv >30 min
|
$31.84 |
$31.84 |
$34.34 |
|
|
Alemtuzumab 12 mg/1.2 ml intravenous solution
|
$37,118.94 |
$37,118.94 |
$37,118.94 |
|
|
Alkaline phosphatase
|
$11.68 |
$23.07 |
$69.15 |
|
|
Allergen alpha lactalbumin ige
|
$10.48 |
$15.20 |
$80.40 |
|
|
Allergen egg white ige
|
$7.34 |
$13.72 |
$250.85 |
|
|
Allergen specific ige qual multi scrn ea
|
$2.16 |
$10.91 |
$31.27 |
|
|
Allergy injections; 2 or more 95117
|
$17.81 |
$17.81 |
$17.81 |
|
|
Allergy injection; single 95115
|
$15.59 |
$15.59 |
$15.59 |
|
|
Allograft allowrap 4x4cm dry 16sqcm
|
$6,551.30 |
$11,244.17 |
$12,249.75 |
|
|
Allograft amnioexcel plus 17mm disk
|
$2,981.51 |
$2,981.51 |
$2,981.51 |
|
|
Allograft amniotic activebarrier 200 2x2cm-q4100-cost per sheet
|
$202.68 |
$484.01 |
$27,033.43 |
|
|
Allograft dermis 20x25x1mm decell w/matracell arthroflex
|
$64.79 |
$231.08 |
$9,422.08 |
|
|
Allograft ecm allopatch hd dehydr thick 0.8-1.7mmx2x5cm-cost per sq cm
|
$34.30 |
$58.98 |
$35,981.42 |
|
|
Allograft epieffect 2x3cm-q4186-cost per sq cm
|
$176.51 |
$248.10 |
$20,704.61 |
|
|
Allograft graftjacket 2x12cm-q4107-cost per sq cm
|
$95.64 |
$3,876.54 |
$9,422.08 |
|
|
Allograft membrn amnio 1x2cm hu ambriodry
|
$780.56 |
$3,668.28 |
$8,849.62 |
|
|
Allograft umbil cord+amniotic membrane-q4148-cost per sq cm
|
$2,293.15 |
$6,652.34 |
$7,247.26 |
|
|
Allograft umbilical epicord 15 sq cm-q4187-cost per sq cm
|
$3,025.07 |
$3,025.07 |
$3,295.60 |
|
|
Alpha-1-proteinase inhibitor (human) 1,000 mg (+/-) IV solution
|
$7.26 |
$1,047.88 |
$2,580.68 |
|
|
Alpha-fetoprotein afp-l3 frac & total
|
$16.30 |
$31.43 |
$108.83 |
|
|
Alpha-fetoprotein amniotic
|
$4.28 |
$8.26 |
$114.27 |
|
|
Alpha-fetoprotein tumor marker
|
$4.28 |
$8.47 |
$164.29 |
|
|
Alprostadil for injection
|
$276.77 |
$276.77 |
$276.77 |
|
|
Alteplase 100 mg infusion from pyxis vial
|
$337.32 |
$8,025.26 |
$30,343.35 |
|
|
Alt/sgpt
|
$9.20 |
$21.58 |
$91.12 |
|
|
Aluminum - quest
|
$6.47 |
$12.78 |
$375.46 |
|
|
Alys cplx sp/pn npgt w/prgrm
|
$86.08 |
$119.37 |
$442.04 |
|
|
Amantadine (symmetrel)-sendout
|
$15.71 |
$35.57 |
$181.76 |
|
|
Ambl bp mntr w/sw a/r
|
$11.29 |
$11.29 |
$11.29 |
|
|
Ambl bp mntr w/sw i&r
|
$27.46 |
$27.46 |
$27.46 |
|
|
Amikacin 4 mg/ml intravitreal injection - cnr
|
$0.02 |
$36.42 |
$172.15 |
|
|
Amino acid single qual
|
$119.47 |
$119.47 |
$119.47 |
|
|
Amino acids quant 2-5
|
$11.12 |
$11.12 |
$11.12 |
|
|
Aminocaproic acid 5 g/250 ml 0.9% nacl IV - cnr
|
$9.94 |
$13.29 |
$14.48 |
|
|
Aminolevulinic acid, 10% gel
|
$477.89 |
$477.89 |
$477.89 |
|
|
Aminolevulinic acid delta
|
$6.30 |
$12.45 |
$217.41 |
|
|
Aminolevulinic acid hcl top
|
$442.36 |
$442.36 |
$442.36 |
|
|
Aminophylline 25 mg/ml intravenous solution (wrapper)
|
$2.62 |
$13.34 |
$103.14 |
|
|
Amiodarone 150 mg/100 ml (1.5 mg/ml) in dextrose, iso-osmotic IV
|
$10.26 |
$86.45 |
$399.20 |
|
|
Amiodarone 50 mg/ml intravenous solution
|
$0.01 |
$52.72 |
$113.53 |
|
|
Amitriptyline (elavil) -sendout
|
$5.71 |
$10.88 |
$42.28 |
|
|
Amivantamab-vmjw 50 mg/ml intravenous solution
|
$5,475.97 |
$5,475.97 |
$5,475.97 |
|
|
Ammonia
|
$17.89 |
$35.36 |
$212.96 |
|
|
Amniocentesisdiagnostic 59000
|
$226.86 |
$408.35 |
$1,033.61 |
|
|
Amniocentesis therapeutic
|
$435.87 |
$870.96 |
$1,279.49 |
|
|
Amniotic fluid scan
|
$16.05 |
$16.05 |
$16.05 |
|
|
Amp f/th 1/2 jt/phalanx w/neurect local flap
|
$1,084.07 |
$1,084.07 |
$1,084.07 |
|
|
Amphetamine confirm urine -sendout
|
$13.10 |
$24.65 |
$87.52 |
|
|
Amphotericin b in d5w IV syringe 0.1 mg/ml (neo/ped) - cnr
|
$69.91 |
$103.99 |
$283.45 |
|
|
Amphotericin b lipid complex
|
$11.37 |
$12.37 |
$514.03 |
|
|
Amphotericin b liposomal in d5w IV syringe 1 mg/ml (neo/ped) - cnr
|
$23.79 |
$620.17 |
$1,578.24 |
|
|
Ampicillin 1 gram solution for injection
|
$24.45 |
$36.18 |
$86.45 |
|
|
Ampicillin-sulbactam 1.5 gram solution for injection
|
$0.16 |
$20.75 |
$153.30 |
|
|
Amp metatarsal w/toe single 28810
|
$1,555.55 |
$1,555.55 |
$4,707.99 |
|
|
Amp thigh through femur re-amp 27596
|
$1,114.49 |
$1,114.49 |
$1,114.49 |
|
|
Amputate leg at thigh
|
$964.60 |
$964.60 |
$964.60 |
|
|
Amputate lower leg at knee
|
$999.48 |
$999.48 |
$999.48 |
|
|
Amputate thigh through femur 27590
|
$1,205.75 |
$1,205.75 |
$1,205.75 |
|
|
Amputation follow-up surgery
|
$894.86 |
$894.86 |
$894.86 |
|
|
Amputation leg thr tib/fib 27880
|
$1,382.35 |
$1,382.35 |
$1,382.35 |
|
|
Amputation leg; tib/fib f/u 27886
|
$998.74 |
$998.74 |
$998.74 |
|
|
Amputation of lower leg
|
$922.31 |
$922.31 |
$922.31 |
|
|
Amputation of midtarsal 28800
|
$817.69 |
$817.69 |
$817.69 |
|
|
Amputation thru metatarsal
|
$1,095.20 |
$1,095.20 |
$1,095.20 |
|
