|
17-hydroxypregnenolone
|
$41.77 |
$41.77 |
$41.77 |
$85.15
|
|
3-d radiotherapy plan
|
$5,794.10 |
$5,794.10 |
$5,794.10 |
$4,886.50
|
|
5' nucleotidase - sendout
|
$20.69 |
$20.69 |
$20.69 |
$50.05
|
|
88334 ap bill cytologic exam each additional site
|
$205.20 |
$205.20 |
$205.20 |
$97.65
|
|
Abd aorta w/runoff s&i
|
$9,453.57 |
$9,453.57 |
$9,453.57 |
$3,667.71
|
|
Abd/low ext cath 1st
|
$1,731.10 |
$1,731.10 |
$1,731.10 |
$2,608.45
|
|
Abd/low ext cath 2nd
|
$1,853.27 |
$1,853.27 |
$1,853.27 |
$2,517.20
|
|
Abd/low ext cath 3rd
|
$1,853.27 |
$1,853.27 |
$1,853.27 |
$3,050.58
|
|
Abd/low ext cath addl
|
$981.95 |
$981.95 |
$981.95 |
$1,009.00
|
|
Abdominal CT scan (with and without contrast)
|
$7,083.46 |
$7,083.46 |
$7,083.46 |
$2,049.00
|
|
Abdominal CT scan (with contrast)
|
$6,192.24 |
$6,192.24 |
$6,192.24 |
$1,683.63
|
|
Abdominal CT scan (without contrast)
|
$4,656.86 |
$4,656.86 |
$4,656.86 |
$1,358.76
|
|
Abdominal MRI (with and without contrast)
|
$6,692.67 |
$6,692.67 |
$6,692.67 |
$2,916.21
|
|
Abdominal MRI (with contrast)
|
$3,969.66 |
$3,969.66 |
$3,969.66 |
$2,187.60
|
|
Abdominal MRI (without contrast)
|
$5,303.46 |
$5,303.46 |
$5,303.46 |
$1,972.66
|
|
Abdominal paracentesis w/image guidance
|
$1,806.77 |
$1,806.77 |
$1,806.77 |
$1,666.30
|
|
Abdominal Ultrasound (complete)
|
$2,456.62 |
$2,456.62 |
$2,456.62 |
$759.57
|
|
Abdominal Ultrasound (limited)
|
$1,268.58 |
$1,268.58 |
$1,268.58 |
$603.33
|
|
Abl1 gene
|
$25,212.56 |
$25,212.56 |
$25,212.56 |
$609.93
|
|
Abscess drain retroperitoneal surg code
|
$4,940.23 |
$4,940.23 |
$4,940.23 |
$3,053.18
|
|
Acetaminophen 10 mg/ml soln 100 ml glass cont
|
$87.71 |
$87.71 |
$87.71 |
$125.63
|
|
Acetaminophen level
|
$64.74 |
$64.74 |
$64.74 |
$117.01
|
|
Acetazolamide 500 mg solution for injection
|
$154.99 |
$154.99 |
$154.99 |
$133.60
|
|
Acetylcholine receptor modulating antibody
|
$117.14 |
$117.14 |
$117.14 |
$65.60
|
|
Acetylcysteine 200 mg/ml (20 %) intravenous solution
|
$70.87 |
$70.87 |
$70.87 |
$323.77
|
|
Acute hepatitis panel
|
$278.33 |
$278.33 |
$278.33 |
$284.70
|
|
Acyclovir 5 mg/ml in ns IV syringe (neo/ped) - cnr
|
$37.31 |
$37.31 |
$37.31 |
$50.70
|
|
Adenosine 3 mg/250 ml bag for osm
|
$473.70 |
$473.70 |
$473.70 |
$219.86
|
|
Adh-sendout
|
$106.40 |
$106.40 |
$106.40 |
$109.28
|
|
Admelog u-100 insulin lispro 100 unit/ml subcutaneous solution
|
$31.77 |
$31.77 |
$31.77 |
$124.70
|
|
Administration chemotherapy IV infusion each additional hour
|
$310.03 |
$310.03 |
$310.03 |
$230.35
|
|
Administration chemotherapy IV infusion each addl sequential infusion diff substance/drug >1 hr
|
$311.52 |
$311.52 |
$311.52 |
$308.10
|
|
Administration chemotherapy IV infusion up to 1 hour single/initial substance/drug
|
$1,133.38 |
$1,133.38 |
$1,133.38 |
$672.03
|
|
Administration chemotherapy subcutaneous/im anti neoplastic hormonal
|
$143.45 |
$143.45 |
$143.45 |
$220.00
|
|
Administration chemotherapy subcutaneous/im anti neoplastic non hormonal
|
$143.45 |
$143.45 |
$143.45 |
$264.00
|
|
Administration immunization 1 vaccine
|
$106.41 |
$106.41 |
$106.41 |
$70.52
|
|
Administration immunization each additional vaccine
|
$106.41 |
$106.41 |
$106.41 |
$46.23
|
|
Administration vaccine influenza virus
|
$352.38 |
$352.38 |
$352.38 |
$49.50
|
|
Air injection into abdomen 49400
|
$1,082.36 |
$1,082.36 |
$1,082.36 |
$531.49
|
|
Albumin body fluid quantitative each specimen
|
$65.58 |
$65.58 |
$65.58 |
$48.00
|
|
Albumin (human), 25%, 50ml
|
$776.81 |
$776.81 |
$776.81 |
$295.80
|
|
Albumin, human 25 % intravenous solution
|
$438.56 |
$438.56 |
$438.56 |
$488.08
|
|
Albumin (human), 5%, 250 ml
|
$701.03 |
$701.03 |
$701.03 |
$295.80
|
|
Albumin (microalbumin) 24 hour urine quantitative
|
$112.18 |
$112.18 |
$112.18 |
$57.60
|
|
Albumin serum plasma or whole blood
|
$86.49 |
$86.49 |
$86.49 |
$43.50
|
|
Albuterol ipratrop non-comp
|
$26.50 |
$26.50 |
$26.50 |
$22.45
|
|
Albuterol non-comp unit
|
$7.44 |
$7.44 |
$7.44 |
$9.59
|
|
Alcohol (ethanol) any specimen except urine/breath
|
$339.82 |
$339.82 |
$339.82 |
$93.60
|
|
Alkaline phosphatase
|
$96.40 |
$96.40 |
$96.40 |
$46.20
|
|
Allergen alpha lactalbumin ige
|
$97.46 |
$97.46 |
$97.46 |
$56.35
|
|
Allergen egg white ige
|
$99.34 |
$99.34 |
$99.34 |
$41.00
|
|
Allograft dermis 20x25x1mm decell w/matracell arthroflex
|
$715.96 |
$715.96 |
$715.96 |
$6,285.56
|
|
Allograft graftjacket 2x12cm-q4107-cost per sq cm
|
$761.04 |
$761.04 |
$761.04 |
$2,513.00
|
|
Alpha-fetoprotein afp-l3 frac & total
|
$335.03 |
$335.03 |
$335.03 |
$189.00
|
|
Alpha-fetoprotein tumor marker
|
$181.10 |
$181.10 |
$181.10 |
$99.00
|
|
Alteplase 100 mg infusion from pyxis vial
|
$476.04 |
$476.04 |
$476.04 |
$2,600.22
|
|
Alt/sgpt
|
$119.02 |
$119.02 |
$119.02 |
$49.00
|
|
Aluminum - quest
|
$17.39 |
$17.39 |
$17.39 |
$87.00
|
|
Amantadine (symmetrel)-sendout
|
$292.24 |
$292.24 |
$292.24 |
$196.20
|
|
Aminophylline 25 mg/ml intravenous solution (wrapper)
|
$30.94 |
$30.94 |
$30.94 |
$41.59
|
|
Amiodarone 150 mg/100 ml (1.5 mg/ml) in dextrose, iso-osmotic IV
|
$293.05 |
$293.05 |
$293.05 |
$202.10
|
|
Amiodarone 50 mg/ml intravenous solution
|
$58.87 |
$58.87 |
$58.87 |
$47.44
|
|
Amitriptyline (elavil) -sendout
|
$34.77 |
$34.77 |
$34.77 |
$101.17
|
|
Amivantamab-vmjw 50 mg/ml intravenous solution
|
$34,159.53 |
$34,159.53 |
$34,159.53 |
$15,167.75
|
|
Ammonia
|
$329.36 |
$329.36 |
$329.36 |
$120.90
|
|
Amphetamine confirm urine -sendout
|
$137.76 |
$137.76 |
$137.76 |
$94.50
|
|
Ampicillin 1 gram solution for injection
|
$61.46 |
$61.46 |
$61.46 |
$57.76
|
|
Ampicillin-sulbactam 1.5 gram solution for injection
|
$106.20 |
$106.20 |
$106.20 |
$51.93
|
|
Amylase
|
$323.64 |
$323.64 |
$323.64 |
$93.00
|
|
Analysis gene f2 20210g>a variant
|
$228.13 |
$228.13 |
$228.13 |
$219.60
|
|
Analysis gene f5 leiden variant
|
$254.81 |
$254.81 |
$254.81 |
$226.60
|
|
Anaplsma phgcytophlm amp prb
|
$123.34 |
$123.34 |
$123.34 |
$95.45
|
|
Anca screen with reflex to titer -quest
|
$147.13 |
$147.13 |
$147.13 |
$109.20
|
|
An cholangiogram percutaneous compl
|
$8,056.37 |
$8,056.37 |
$8,056.37 |
$2,626.65
|
|
An fluoro guide for cvp
|
$813.99 |
$813.99 |
$813.99 |
$484.45
|
|
Angioplasty fem/pop unilat 37224
|
$18,550.34 |
$18,550.34 |
$18,550.34 |
$9,182.45
|
|
Angioplasty/iliac/init ves/unilat 37220
|
$17,942.65 |
$17,942.65 |
$17,942.65 |
$11,524.11
|
|
Angioplasty tib/pero/unilat/ea add 37232
|
$38,056.99 |
$38,056.99 |
$38,056.99 |
$6,513.10
|
|
Angiotensin ii 0.5 mg/ml soln 1 ml vial
|
$5,501.23 |
$5,501.23 |
$5,501.23 |
$6,736.02
|
|
Angio tib/peroneal/init ves/unila 37228
|
$38,056.99 |
$38,056.99 |
$38,056.99 |
$13,351.25
|
|
Angio trnslmnl balloon same artery ini
|
$17,942.65 |
$17,942.65 |
$17,942.65 |
$9,074.63
|
|
Angio trnslmnl balloon same vein ea addl
|
$9,070.69 |
$9,070.69 |
$9,070.69 |
$4,865.57
|
|
Angio trnslmnl balloon same vein ini
|
$17,942.65 |
$17,942.65 |
$17,942.65 |
$8,689.20
|
|
Ankle X-ray
|
$796.48 |
$796.48 |
$796.48 |
$339.44
|
|
Anodyne therapy charges pt
|
$74.51 |
$74.51 |
$74.51 |
$41.02
|
|
Antibody elution rbc reference
|
$192.22 |
$192.22 |
$192.22 |
$176.54
|
|
Antibody htlv/hiv confirm test
|
$118.30 |
$118.30 |
$118.30 |
$141.74
|
|
Antibody identification platelet antibodies heparin-pf4 igg
|
$406.82 |
$406.82 |
$406.82 |
$220.73
|
|
Antibody id rbc panel
|
$735.09 |
$735.09 |
$735.09 |
$291.75
|
|
Antibody screen rbc
|
$110.76 |
$110.76 |
$110.76 |
$105.00
|
|
Anti mog serum - sendout
|
$380.63 |
$380.63 |
$380.63 |
$140.62
|
|
Antineutrophil cytoplasmic antibody screen each antibody
|
$34.13 |
$34.13 |
$34.13 |
$50.88
|
|
Antineutrophil cytoplasmic antibody titer each antibody
|
$33.22 |
$33.22 |
$33.22 |
$45.82
|
|
Antinuclear antibodies
|
$199.30 |
$199.30 |
$199.30 |
$91.70
|
|
Antinuclear antibodies titer
|
$38.20 |
$38.20 |
$38.20 |
$80.25
|
|
Antiphosphatidylserine antibody
|
$273.03 |
$273.03 |
$273.03 |
$74.20
|
|
Antistreptolysin o screen
|
$10.23 |
$10.23 |
$10.23 |
$59.40
|
|
Antistreptolysin o titer
|
$21.13 |
$21.13 |
$21.13 |
$57.96
|
|
Antithrombin iii activity
|
$26.06 |
$26.06 |
$26.06 |
$115.23
|
|
Apheresis plasma
|
$3,056.40 |
$3,056.40 |
$3,056.40 |
$3,411.50
|
