|
3-d radiotherapy plan
|
$10,325.45 |
$10,325.45 |
$10,325.45 |
$5,002.69
|
|
5' nucleotidase - sendout
|
$312.78 |
$312.78 |
$312.78 |
$50.05
|
|
Abd aorta w/runoff s&i
|
$6,804.81 |
$6,804.81 |
$6,804.81 |
$3,724.63
|
|
Abd/low ext cath 2nd
|
$2,218.24 |
$2,218.24 |
$2,218.24 |
$2,401.80
|
|
Abd/low ext cath 3rd
|
$2,366.63 |
$2,366.63 |
$2,366.63 |
$2,727.40
|
|
Abdominal CT scan (with and without contrast)
|
$3,438.28 |
$3,438.28 |
$3,438.28 |
$2,009.80
|
|
Abdominal CT scan (with contrast)
|
$2,951.45 |
$2,951.45 |
$2,951.45 |
$1,683.63
|
|
Abdominal CT scan (without contrast)
|
$1,840.89 |
$1,840.89 |
$1,840.89 |
$1,358.76
|
|
Abdominal MRI (with and without contrast)
|
$5,734.46 |
$5,734.46 |
$5,734.46 |
$2,933.60
|
|
Abdominal MRI (with contrast)
|
$4,478.52 |
$4,478.52 |
$4,478.52 |
$2,200.55
|
|
Abdominal MRI (without contrast)
|
$4,289.83 |
$4,289.83 |
$4,289.83 |
$1,975.74
|
|
Abdominal paracentesis w/image guidance
|
$3,631.07 |
$3,631.07 |
$3,631.07 |
$1,688.29
|
|
Abdominal Ultrasound (complete)
|
$944.78 |
$944.78 |
$944.78 |
$785.25
|
|
Abdominal Ultrasound (limited)
|
$979.40 |
$979.40 |
$979.40 |
$604.43
|
|
Abd paracentesis/w/o image guide 49082
|
$5,774.94 |
$5,774.94 |
$5,774.94 |
$1,248.00
|
|
Ablate bone tumor(s) perq
|
$22,771.88 |
$22,771.88 |
$22,771.88 |
$9,812.40
|
|
Ablation of upper extremity nerves rf
|
$1,454.14 |
$1,454.14 |
$1,454.14 |
$825.60
|
|
Abscess drain retroperitoneal surg code
|
$4,557.69 |
$4,557.69 |
$4,557.69 |
$3,053.18
|
|
Access & clsr pq fem art endogft dlvry w/img uni
|
$8,173.01 |
$8,173.01 |
$8,173.01 |
$3,287.87
|
|
Acetaminophen 10 mg/ml soln 100 ml glass cont
|
$264.66 |
$264.66 |
$264.66 |
$89.91
|
|
Acetaminophen level
|
$307.88 |
$307.88 |
$307.88 |
$117.01
|
|
Acetazolamide 500 mg solution for injection
|
$730.21 |
$730.21 |
$730.21 |
$137.80
|
|
Acetylcholine receptor modulating antibody
|
$35.76 |
$35.76 |
$35.76 |
$64.50
|
|
Acetylcysteine 200 mg/ml (20 %) intravenous solution
|
$309.26 |
$309.26 |
$309.26 |
$306.22
|
|
Acute hepatitis panel
|
$142.91 |
$142.91 |
$142.91 |
$284.70
|
|
Acyclovir 5 mg/ml in ns IV syringe (neo/ped) - cnr
|
$139.18 |
$139.18 |
$139.18 |
$64.45
|
|
#acylcarnitineprfl
|
$595.76 |
$595.76 |
$595.76 |
$87.72
|
|
Adenosine 3 mg/250 ml bag for osm
|
$2,324.97 |
$2,324.97 |
$2,324.97 |
$217.04
|
|
Adenovirus antibody,serum - quest
|
$203.53 |
$203.53 |
$203.53 |
$60.00
|
|
Adh-sendout
|
$733.85 |
$733.85 |
$733.85 |
$109.28
|
|
Admelog u-100 insulin lispro 100 unit/ml subcutaneous solution
|
$111.93 |
$111.93 |
$111.93 |
$158.18
|
|
Administration chemotherapy IV infusion each additional hour
|
$518.84 |
$518.84 |
$518.84 |
$233.56
|
|
Administration chemotherapy IV infusion each addl sequential infusion diff substance/drug >1 hr
|
$558.13 |
$558.13 |
$558.13 |
$308.10
|
|
Administration chemotherapy IV infusion up to 1 hour single/initial substance/drug
|
$1,493.35 |
$1,493.35 |
$1,493.35 |
$695.37
|
|
Administration chemotherapy IV push single/initial substance/drug
|
$1,092.12 |
$1,092.12 |
$1,092.12 |
$444.49
|
|
Administration chemotherapy subcutaneous/im anti neoplastic hormonal
|
$514.43 |
$514.43 |
$514.43 |
$220.00
|
|
Administration chemotherapy subcutaneous/im anti neoplastic non hormonal
|
$527.96 |
$527.96 |
$527.96 |
$267.43
|
|
Administration immunization 1 vaccine
|
$143.00 |
$143.00 |
$143.00 |
$70.00
|
|
Administration immunization each additional vaccine
|
$137.10 |
$137.10 |
$137.10 |
$46.23
|
|
Administration vaccine hepatitis b
|
$407.06 |
$407.06 |
$407.06 |
$51.11
|
|
Administration vaccine influenza virus
|
$1,717.88 |
$1,717.88 |
$1,717.88 |
$49.40
|
|
_afb org id by sequencing rflx ast-sendout
|
$389.50 |
$389.50 |
$389.50 |
$289.60
|
|
Albumin body fluid quantitative each specimen
|
$45.18 |
$45.18 |
$45.18 |
$48.00
|
|
Albumin (human), 25%, 50ml
|
$4,398.18 |
$4,398.18 |
$4,398.18 |
$277.87
|
|
Albumin, human 25 % intravenous solution
|
$2,710.31 |
$2,710.31 |
$2,710.31 |
$488.08
|
|
Albumin (human), 5%, 250 ml
|
$4,371.42 |
$4,371.42 |
$4,371.42 |
$292.50
|
|
Albumin (microalbumin) 24 hour urine quantitative
|
$118.54 |
$118.54 |
$118.54 |
$58.00
|
|
Albumin serum plasma or whole blood
|
$96.64 |
$96.64 |
$96.64 |
$43.45
|
|
Albuterol ipratrop non-comp
|
$61.36 |
$61.36 |
$61.36 |
$9.93
|
|
Albuterol non-comp unit
|
$14.54 |
$14.54 |
$14.54 |
$9.43
|
|
Alcohol (ethanol) any specimen except urine/breath
|
$316.46 |
$316.46 |
$316.46 |
$94.90
|
|
Alkaline phosphatase
|
$123.28 |
$123.28 |
$123.28 |
$46.50
|
|
Allergen alpha lactalbumin ige
|
$231.68 |
$231.68 |
$231.68 |
$56.35
|
|
Allergen egg white ige
|
$95.32 |
$95.32 |
$95.32 |
$39.78
|
|
Allograft epieffect 2x3cm-q4186-cost per sq cm
|
$1,974.40 |
$1,974.40 |
$1,974.40 |
$3,621.72
|
|
Alpha-fetoprotein afp-l3 frac & total
|
$749.21 |
$749.21 |
$749.21 |
$187.20
|
|
Alpha-fetoprotein tumor marker
|
$276.99 |
$276.99 |
$276.99 |
$103.60
|
|
Alteplase 100 mg infusion from pyxis vial
|
$2,336.68 |
$2,336.68 |
$2,336.68 |
$9,600.63
|
|
Alt/sgpt
|
$97.45 |
$97.45 |
$97.45 |
$49.00
|
|
Aluminum - quest
|
$190.42 |
$190.42 |
$190.42 |
$83.05
|
|
Amantadine (symmetrel)-sendout
|
$219.60 |
$219.60 |
$219.60 |
$188.65
|
|
Aminolevulinic acid delta
|
$177.68 |
$177.68 |
$177.68 |
$85.15
|
|
Aminophylline 25 mg/ml intravenous solution (wrapper)
|
$99.87 |
$99.87 |
$99.87 |
$43.72
|
|
Amiodarone 150 mg/100 ml (1.5 mg/ml) in dextrose, iso-osmotic IV
|
$1,137.68 |
$1,137.68 |
$1,137.68 |
$174.72
|
|
Amiodarone 50 mg/ml intravenous solution
|
$242.54 |
$242.54 |
$242.54 |
$50.85
|
|
Amitriptyline (elavil) -sendout
|
$110.64 |
$110.64 |
$110.64 |
$101.17
|
|
Amivantamab-vmjw 50 mg/ml intravenous solution
|
$33,738.02 |
$33,738.02 |
$33,738.02 |
$15,167.75
|
|
Ammonia
|
$311.48 |
$311.48 |
$311.48 |
$123.48
|
|
Amphetamine confirm urine -sendout
|
$117.24 |
$117.24 |
$117.24 |
$94.50
|
|
Amphetamines 5 or more
|
$393.38 |
$393.38 |
$393.38 |
$93.60
|
|
Ampicillin 1 gram solution for injection
|
$178.05 |
$178.05 |
$178.05 |
$68.44
|
|
Ampicillin-sulbactam 1.5 gram solution for injection
|
$364.64 |
$364.64 |
$364.64 |
$57.38
|
|
Amylase
|
$233.72 |
$233.72 |
$233.72 |
$93.00
|
|
Analysis gene f2 20210g>a variant
|
$821.13 |
$821.13 |
$821.13 |
$219.13
|
|
Analysis gene f5 leiden variant
|
$917.12 |
$917.12 |
$917.12 |
$226.60
|
|
Anaplsma phgcytophlm amp prb
|
$110.40 |
$110.40 |
$110.40 |
$95.45
|
|
Anca screen with reflex to titer -quest
|
$174.73 |
$174.73 |
$174.73 |
$103.20
|
|
An cholangiogram percutaneous compl
|
$1,227.19 |
$1,227.19 |
$1,227.19 |
$2,426.60
|
|
An fluoro guide for cvp
|
$1,982.67 |
$1,982.67 |
$1,982.67 |
$509.60
|
|
Angioplasty fem/pop unilat 37224
|
$17,250.00 |
$17,250.00 |
$17,250.00 |
$9,462.03
|
|
Angioplasty tib/pero/unilat/ea add 37232
|
$6,366.63 |
$6,366.63 |
$6,366.63 |
$6,513.10
|
|
Angiotensin ii 0.5 mg/ml soln 1 ml vial
|
$14,937.12 |
$14,937.12 |
$14,937.12 |
$6,048.00
|
|
Angio tib/peroneal/init ves/unila 37228
|
$33,920.57 |
$33,920.57 |
$33,920.57 |
$13,351.25
|
|
Angio trnslmnl balloon same vein ini
|
$5,599.53 |
$5,599.53 |
$5,599.53 |
$8,745.10
|
|
Ankle X-ray
|
$280.78 |
$280.78 |
$280.78 |
$350.85
|
|
Antibody elution rbc reference
|
$554.99 |
$554.99 |
$554.99 |
$179.62
|
|
Antibody htlv/hiv confirm test
|
$230.48 |
$230.48 |
$230.48 |
$141.26
|
|
Antibody identification platelet antibodies heparin-pf4 igg
|
$805.44 |
$805.44 |
$805.44 |
$218.30
|
|
Antibody id rbc panel
|
$480.03 |
$480.03 |
$480.03 |
$291.75
|
|
Antibody screen rbc
|
$544.86 |
$544.86 |
$544.86 |
$105.00
|
|
Antidepressant not specified
|
$355.16 |
$355.16 |
$355.16 |
$89.50
|
|
Anti mog serum - sendout
|
$427.68 |
$427.68 |
$427.68 |
$142.29
|
|
Antineutrophil cytoplasmic antibody screen each antibody
|
$116.30 |
$116.30 |
$116.30 |
$50.88
|
|
Antinuclear antibodies
|
$234.65 |
$234.65 |
$234.65 |
$91.70
|
|
Antinuclear antibodies titer
|
$102.01 |
$102.01 |
$102.01 |
$80.25
|
|
Antistreptolysin o titer
|
$399.24 |
$399.24 |
$399.24 |
$57.85
|
|
Antithrombin iii activity
|
$533.13 |
$533.13 |
$533.13 |
$106.85
|
|
Apl(pml-rara) quant - sendout
|
$1,184.70 |
$1,184.70 |
$1,184.70 |
$465.60
|
|
App high cost ss f/n/g/h/f >100sq cm 1st 100sq cm
|
$6,432.61 |
$6,432.61 |
$6,432.61 |
$2,164.64
|
|
App high cost ss f/n/g/h/f >100sq cm addl 100sq cm
|
$1,663.12 |
$1,663.12 |
$1,663.12 |
$908.05
|
