|
11-desoxycortisol - sendout
|
$4.16 |
$4.16 |
$4.16 |
$84.56
|
|
17-hydroxypregnenolone
|
$3.24 |
$3.24 |
$3.24 |
$87.50
|
|
17-ketosteroids
|
$4.76 |
$4.76 |
$4.76 |
$46.20
|
|
2nd order venous cath
|
$323.68 |
$323.68 |
$323.68 |
$1,635.60
|
|
3d ech img cgen car anomal
|
$192.80 |
$192.80 |
$192.80 |
$532.35
|
|
3d recon without postprocess indpndt
|
$285.28 |
$285.28 |
$285.28 |
$480.00
|
|
5% dextrose and 0.45% saline
|
$21.43 |
$21.43 |
$21.43 |
$48.00
|
|
5' nucleotidase - sendout
|
$1.59 |
$1.59 |
$1.59 |
$48.60
|
|
88334 ap bill cytologic exam each additional site
|
$29.76 |
$29.76 |
$29.76 |
$97.65
|
|
#a/b/c/c/h pnl-candida albicans ab
|
$1.71 |
$1.71 |
$1.71 |
$53.95
|
|
Abd aorta w/runoff s&i
|
$1,848.64 |
$1,848.64 |
$1,848.64 |
$3,569.56
|
|
Abd/low ext cath 1st
|
$690.56 |
$690.56 |
$690.56 |
$2,121.00
|
|
Abd/low ext cath 2nd
|
$2,016.00 |
$2,016.00 |
$2,016.00 |
$2,167.80
|
|
Abd/low ext cath 3rd
|
$802.24 |
$802.24 |
$802.24 |
$2,639.65
|
|
Abd/low ext cath addl
|
$363.04 |
$363.04 |
$363.04 |
$965.25
|
|
Abdominal CT scan (with and without contrast)
|
$935.52 |
$935.52 |
$935.52 |
$1,997.40
|
|
Abdominal CT scan (with contrast)
|
$830.72 |
$830.72 |
$830.72 |
$1,670.88
|
|
Abdominal CT scan (without contrast)
|
$642.88 |
$642.88 |
$642.88 |
$1,363.35
|
|
Abdominal MRI (with and without contrast)
|
$1,633.12 |
$1,633.12 |
$1,633.12 |
$3,061.80
|
|
Abdominal MRI (with contrast)
|
$1,076.32 |
$1,076.32 |
$1,076.32 |
$2,210.00
|
|
Abdominal MRI (without contrast)
|
$895.68 |
$895.68 |
$895.68 |
$2,048.36
|
|
Abdominal paracentesis w/image guidance
|
$356.48 |
$356.48 |
$356.48 |
$1,655.40
|
|
Abdominal Ultrasound (complete)
|
$422.56 |
$422.56 |
$422.56 |
$785.55
|
|
Abdominal Ultrasound (limited)
|
$301.28 |
$301.28 |
$301.28 |
$603.33
|
|
Abd paracentesis/w/o image guide 49082
|
$329.92 |
$329.92 |
$329.92 |
$1,145.00
|
|
Abl1 gene
|
$118.58 |
$118.58 |
$118.58 |
$668.85
|
|
Ablate arrhythmia add on
|
$3,973.44 |
$3,973.44 |
$3,973.44 |
$6,913.20
|
|
Ablate heart dysrhythm focus
|
$3,987.04 |
$3,987.04 |
$3,987.04 |
$9,523.80
|
|
Ablation cardiac vagal inputs atrium
|
$165.92 |
$165.92 |
$165.92 |
$2,260.30
|
|
Ablation cryo pq liver tumor(s)
|
$8,328.96 |
$8,328.96 |
$8,328.96 |
$8,581.80
|
|
Ablation of upper extremity nerves rf
|
$236.16 |
$236.16 |
$236.16 |
$832.50
|
|
Abscess drain retroperitoneal surg code
|
$578.08 |
$578.08 |
$578.08 |
$2,957.17
|
|
Access & clsr pq fem art endogft dlvry w/img uni
|
$193.60 |
$193.60 |
$193.60 |
$2,670.25
|
|
Acetaminophen 10 mg/ml soln 100 ml glass cont
|
$16.16 |
$16.16 |
$16.16 |
$80.14
|
|
Acetaminophen level
|
$32.00 |
$32.00 |
$32.00 |
$109.85
|
|
Acetazolamide 500 mg solution for injection
|
$60.99 |
$60.99 |
$60.99 |
$122.55
|
|
Acetone qualitative
|
$28.32 |
$28.32 |
$28.32 |
$43.80
|
|
Acetylcholine receptor modulating antibody
|
$1.38 |
$1.38 |
$1.38 |
$61.80
|
|
Acetylcysteine 200 mg/ml (20 %) intravenous solution
|
$117.73 |
$117.73 |
$117.73 |
$232.95
|
|
Acute hepatitis panel
|
$148.00 |
$148.00 |
$148.00 |
$284.70
|
|
Acyclovir 400 mg tablet
|
$51.36 |
$51.36 |
$51.36 |
$54.77
|
|
Acyclovir 5 mg/ml in ns IV syringe (neo/ped) - cnr
|
$36.00 |
$36.00 |
$36.00 |
$64.45
|
|
Adenosine 3 mg/250 ml bag for osm
|
$12.05 |
$12.05 |
$12.05 |
$234.26
|
|
Adenovirus antibody,serum - quest
|
$12.64 |
$12.64 |
$12.64 |
$60.40
|
|
Adh-sendout
|
$48.80 |
$48.80 |
$48.80 |
$109.28
|
|
Admelog u-100 insulin lispro 100 unit/ml subcutaneous solution
|
$8.00 |
$8.00 |
$8.00 |
$186.07
|
|
Administration chemotherapy IV infusion each additional hour
|
$142.08 |
$142.08 |
$142.08 |
$233.11
|
|
Administration chemotherapy IV infusion each addl sequential infusion diff substance/drug >1 hr
|
$117.60 |
$117.60 |
$117.60 |
$307.45
|
|
Administration chemotherapy IV infusion up to 1 hour single/initial substance/drug
|
$228.80 |
$228.80 |
$228.80 |
$659.36
|
|
Administration chemotherapy IV push single/initial substance/drug
|
$123.84 |
$123.84 |
$123.84 |
$444.49
|
|
Administration chemotherapy subcutaneous/im anti neoplastic hormonal
|
$161.28 |
$161.28 |
$161.28 |
$220.00
|
|
Administration chemotherapy subcutaneous/im anti neoplastic non hormonal
|
$161.28 |
$161.28 |
$161.28 |
$264.00
|
|
Administration immunization 1 vaccine
|
$23.36 |
$23.36 |
$23.36 |
$66.51
|
|
Administration immunization each additional vaccine
|
$17.76 |
$17.76 |
$17.76 |
$46.23
|
|
Administration immunization intranasal/oral route 1 vaccine
|
$16.16 |
$16.16 |
$16.16 |
$48.00
|
|
Administration immunization intranasal/oral route each additional vaccine
|
$16.16 |
$16.16 |
$16.16 |
$31.20
|
|
_afb id by dna probe rflx ast
|
$91.04 |
$91.04 |
$91.04 |
$93.52
|
|
_afb org id by sequencing rflx ast-sendout
|
$16.41 |
$16.41 |
$16.41 |
$289.60
|
|
Albumin body fluid quantitative each specimen
|
$25.12 |
$25.12 |
$25.12 |
$47.50
|
|
Albumin (human), 25%, 50ml
|
$191.83 |
$191.83 |
$191.83 |
$227.64
|
|
Albumin (human), 5%, 250 ml
|
$94.40 |
$94.40 |
$94.40 |
$237.90
|
|
Albumin (microalbumin) 24 hour urine quantitative
|
$16.32 |
$16.32 |
$16.32 |
$57.20
|
|
Albumin serum plasma or whole blood
|
$30.24 |
$30.24 |
$30.24 |
$41.34
|
|
Alcohol (ethanol) any specimen except urine/breath
|
$2.84 |
$2.84 |
$2.84 |
$93.60
|
|
Alkaline phosphatase
|
$28.48 |
$28.48 |
$28.48 |
$46.65
|
|
Allergen alpha lactalbumin ige
|
$6.44 |
$6.44 |
$6.44 |
$46.80
|
|
Allergen egg white ige
|
$27.04 |
$27.04 |
$27.04 |
$36.60
|
|
Allergen specific ige qual multi scrn ea
|
$1.28 |
$1.28 |
$1.28 |
$24.00
|
|
Allograft umbil cord+amniotic membrane-q4148-cost per sq cm
|
$3,988.96 |
$3,988.96 |
$3,988.96 |
$4,687.16
|
|
Allograft umbilical epicord 15 sq cm-q4187-cost per sq cm
|
$2,041.28 |
$2,041.28 |
$2,041.28 |
$1,616.79
|
|
Alpha-fetoprotein afp-l3 frac & total
|
$9.16 |
$9.16 |
$9.16 |
$175.20
|
|
Alpha-fetoprotein amniotic
|
$1.92 |
$1.92 |
$1.92 |
$97.80
|
|
Alpha-fetoprotein tumor marker
|
$47.36 |
$47.36 |
$47.36 |
$106.00
|
|
Alteplase 100 mg infusion from pyxis vial
|
$197.32 |
$197.32 |
$197.32 |
$15,857.45
|
|
Alt/sgpt
|
$40.00 |
$40.00 |
$40.00 |
$48.00
|
|
Aluminum - quest
|
$3.16 |
$3.16 |
$3.16 |
$83.05
|
|
Alys cplx sp/pn npgt w/prgrm
|
$151.36 |
$151.36 |
$151.36 |
$437.50
|
|
Amantadine (symmetrel)-sendout
|
$40.96 |
$40.96 |
$40.96 |
$178.10
|
|
Amino acids quant 2-5
|
$2.51 |
$2.51 |
$2.51 |
$113.60
|
|
Aminolevulinic acid delta
|
$2.34 |
$2.34 |
$2.34 |
$79.30
|
|
Amiodarone 150 mg/100 ml (1.5 mg/ml) in dextrose, iso-osmotic IV
|
$52.27 |
$52.27 |
$52.27 |
$123.03
|
|
Amiodarone 50 mg/ml intravenous solution
|
$10.56 |
$10.56 |
$10.56 |
$55.86
|
|
Amitriptyline (elavil) -sendout
|
$5.56 |
$5.56 |
$5.56 |
$87.60
|
|
Ammonia
|
$90.08 |
$90.08 |
$90.08 |
$118.83
|
|
Amniocentesisdiagnostic 59000
|
$180.64 |
$180.64 |
$180.64 |
$943.50
|
|
Amphetamine confirm urine -sendout
|
$36.64 |
$36.64 |
$36.64 |
$93.61
|
|
Amphetamines 5 or more
|
$42.88 |
$42.88 |
$42.88 |
$85.15
|
|
Amphotericin b liposomal in d5w IV syringe 1 mg/ml (neo/ped) - cnr
|
$200.54 |
$200.54 |
$200.54 |
$558.95
|
|
Ampicillin 1 gram solution for injection
|
$20.10 |
$20.10 |
$20.10 |
$61.96
|
|
Ampicillin-sulbactam 1.5 gram solution for injection
|
$12.47 |
$12.47 |
$12.47 |
$54.69
|
|
Amylase
|
$68.80 |
$68.80 |
$68.80 |
$85.65
|
|
Anabolic steroid 1 or 2
|
$22.88 |
$22.88 |
$22.88 |
$80.08
|
|
Analgesics non-opioid definitive assay 1 or 2 acetaminophen
|
$9.92 |
$9.92 |
$9.92 |
$113.28
|
|
Analysis gene f2 20210g>a variant
|
$6.06 |
$6.06 |
$6.06 |
$219.13
|
|
Analysis gene f5 leiden variant
|
$6.08 |
$6.08 |
$6.08 |
$230.40
|
|
Analysis tumor
|
$67.36 |
$67.36 |
$67.36 |
$248.80
|
|
Anaplsma phgcytophlm amp prb
|
$4.82 |
$4.82 |
$4.82 |
$76.70
|
|
Anastrozole 1 mg
|
$5.60 |
$5.60 |
$5.60 |
$22.40
|
|
Anca screen with reflex to titer -quest
|
$42.88 |
$42.88 |
$42.88 |
$101.50
|
|
An cholangiogram percutaneous compl
|
$896.80 |
$896.80 |
$896.80 |
$2,494.35
|
