|
17-hydroxypregnenolone
|
$74.10 |
$74.10 |
$74.10 |
$92.65
|
|
1pc ost pch drain hgh output
|
$9.75 |
$9.75 |
$9.75 |
$8.40
|
|
1 pc ost pouch w filter
|
$3.25 |
$3.25 |
$3.25 |
$6.72
|
|
1 pc ost pou w built-in conv
|
$11.05 |
$11.05 |
$11.05 |
$11.05
|
|
24 hr ambulatory b/p monitor
|
$320.45 |
$320.45 |
$320.45 |
$313.04
|
|
2d tee w or without fol w/con,in
|
$3,031.60 |
$3,031.60 |
$3,031.60 |
$1,724.25
|
|
2d tte w or without fol w/con,co
|
$2,254.85 |
$2,254.85 |
$2,254.85 |
$1,284.00
|
|
3d anat seg imaging preop
|
$431.60 |
$431.60 |
$431.60 |
$192.08
|
|
3d ech img cgen car anomal
|
$805.35 |
$805.35 |
$805.35 |
$511.60
|
|
3d recon without postprocess indpndt
|
$176.80 |
$176.80 |
$176.80 |
$508.13
|
|
5' nucleotidase - sendout
|
$20.15 |
$20.15 |
$20.15 |
$50.05
|
|
88334 ap bill cytologic exam each additional site
|
$120.90 |
$120.90 |
$120.90 |
$100.10
|
|
Abatacept (with maltose) 250 mg intravenous solution
|
$356.20 |
$356.20 |
$356.20 |
$3,138.72
|
|
#a/b/c/c/h pnl-candida albicans ab
|
$27.30 |
$27.30 |
$27.30 |
$53.95
|
|
Abciximab injection
|
$8,730.15 |
$8,730.15 |
$8,730.15 |
$2,443.52
|
|
Abdominal and Pelvic Blood Vessel Ultrasound (complete)
|
$1,494.35 |
$1,494.35 |
$1,494.35 |
$988.00
|
|
Abdominal and Pelvic Blood Vessel Ultrasound (limited)
|
$516.75 |
$516.75 |
$516.75 |
$662.40
|
|
Abdominal CT scan (with and without contrast)
|
$3,948.75 |
$3,948.75 |
$3,948.75 |
$1,976.94
|
|
Abdominal CT scan (with contrast)
|
$3,341.65 |
$3,341.65 |
$3,341.65 |
$1,667.60
|
|
Abdominal CT scan (without contrast)
|
$3,194.75 |
$3,194.75 |
$3,194.75 |
$1,353.32
|
|
Abdominal MRI (with and without contrast)
|
$4,013.75 |
$4,013.75 |
$4,013.75 |
$2,967.00
|
|
Abdominal MRI (with contrast)
|
$3,765.45 |
$3,765.45 |
$3,765.45 |
$2,240.00
|
|
Abdominal MRI (without contrast)
|
$3,647.80 |
$3,647.80 |
$3,647.80 |
$2,048.36
|
|
Abdominal Ultrasound (complete)
|
$1,479.40 |
$1,479.40 |
$1,479.40 |
$783.00
|
|
Abdominal Ultrasound (limited)
|
$1,167.40 |
$1,167.40 |
$1,167.40 |
$586.43
|
|
Abdominal X-ray (2 views)
|
$640.25 |
$640.25 |
$640.25 |
$318.20
|
|
Abdominal X-ray Series (acute, with chest view)
|
$761.15 |
$761.15 |
$761.15 |
$418.63
|
|
Abdominal X-ray (single view)
|
$575.90 |
$575.90 |
$575.90 |
$260.00
|
|
Abl1 gene
|
$668.85 |
$668.85 |
$668.85 |
$683.20
|
|
Ablat 1/+thyr ndul addl prq rf
|
$3,081.00 |
$3,081.00 |
$3,081.00 |
$1,155.50
|
|
Ablate arrhythmia add on
|
$16,352.05 |
$16,352.05 |
$16,352.05 |
$6,828.51
|
|
Ablate atria lmtd endo 33265
|
$6,860.75 |
$6,860.75 |
$6,860.75 |
$2,738.40
|
|
Ablate atria x10sv endo 33266
|
$11,873.55 |
$11,873.55 |
$11,873.55 |
$11,873.55
|
|
Ablate heart dysrhythm focus
|
$17,585.75 |
$17,585.75 |
$17,585.75 |
$9,332.05
|
|
Ablation cardiac vagal inputs atrium
|
$25,432.55 |
$25,432.55 |
$25,432.55 |
$2,260.30
|
|
Abltj 1/+thyr ndul 1lobe prq
|
$4,465.50 |
$4,465.50 |
$4,465.50 |
$3,055.20
|
|
Abobotulinumtoxina
|
$83.85 |
$83.85 |
$83.85 |
$1,541.21
|
|
Acetaminophen 10 mg/ml soln 100 ml glass cont
|
$92.30 |
$92.30 |
$92.30 |
$72.74
|
|
Acetaminophen 120 mg rectal suppository
|
$403.65 |
$403.65 |
$403.65 |
$146.76
|
|
Acetaminophen level
|
$241.80 |
$241.80 |
$241.80 |
$116.80
|
|
Acetazolamide 500 mg solution for injection
|
$347.10 |
$347.10 |
$347.10 |
$122.55
|
|
Acetone qualitative
|
$122.85 |
$122.85 |
$122.85 |
$46.80
|
|
Acetylcholine receptor modulating antibody
|
$137.80 |
$137.80 |
$137.80 |
$67.50
|
|
Acetylcysteine 200 mg/ml (20 %) intravenous solution
|
$14.30 |
$14.30 |
$14.30 |
$218.79
|
|
Aco cont gluc mnt phys/qhp eqp 95250aco
|
$385.45 |
$385.45 |
$385.45 |
$341.00
|
|
Actigraphy testing
|
$163.80 |
$163.80 |
$163.80 |
$234.00
|
|
Acute hepatitis panel
|
$1,250.60 |
$1,250.60 |
$1,250.60 |
$284.95
|
|
Acyclovir 400 mg tablet
|
$3,087.50 |
$3,087.50 |
$3,087.50 |
$54.77
|
|
Acyclovir 5 mg/ml in ns IV syringe (neo/ped) - cnr
|
$142.35 |
$142.35 |
$142.35 |
$64.45
|
|
#acylcarnitineprfl
|
$24.70 |
$24.70 |
$24.70 |
$121.55
|
|
Adapter b 8 channel 10cm
|
$16,157.05 |
$16,157.05 |
$16,157.05 |
$5,109.58
|
|
Adenosine 3 mg/250 ml bag for osm
|
$947.05 |
$947.05 |
$947.05 |
$271.98
|
|
Adenovirus ag ia
|
$31.20 |
$31.20 |
$31.20 |
$53.95
|
|
Adh-sendout
|
$37.70 |
$37.70 |
$37.70 |
$118.79
|
|
Admelog u-100 insulin lispro 100 unit/ml subcutaneous solution
|
$393.90 |
$393.90 |
$393.90 |
$193.40
|
|
Administration chemotherapy IV infusion each additional hour
|
$308.10 |
$308.10 |
$308.10 |
$230.35
|
|
Administration chemotherapy IV infusion each addl sequential infusion diff substance/drug >1 hr
|
$308.10 |
$308.10 |
$308.10 |
$298.98
|
|
Administration chemotherapy IV infusion up to 1 hour single/initial substance/drug
|
$848.25 |
$848.25 |
$848.25 |
$668.98
|
|
Administration chemotherapy IV push single/initial substance/drug
|
$626.60 |
$626.60 |
$626.60 |
$439.20
|
|
Administration chemotherapy subcutaneous/im anti neoplastic hormonal
|
$274.30 |
$274.30 |
$274.30 |
$212.80
|
|
Administration chemotherapy subcutaneous/im anti neoplastic non hormonal
|
$274.30 |
$274.30 |
$274.30 |
$256.49
|
|
Administration immunization each additional vaccine
|
$118.30 |
$118.30 |
$118.30 |
$47.40
|
|
Administration immunization intranasal/oral route 1 vaccine
|
$118.30 |
$118.30 |
$118.30 |
$48.00
|
|
Administration immunization intranasal/oral route each additional vaccine
|
$116.35 |
$116.35 |
$116.35 |
$30.24
|
|
Ado-trastuzumab emtansine 100 mg intravenous solution
|
$199.55 |
$199.55 |
$199.55 |
$11,350.31
|
|
Aep hearing status deter i&r
|
$456.30 |
$456.30 |
$456.30 |
$303.00
|
|
Aep neurodiagnostic i&r
|
$916.50 |
$916.50 |
$916.50 |
$583.80
|
|
Aep thrshld est mlt freq i&r
|
$863.85 |
$863.85 |
$863.85 |
$635.00
|
|
_afb id by dna probe rflx ast
|
$245.05 |
$245.05 |
$245.05 |
$104.50
|
|
_afb org id by sequencing rflx ast-sendout
|
$264.55 |
$264.55 |
$264.55 |
$300.00
|
|
Agalsidase beta 35 mg intravenous solution
|
$1,873.30 |
$1,873.30 |
$1,873.30 |
$14,475.20
|
|
Airway resistance by impulse oscillometry 94728
|
$582.40 |
$582.40 |
$582.40 |
$297.00
|
|
Albumin body fluid quantitative each specimen
|
$143.00 |
$143.00 |
$143.00 |
$47.45
|
|
Albumin (human), 25%, 50ml
|
$421.85 |
$421.85 |
$421.85 |
$244.70
|
|
Albumin, human 25 % intravenous solution
|
$272.35 |
$272.35 |
$272.35 |
$234.94
|
|
Albumin (human), 5%, 250 ml
|
$455.00 |
$455.00 |
$455.00 |
$252.77
|
|
Albumin, human 5 % intravenous solution
|
$297.70 |
$297.70 |
$297.70 |
$275.16
|
|
Albumin (microalbumin) 24 hour urine quantitative
|
$149.50 |
$149.50 |
$149.50 |
$58.17
|
|
Albumin serum plasma or whole blood
|
$113.10 |
$113.10 |
$113.10 |
$43.00
|
|
Alcohol (ethanol) any specimen except urine/breath
|
$376.35 |
$376.35 |
$376.35 |
$96.00
|
|
Aldesleukin injection
|
$33,582.25 |
$33,582.25 |
$33,582.25 |
$9,030.11
|
|
Alemtuzumab 12 mg/1.2 ml intravenous solution
|
$6,251.05 |
$6,251.05 |
$6,251.05 |
$47,974.31
|
|
Alginate dressing <=16 sq in
|
$18.20 |
$18.20 |
$18.20 |
$16.56
|
|
Alginate drsg >16 <=48 sq in
|
$150.15 |
$150.15 |
$150.15 |
$43.72
|
|
Alginate drsg wound filler
|
$278.85 |
$278.85 |
$278.85 |
$15.79
|
|
Alkaline phosphatase
|
$54.60 |
$54.60 |
$54.60 |
$46.80
|
|
Allergen egg white ige
|
$15.60 |
$15.60 |
$15.60 |
$38.00
|
|
Allograft 160mg placental salera mini membrane
|
$8,247.85 |
$8,247.85 |
$8,247.85 |
$5,835.10
|
|
Allograft amnioexcel plus 17mm disk
|
$19,440.20 |
$19,440.20 |
$19,440.20 |
$497.95
|
|
Allograft amniotic activebarrier 200 2x2cm-q4100-cost per sheet
|
$43,548.70 |
$43,548.70 |
$43,548.70 |
$9,900.02
|
|
Allograft dermis 20x25x1mm decell w/matracell arthroflex
|
$17,189.25 |
$17,189.25 |
$17,189.25 |
$6,285.56
|
|
Allograft ecm allopatch hd dehydr thick 0.8-1.7mmx2x5cm-cost per sq cm
|
$67,857.40 |
$67,857.40 |
$67,857.40 |
$20,311.34
|
|
Allograft epieffect 2x3cm-q4186-cost per sq cm
|
$33,216.30 |
$33,216.30 |
$33,216.30 |
$858.66
|
|
Allograft graftjacket 2x12cm-q4107-cost per sq cm
|
$30,569.50 |
$30,569.50 |
$30,569.50 |
$4,677.40
|
|
Allograft membrn amnio 1x2cm hu ambriodry
|
$14,605.50 |
$14,605.50 |
$14,605.50 |
$5,096.00
|
|
Allograft umbil cord+amniotic membrane-q4148-cost per sq cm
|
$13,923.65 |
$13,923.65 |
$13,923.65 |
$5,278.73
|
|
Allograft umbilical epicord 15 sq cm-q4187-cost per sq cm
|
$13,185.90 |
$13,185.90 |
$13,185.90 |
$1,225.35
|
|
Alpha-1-proteinase inhibitor (human) 1,000 mg (+/-) IV solution
|
$3.25 |
$3.25 |
$3.25 |
$13.14
|
|
Alpha-fetoprotein tumor marker
|
$360.10 |
$360.10 |
$360.10 |
$106.00
|
|
Alteplase 100 mg infusion from pyxis vial
|
$814.45 |
$814.45 |
$814.45 |
$15,857.45
|
