|
17-hydroxypregnenolone
|
$18.75 |
$18.75 |
$18.75 |
$87.50
|
|
17-ketosteroids
|
$35.00 |
$35.00 |
$35.00 |
$44.88
|
|
24 hr ambulatory b/p monitor
|
$142.50 |
$142.50 |
$142.50 |
$320.45
|
|
2nd order venous cath
|
$200.00 |
$200.00 |
$200.00 |
$1,720.80
|
|
3d ech img cgen car anomal
|
$75.00 |
$75.00 |
$75.00 |
$632.45
|
|
3-d radiotherapy plan
|
$1,900.00 |
$1,900.00 |
$1,900.00 |
$5,002.69
|
|
3d recon without postprocess indpndt
|
$200.00 |
$200.00 |
$200.00 |
$425.10
|
|
5' nucleotidase - sendout
|
$35.00 |
$35.00 |
$35.00 |
$50.05
|
|
88334 ap bill cytologic exam each additional site
|
$75.00 |
$75.00 |
$75.00 |
$97.65
|
|
Abatacept (with maltose) 250 mg intravenous solution
|
$992.50 |
$992.50 |
$992.50 |
$3,998.03
|
|
#a/b/c/c/h pnl-candida albicans ab
|
$35.00 |
$35.00 |
$35.00 |
$52.25
|
|
Abd aorta w/runoff s&i
|
$1,875.00 |
$1,875.00 |
$1,875.00 |
$3,724.63
|
|
Abd/low ext cath 1st
|
$375.00 |
$375.00 |
$375.00 |
$2,300.20
|
|
Abd/low ext cath 2nd
|
$375.00 |
$375.00 |
$375.00 |
$2,401.80
|
|
Abd/low ext cath 3rd
|
$375.00 |
$375.00 |
$375.00 |
$2,727.40
|
|
Abd/low ext cath addl
|
$200.00 |
$200.00 |
$200.00 |
$988.80
|
|
Abdominal CT scan (with and without contrast)
|
$750.00 |
$750.00 |
$750.00 |
$2,009.80
|
|
Abdominal CT scan (with contrast)
|
$700.00 |
$700.00 |
$700.00 |
$1,683.63
|
|
Abdominal CT scan (without contrast)
|
$625.00 |
$625.00 |
$625.00 |
$1,358.76
|
|
Abdominal MRI (with and without contrast)
|
$1,350.00 |
$1,350.00 |
$1,350.00 |
$2,933.60
|
|
Abdominal MRI (with contrast)
|
$1,050.00 |
$1,050.00 |
$1,050.00 |
$2,200.55
|
|
Abdominal MRI (without contrast)
|
$950.00 |
$950.00 |
$950.00 |
$1,975.74
|
|
Abdominal paracentesis w/image guidance
|
$575.00 |
$575.00 |
$575.00 |
$1,688.29
|
|
Abdominal Ultrasound (complete)
|
$475.00 |
$475.00 |
$475.00 |
$785.25
|
|
Abdominal Ultrasound (limited)
|
$375.00 |
$375.00 |
$375.00 |
$604.43
|
|
Abd paracentesis/w/o image guide 49082
|
$575.00 |
$575.00 |
$575.00 |
$1,248.00
|
|
Abl1 gene
|
$200.00 |
$200.00 |
$200.00 |
$614.25
|
|
Ablate arrhythmia add on
|
$4,125.00 |
$4,125.00 |
$4,125.00 |
$7,717.80
|
|
Ablate bone tumor(s) perq
|
$4,000.00 |
$4,000.00 |
$4,000.00 |
$9,812.40
|
|
Ablate heart dysrhythm focus
|
$2,837.50 |
$2,837.50 |
$2,837.50 |
$9,836.16
|
|
Ablation cryo pq liver tumor(s)
|
$3,000.00 |
$3,000.00 |
$3,000.00 |
$8,581.80
|
|
Ablation of upper extremity nerves rf
|
$200.00 |
$200.00 |
$200.00 |
$825.60
|
|
Abobotulinumtoxina
|
$602.06 |
$602.06 |
$602.06 |
$1,066.88
|
|
Abscess drain retroperitoneal surg code
|
$600.00 |
$600.00 |
$600.00 |
$3,053.18
|
|
Access & clsr pq fem art endogft dlvry w/img uni
|
$375.00 |
$375.00 |
$375.00 |
$3,287.87
|
|
Acetaminophen 10 mg/ml soln 100 ml glass cont
|
$3.35 |
$3.35 |
$3.35 |
$89.91
|
|
Acetaminophen 120 mg rectal suppository
|
$0.32 |
$0.32 |
$0.32 |
$146.76
|
|
Acetaminophen level
|
$40.00 |
$40.00 |
$40.00 |
$117.01
|
|
Acetazolamide 500 mg solution for injection
|
$85.86 |
$85.86 |
$85.86 |
$137.80
|
|
Acetone qualitative
|
$20.00 |
$20.00 |
$20.00 |
$48.00
|
|
Acetylcholine receptor modulating antibody
|
$35.00 |
$35.00 |
$35.00 |
$64.50
|
|
Acetylcysteine 200 mg/ml (20 %) intravenous solution
|
$19.63 |
$19.63 |
$19.63 |
$306.22
|
|
Aco med nutria tx/group, ea 30 min 97804aco
|
$27.50 |
$27.50 |
$27.50 |
$44.40
|
|
Acute hepatitis panel
|
$66.25 |
$66.25 |
$66.25 |
$284.70
|
|
Acyclovir 400 mg tablet
|
$0.93 |
$0.93 |
$0.93 |
$467.94
|
|
Acyclovir 5 mg/ml in ns IV syringe (neo/ped) - cnr
|
$10.56 |
$10.56 |
$10.56 |
$64.45
|
|
#acylcarnitineprfl
|
$46.25 |
$46.25 |
$46.25 |
$87.72
|
|
Adapter b 8 channel 10cm
|
$368.03 |
$368.03 |
$368.03 |
$6,875.44
|
|
Adenosine 3 mg/250 ml bag for osm
|
$31.43 |
$31.43 |
$31.43 |
$217.04
|
|
Adenovirus ag ia
|
$10.50 |
$10.50 |
$10.50 |
$31.20
|
|
Adenovirus antibody,serum - quest
|
$37.50 |
$37.50 |
$37.50 |
$60.00
|
|
Adh-sendout
|
$29.75 |
$29.75 |
$29.75 |
$109.28
|
|
Admelog u-100 insulin lispro 100 unit/ml subcutaneous solution
|
$199.44 |
$199.44 |
$199.44 |
$158.18
|
|
Administration chemotherapy IV infusion each additional hour
|
$68.75 |
$68.75 |
$68.75 |
$233.56
|
|
Administration chemotherapy IV infusion each addl sequential infusion diff substance/drug >1 hr
|
$62.50 |
$62.50 |
$62.50 |
$308.10
|
|
Administration chemotherapy IV infusion up to 1 hour single/initial substance/drug
|
$243.75 |
$243.75 |
$243.75 |
$695.37
|
|
Administration chemotherapy IV push single/initial substance/drug
|
$187.50 |
$187.50 |
$187.50 |
$444.49
|
|
Administration chemotherapy subcutaneous/im anti neoplastic hormonal
|
$62.50 |
$62.50 |
$62.50 |
$220.00
|
|
Administration chemotherapy subcutaneous/im anti neoplastic non hormonal
|
$62.50 |
$62.50 |
$62.50 |
$267.43
|
|
Administration immunization 1 vaccine
|
$28.75 |
$28.75 |
$28.75 |
$70.00
|
|
Administration immunization each additional vaccine
|
$11.25 |
$11.25 |
$11.25 |
$46.23
|
|
Administration immunization first component each vaccine
|
$16.25 |
$16.25 |
$16.25 |
$45.50
|
|
Ado-trastuzumab emtansine 100 mg intravenous solution
|
$5,141.38 |
$5,141.38 |
$5,141.38 |
$14,346.62
|
|
_afb id by dna probe rflx ast
|
$17.50 |
$17.50 |
$17.50 |
$105.00
|
|
_afb org id by sequencing rflx ast-sendout
|
$93.75 |
$93.75 |
$93.75 |
$289.60
|
|
Aflibercept injection
|
$28,307.80 |
$28,307.80 |
$28,307.80 |
$821.98
|
|
Agalsidase beta 35 mg intravenous solution
|
$3,508.71 |
$3,508.71 |
$3,508.71 |
$14,467.53
|
|
Air injection into abdomen 49400
|
$100.00 |
$100.00 |
$100.00 |
$545.00
|
|
Albumin body fluid quantitative each specimen
|
$17.50 |
$17.50 |
$17.50 |
$48.00
|
|
Albumin (human), 25%, 50ml
|
$8.71 |
$8.71 |
$8.71 |
$277.87
|
|
Albumin, human 25 % intravenous solution
|
$13.86 |
$13.86 |
$13.86 |
$488.08
|
|
Albumin (human), 5%, 250 ml
|
$3.77 |
$3.77 |
$3.77 |
$292.50
|
|
Albumin, human 5 % intravenous solution
|
$7.73 |
$7.73 |
$7.73 |
$248.88
|
|
Albumin (microalbumin) 24 hour urine quantitative
|
$22.50 |
$22.50 |
$22.50 |
$58.00
|
|
Albumin serum plasma or whole blood
|
$20.00 |
$20.00 |
$20.00 |
$43.45
|
|
Alcohol (ethanol) any specimen except urine/breath
|
$52.50 |
$52.50 |
$52.50 |
$94.90
|
|
Aldesleukin injection
|
$4,349.53 |
$4,349.53 |
$4,349.53 |
$6,538.20
|
|
Alemtuzumab 12 mg/1.2 ml intravenous solution
|
$78.63 |
$78.63 |
$78.63 |
$8,173.80
|
|
Alkaline phosphatase
|
$22.50 |
$22.50 |
$22.50 |
$46.50
|
|
Allergen alpha lactalbumin ige
|
$20.75 |
$20.75 |
$20.75 |
$56.35
|
|
Allergen egg white ige
|
$22.50 |
$22.50 |
$22.50 |
$39.78
|
|
Allergen specific ige qual multi scrn ea
|
$7.00 |
$7.00 |
$7.00 |
$26.95
|
|
Allergy injections; 2 or more 95117
|
$43.75 |
$43.75 |
$43.75 |
$47.20
|
|
Allergy injection; single 95115
|
$26.25 |
$26.25 |
$26.25 |
$42.75
|
|
Allergy Skin Testing
|
$25.00 |
$25.00 |
$25.00 |
$47.44
|
|
Allograft epieffect 2x3cm-q4186-cost per sq cm
|
$281.22 |
$281.22 |
$281.22 |
$3,621.72
|
|
All tstg perq&iq drugs/biol
|
$25.00 |
$25.00 |
$25.00 |
$64.80
|
|
Alpha-1-proteinase inhibitor (human) 1,000 mg (+/-) IV solution
|
$279.81 |
$279.81 |
$279.81 |
$51.00
|
|
Alpha-fetoprotein afp-l3 frac & total
|
$53.75 |
$53.75 |
$53.75 |
$187.20
|
|
Alpha-fetoprotein tumor marker
|
$25.00 |
$25.00 |
$25.00 |
$103.60
|
|
Alprostadil for injection
|
$220.40 |
$220.40 |
$220.40 |
$550.20
|
|
Alteplase 100 mg infusion from pyxis vial
|
$6,499.79 |
$6,499.79 |
$6,499.79 |
$9,600.63
|
|
Alt/sgpt
|
$22.50 |
$22.50 |
$22.50 |
$49.00
|
|
Aluminum - quest
|
$43.75 |
$43.75 |
$43.75 |
$83.05
|
|
Amantadine (symmetrel)-sendout
|
$75.00 |
$75.00 |
$75.00 |
$188.65
|
|
Amikacin 4 mg/ml intravitreal injection - cnr
|
$23.13 |
$23.13 |
$23.13 |
$44.00
|
|
Aminolevulinic acid delta
|
$25.00 |
$25.00 |
$25.00 |
$85.15
|
|
Aminophylline 25 mg/ml intravenous solution (wrapper)
|
$16.11 |
$16.11 |
$16.11 |
$43.72
|
|
Amiodarone 150 mg/100 ml (1.5 mg/ml) in dextrose, iso-osmotic IV
|
$5.41 |
$5.41 |
$5.41 |
$174.72
|
|
Amiodarone 50 mg/ml intravenous solution
|
$20.68 |
$20.68 |
$20.68 |
$50.85
|
