|
17-ketosteroids
|
$38.16 |
$38.16 |
$38.16 |
$55.00
|
|
3d recon without postprocess indpndt
|
$936.00 |
$936.00 |
$936.00 |
$485.00
|
|
5' nucleotidase - sendout
|
$77.76 |
$77.76 |
$77.76 |
$50.40
|
|
88334 ap bill cytologic exam each additional site
|
$117.36 |
$117.36 |
$117.36 |
$97.65
|
|
Abatacept (with maltose) 250 mg intravenous solution
|
$214.27 |
$214.27 |
$214.27 |
$3,128.29
|
|
#a/b/c/c/h pnl-candida albicans ab
|
$48.96 |
$48.96 |
$48.96 |
$53.95
|
|
Abdominal CT scan (with and without contrast)
|
$3,099.60 |
$3,099.60 |
$3,099.60 |
$2,009.80
|
|
Abdominal CT scan (with contrast)
|
$2,356.56 |
$2,356.56 |
$2,356.56 |
$1,680.60
|
|
Abdominal CT scan (without contrast)
|
$2,142.72 |
$2,142.72 |
$2,142.72 |
$1,358.76
|
|
Abdominal MRI (with and without contrast)
|
$4,553.28 |
$4,553.28 |
$4,553.28 |
$3,015.94
|
|
Abdominal MRI (with contrast)
|
$3,646.80 |
$3,646.80 |
$3,646.80 |
$2,268.20
|
|
Abdominal MRI (without contrast)
|
$3,171.60 |
$3,171.60 |
$3,171.60 |
$2,050.14
|
|
Abdominal paracentesis w/image guidance
|
$1,650.96 |
$1,650.96 |
$1,650.96 |
$1,651.20
|
|
Abdominal Ultrasound (complete)
|
$1,391.76 |
$1,391.76 |
$1,391.76 |
$785.55
|
|
Abdominal Ultrasound (limited)
|
$1,209.60 |
$1,209.60 |
$1,209.60 |
$590.00
|
|
Abd paracentesis/w/o image guide 49082
|
$3,994.56 |
$3,994.56 |
$3,994.56 |
$1,145.40
|
|
Ablate inf turbinate superf 30801
|
$1,599.84 |
$1,599.84 |
$1,599.84 |
$1,944.80
|
|
Ablation of upper extremity nerves rf
|
$340.56 |
$340.56 |
$340.56 |
$808.50
|
|
Abscess drain retroperitoneal surg code
|
$3,782.88 |
$3,782.88 |
$3,782.88 |
$2,957.17
|
|
Acetazolamide 500 mg solution for injection
|
$113.44 |
$113.44 |
$113.44 |
$122.55
|
|
Acetylcholine receptor modulating antibody
|
$136.80 |
$136.80 |
$136.80 |
$64.50
|
|
Acetylcysteine 200 mg/ml (20 %) intravenous solution
|
$6.34 |
$6.34 |
$6.34 |
$216.00
|
|
Aco cont gluc mnt phys/qhp eqp 95250aco
|
$309.60 |
$309.60 |
$309.60 |
$345.15
|
|
Acute hepatitis panel
|
$457.92 |
$457.92 |
$457.92 |
$292.00
|
|
Acyclovir 5 mg/ml in ns IV syringe (neo/ped) - cnr
|
$0.46 |
$0.46 |
$0.46 |
$63.48
|
|
#acylcarnitineprfl
|
$204.48 |
$204.48 |
$204.48 |
$125.40
|
|
Adenosine 3 mg/250 ml bag for osm
|
$3.60 |
$3.60 |
$3.60 |
$255.41
|
|
Adenovirus antibody,serum - quest
|
$36.72 |
$36.72 |
$36.72 |
$63.00
|
|
Admelog u-100 insulin lispro 100 unit/ml subcutaneous solution
|
$295.20 |
$295.20 |
$295.20 |
$181.12
|
|
Administration chemotherapy IV infusion each additional hour
|
$285.12 |
$285.12 |
$285.12 |
$230.35
|
|
Administration chemotherapy IV infusion up to 1 hour single/initial substance/drug
|
$671.04 |
$671.04 |
$671.04 |
$657.12
|
|
Administration chemotherapy IV push single/initial substance/drug
|
$354.96 |
$354.96 |
$354.96 |
$439.20
|
|
Administration chemotherapy subcutaneous/im anti neoplastic hormonal
|
$149.76 |
$149.76 |
$149.76 |
$211.09
|
|
Administration immunization 1 vaccine
|
$109.44 |
$109.44 |
$109.44 |
$69.21
|
|
Administration immunization each additional vaccine
|
$87.12 |
$87.12 |
$87.12 |
$47.40
|
|
Administration vaccine hepatitis b
|
$87.12 |
$87.12 |
$87.12 |
$54.40
|
|
Administration vaccine influenza virus
|
$87.12 |
$87.12 |
$87.12 |
$50.43
|
|
Administration vaccine pneumococcal
|
$87.12 |
$87.12 |
$87.12 |
$50.43
|
|
_afb id by dna probe rflx ast
|
$97.20 |
$97.20 |
$97.20 |
$93.52
|
|
Albumin body fluid quantitative each specimen
|
$40.32 |
$40.32 |
$40.32 |
$46.23
|
|
Albumin (human), 25%, 50ml
|
$198.43 |
$198.43 |
$198.43 |
$244.70
|
|
Albumin (microalbumin) 24 hour urine quantitative
|
$92.16 |
$92.16 |
$92.16 |
$57.00
|
|
Albumin serum plasma or whole blood
|
$64.08 |
$64.08 |
$64.08 |
$40.80
|
|
Alginate drsg >16 <=48 sq in
|
$86.40 |
$86.40 |
$86.40 |
$43.72
|
|
Alginate drsg wound filler
|
$58.32 |
$58.32 |
$58.32 |
$15.79
|
|
Alkaline phosphatase
|
$68.40 |
$68.40 |
$68.40 |
$46.40
|
|
Allergen alpha lactalbumin ige
|
$46.80 |
$46.80 |
$46.80 |
$48.00
|
|
Allergen egg white ige
|
$47.52 |
$47.52 |
$47.52 |
$38.00
|
|
Allograft amnioexcel plus 17mm disk
|
$244.80 |
$244.80 |
$244.80 |
$2,250.00
|
|
Allograft epieffect 2x3cm-q4186-cost per sq cm
|
$654.48 |
$654.48 |
$654.48 |
$874.65
|
|
Allograft umbilical epicord 15 sq cm-q4187-cost per sq cm
|
$424.80 |
$424.80 |
$424.80 |
$1,495.63
|
|
Alpha-1-proteinase inhibitor (human) 1,000 mg (+/-) IV solution
|
$20.42 |
$20.42 |
$20.42 |
$12.50
|
|
Alpha-fetoprotein afp-l3 frac & total
|
$195.12 |
$195.12 |
$195.12 |
$175.20
|
|
Alpha-fetoprotein tumor marker
|
$182.88 |
$182.88 |
$182.88 |
$106.00
|
|
Alteplase 100 mg infusion from pyxis vial
|
$319.97 |
$319.97 |
$319.97 |
$15,857.45
|
|
Alt/sgpt
|
$89.28 |
$89.28 |
$89.28 |
$47.45
|
|
Aluminum - quest
|
$74.16 |
$74.16 |
$74.16 |
$83.05
|
|
Amiodarone 150 mg/100 ml (1.5 mg/ml) in dextrose, iso-osmotic IV
|
$13.30 |
$13.30 |
$13.30 |
$119.07
|
|
Amiodarone 50 mg/ml intravenous solution
|
$2.59 |
$2.59 |
$2.59 |
$55.86
|
|
Ammonia
|
$178.56 |
$178.56 |
$178.56 |
$119.70
|
|
Amphetamine confirm urine -sendout
|
$33.84 |
$33.84 |
$33.84 |
$92.61
|
|
Ampicillin 1 gram solution for injection
|
$11.47 |
$11.47 |
$11.47 |
$56.70
|
|
Ampicillin-sulbactam 1.5 gram solution for injection
|
$27.58 |
$27.58 |
$27.58 |
$53.86
|
|
Amplification real-time pcr dna markers infectious disease bacterial vaginosis and vaginitis
|
$378.72 |
$378.72 |
$378.72 |
$262.99
|
|
Amylase
|
$105.84 |
$105.84 |
$105.84 |
$89.04
|
|
Analysis gene f2 20210g>a variant
|
$336.96 |
$336.96 |
$336.96 |
$219.60
|
|
Analysis gene f5 leiden variant
|
$113.76 |
$113.76 |
$113.76 |
$230.40
|
|
Anca screen with reflex to titer -quest
|
$95.04 |
$95.04 |
$95.04 |
$103.20
|
|
An cholangiogram percutaneous compl
|
$3,811.68 |
$3,811.68 |
$3,811.68 |
$2,626.65
|
|
An fluoro guide for cvp
|
$1,078.56 |
$1,078.56 |
$1,078.56 |
$515.00
|
|
Angiotensin ii 0.5 mg/ml soln 1 ml vial
|
$108.86 |
$108.86 |
$108.86 |
$3,080.85
|
|
Ankle X-ray
|
$425.52 |
$425.52 |
$425.52 |
$353.60
|
|
Antibody bacterium, not elsewhere specified
|
$78.48 |
$78.48 |
$78.48 |
$57.81
|
|
Antibody elution rbc reference
|
$216.00 |
$216.00 |
$216.00 |
$175.50
|
|
Antibody htlv/hiv confirm test
|
$246.24 |
$246.24 |
$246.24 |
$130.00
|
|
Antibody identification platelet antibodies heparin-pf4 igg
|
$110.16 |
$110.16 |
$110.16 |
$218.30
|
|
Antibody id rbc panel
|
$403.20 |
$403.20 |
$403.20 |
$274.56
|
|
Antibody influenza virus
|
$92.16 |
$92.16 |
$92.16 |
$53.95
|
|
Antibody screen rbc
|
$141.84 |
$141.84 |
$141.84 |
$100.00
|
|
Antibody tetanus
|
$34.56 |
$34.56 |
$34.56 |
$53.95
|
|
Antineutrophil cytoplasmic antibody screen each antibody
|
$169.92 |
$169.92 |
$169.92 |
$37.05
|
|
Antineutrophil cytoplasmic antibody titer each antibody
|
$43.20 |
$43.20 |
$43.20 |
$40.00
|
|
Antinuclear antibodies
|
$149.76 |
$149.76 |
$149.76 |
$89.40
|
|
Antinuclear antibodies titer
|
$86.40 |
$86.40 |
$86.40 |
$77.00
|
|
Antiphosphatidylserine antibody
|
$38.88 |
$38.88 |
$38.88 |
$65.97
|
|
Antistreptolysin o titer
|
$108.00 |
$108.00 |
$108.00 |
$51.45
|
|
Antithrombin iii activity
|
$90.72 |
$90.72 |
$90.72 |
$114.00
|
|
App high cost ss f/n/g/h/f >100sq cm 1st 100sq cm
|
$1,975.68 |
$1,975.68 |
$1,975.68 |
$2,114.00
|
|
App high cost ss f/n/g/h/f >100sq cm addl 100sq cm
|
$843.84 |
$843.84 |
$843.84 |
$851.85
|
|
App high cost ss f/n/g/h/f <100sq cm addl <25sq cm
|
$308.88 |
$308.88 |
$308.88 |
$463.65
|
|
App high cost ss t/a/l >100sq cm 1st 100sq cm
|
$3,953.52 |
$3,953.52 |
$3,953.52 |
$3,345.60
|
|
App high cost ss t/a/l >100sq cm addl 100sq cm
|
$843.84 |
$843.84 |
$843.84 |
$1,091.30
|
|
App high cost ss t/a/l <100sq cm addl <25sq cm
|
$308.88 |
$308.88 |
$308.88 |
$498.81
|
|
Application finger splntstatic 29130
|
$138.96 |
$138.96 |
$138.96 |
$208.16
|
|
Application long leg splint 29505
|
$170.64 |
$170.64 |
$170.64 |
$338.25
|
|
Application lower leg splint 29515
|
$203.04 |
$203.04 |
$203.04 |
$330.48
|
|
Application multi layer compression below knee (both sides)
|
$415.44 |
$415.44 |
$415.44 |
$373.20
|
|
Application of cylinder cast 29365
|
$286.56 |
$286.56 |
$286.56 |
$420.00
|
|
Application of forearm cast 29075
|
$286.56 |
$286.56 |
$286.56 |
$339.30
|
|
Application of long arm cast 29065
|
$286.56 |
$286.56 |
$286.56 |
$395.00
|