|
Albuterol ipratrop non-comp
|
$0.80 |
$6.62 |
$6.62 |
|
|
Albuterol non-comp con
|
$0.80 |
$0.80 |
$0.80 |
|
|
Albuterol non-comp unit
|
$1.06 |
$5.83 |
$5.83 |
|
|
Alcohol (ethanol) any specimen except urine/breath
|
$52.50 |
$223.20 |
$419.20 |
|
|
Alcohols biomarkers 3/more
|
$72.14 |
$72.14 |
$72.14 |
|
|
Alcohol/sub misuse assess
|
$31.20 |
$31.20 |
$31.20 |
|
|
Alcohol/subs interv 15-30mn
|
$64.80 |
$75.00 |
$160.05 |
|
|
Alcohol/subs interv >30 min
|
$120.80 |
$120.80 |
$139.80 |
|
|
Aldesleukin injection
|
$1,496.81 |
$4,349.53 |
$27,985.12 |
|
|
Aldosterone suppression eval
|
$315.20 |
$315.20 |
$315.20 |
|
|
Alemtuzumab 12 mg/1.2 ml intravenous solution
|
$78.63 |
$78.63 |
$79,514.30 |
|
|
Alginate dressing <=16 sq in
|
$9.60 |
$9.60 |
$20.80 |
|
|
Alginate drsg >16 <=48 sq in
|
$23.04 |
$29.36 |
$87.84 |
|
|
Alginate drsg wound filler
|
$7.86 |
$9.00 |
$58.32 |
|
|
Alkaline phosphatase
|
$14.85 |
$68.40 |
$175.80 |
|
|
Allergen alpha lactalbumin ige
|
$19.44 |
$85.80 |
$567.20 |
|
|
Allergen egg white ige
|
$8.91 |
$56.88 |
$594.30 |
|
|
Allergen specific ige qual multi scrn ea
|
$7.00 |
$12.50 |
$50.40 |
|
|
Allergy injections; 2 or more 95117
|
$22.80 |
$43.75 |
$141.84 |
|
|
Allergy injection; single 95115
|
$19.20 |
$54.60 |
$99.36 |
|
|
Allergy Skin Testing
|
$25.00 |
$47.40 |
$62.40 |
|
|
Allg patch or app # of tests 95044
|
$9.00 |
$9.00 |
$16.00 |
|
|
Allgrft implnt knee w/scope
|
$6,286.40 |
$32,826.50 |
$73,252.54 |
|
|
Allograft allowrap 4x4cm dry 16sqcm
|
$970.98 |
$1,592.49 |
$31,673.54 |
|
|
Allograft amnioexcel plus 17mm disk
|
$112.61 |
$1,177.20 |
$36,763.36 |
|
|
Allograft amniotic activebarrier 200 2x2cm-q4100-cost per sheet
|
$226.47 |
$1,842.66 |
$12,402.00 |
|
|
Allograft dermis 20x25x1mm decell w/matracell arthroflex
|
$262.09 |
$4,303.20 |
$16,124.58 |
|
|
Allograft ecm allopatch hd dehydr thick 0.8-1.7mmx2x5cm-cost per sq cm
|
$54.78 |
$4,885.38 |
$80,694.10 |
|
|
Allograft epieffect 2x3cm-q4186-cost per sq cm
|
$157.68 |
$715.20 |
$27,978.92 |
|
|
Allograft graftjacket 2x12cm-q4107-cost per sq cm
|
$82.12 |
$592.80 |
$25,841.07 |
|
|
Allograft membrn amnio 1x2cm hu ambriodry
|
$1,429.65 |
$5,506.09 |
$21,670.14 |
|
|
Allograft umbil cord+amniotic membrane-q4148-cost per sq cm
|
$1,316.14 |
$3,625.32 |
$8,880.68 |
|
|
Allograft umbilical epicord 15 sq cm-q4187-cost per sq cm
|
$162.86 |
$922.40 |
$2,598.40 |
|
|
Alloskin
|
$1,086.00 |
$1,086.00 |
$3,240.00 |
|
|
All tstg perq&iq drugs/biol
|
$25.00 |
$25.00 |
$64.80 |
|
|
All tstg perq&iq w/venoms
|
$25.60 |
$25.60 |
$25.60 |
|
|
Alpha-1-proteinase inhibitor (human) 1,000 mg (+/-) IV solution
|
$9.62 |
$279.81 |
$8,510.42 |
|
|
Alpha-fetoprotein afp-l3 frac & total
|
$53.75 |
$198.80 |
$450.80 |
|
|
Alpha-fetoprotein amniotic
|
$30.03 |
$140.00 |
$645.40 |
|
|
Alpha-fetoprotein tumor marker
|
$17.40 |
$175.00 |
$388.00 |
|
|
Alprostadil for injection
|
$1.37 |
$220.40 |
$1,502.37 |
|
|
Alprostadil urethral suppos
|
$67.20 |
$67.20 |
$67.20 |
|
|
Als1-emergency
|
$2,253.30 |
$2,253.30 |
$2,253.30 |
|
|
Als 2
|
$2,981.30 |
$2,981.30 |
$2,981.30 |
|
|
Alteplase 100 mg infusion from pyxis vial
|
$160.02 |
$377.96 |
$56,853.12 |
|
|
Alt/sgpt
|
$15.51 |
$87.84 |
$166.32 |
|
|
Aluminum - quest
|
$27.72 |
$140.00 |
$247.20 |
|
|
Alveoloplasty each quadrant
|
$183.60 |
$968.80 |
$22,132.67 |
|
|
Alys cplx sp/pn npgt w/prgrm
|
$201.00 |
$223.20 |
$830.40 |
|
|
Amantadine (symmetrel)-sendout
|
$75.00 |
$328.30 |
$345.10 |
|
|
Ambl bp mntr w/software
|
$187.20 |
$251.20 |
$455.40 |
|
|
Ambl bp mntr w/sw a/r
|
$127.20 |
$127.20 |
$136.80 |
|
|
Ambl bp mntr w/sw i&r
|
$42.40 |
$59.40 |
$69.00 |
|
|
Amifostine
|
$1,332.56 |
$1,332.56 |
$9,360.22 |
|
|
Amikacin 4 mg/ml intravitreal injection - cnr
|
$1.60 |
$50.73 |
$219.45 |
|
|
Amines vaginal fluid qual
|
$12.00 |
$12.00 |
$12.00 |
|
|
Amino acid screen, urine
|
$25.00 |
$102.60 |
$897.60 |
|
|
Amino acid single qual
|
$36.00 |
$36.00 |
$99.36 |
|
|
Amino acids quant 2-5
|
$43.40 |
$236.60 |
$423.00 |
|
|
Aminocaproic acid 5 g/250 ml 0.9% nacl IV - cnr
|
$8.61 |
$31.50 |
$387.27 |
|
|
Aminolevulinic acid delta
|
$25.00 |
$163.10 |
$336.80 |
|
|
Aminolevulinic acid hcl top
|
$386.40 |
$386.40 |
$386.40 |
|
|
Aminophylline 25 mg/ml intravenous solution (wrapper)
|
$16.11 |
$69.12 |
$295.92 |
|
|
Amiodarone 150 mg/100 ml (1.5 mg/ml) in dextrose, iso-osmotic IV
|
$5.41 |
$13.32 |
$722.75 |
|
|
Amiodarone 50 mg/ml intravenous solution
|
$2.59 |
$20.68 |
$386.40 |
|
|
Amitriptyline (elavil) -sendout
|
$24.50 |
$160.00 |
$347.50 |
|
|
Amitriptyline injection
|
$31.10 |
$31.10 |
$31.10 |
|
|
Amivantamab-vmjw 50 mg/ml intravenous solution
|
$33.52 |
$6,499.82 |
$35,457.62 |
|
|
Ammonia
|
$40.00 |
$145.20 |
$525.60 |
|
|
Amniocentesisdiagnostic 59000
|
$250.00 |
$731.20 |
$7,121.10 |
|
|
Amniocentesis therapeutic
|
$431.20 |
$607.60 |
$1,702.80 |
|
|
Amniotic fluid scan
|
$19.20 |
$231.70 |
$252.80 |
|
|
Amobarbital 125 mg inj
|
$526.29 |
$526.29 |
$526.29 |
|
|
Amp f/th 1/2 jt/phalanx w/neurect local flap
|
$2,036.30 |
$2,785.15 |
$7,008.48 |
|
|
Amphetamine confirm urine -sendout
|
$33.84 |
$207.20 |
$475.20 |
|
|
Amphetamines 5 or more
|
$35.00 |
$240.00 |
$333.60 |
|
|
Amphotericin b in d5w IV syringe 0.1 mg/ml (neo/ped) - cnr
|
$81.58 |
$166.25 |
$623.87 |
|
|
Amphotericin b lipid complex
|
$24.32 |
$24.32 |
$422.10 |
|
|
Amphotericin b liposomal in d5w IV syringe 1 mg/ml (neo/ped) - cnr
|
$45.24 |
$220.09 |
$1,833.28 |
|
|
Ampicillin 1 gram solution for injection
|
$11.47 |
$57.76 |
$854.87 |
|
|
Ampicillin-sulbactam 1.5 gram solution for injection
|
$13.86 |
$49.89 |
$866.42 |
|
|
Amplification real-time pcr dna markers infectious disease bacterial vaginosis and vaginitis
|
$101.75 |
$299.60 |
$378.72 |
|
|
Amp metatarsal w/toe single 28810
|
$724.80 |
$849.00 |
$7,008.48 |
|
|
Amp thigh through femur re-amp 27596
|
$1,398.00 |
$1,398.00 |
$3,494.40 |
|
|
Amputate hand at wrist
|
$3,086.40 |
$3,086.40 |
$3,086.40 |
|
|
Amputate leg at thigh
|
$3,305.60 |
$3,305.60 |
$3,305.60 |
|
|
Amputate lower leg at knee
|
$1,372.80 |
$1,372.80 |
$3,480.00 |
|
|
Amputate metacarpal bone 26910
|
$1,351.20 |
$1,351.20 |
$1,804.80 |
|
|
Amputate thigh through femur 27590
|
$1,569.60 |
$1,569.60 |
$3,880.00 |
|
|
Amputation follow-up surgery
|
$2,785.60 |
$2,785.60 |
$2,785.60 |
|
|
Amputation follow-up surgery
|
$3,016.00 |
$3,016.00 |
$3,016.00 |
|
|
Amputation follow-up surgery
|
$3,368.00 |
$3,368.00 |
$3,368.00 |
|
|
Amputation follow-up surgery
|
$2,934.40 |
$2,934.40 |
$2,934.40 |
|
|
Amputation follow-up surgery
|
$3,766.40 |
$3,766.40 |
$3,766.40 |
|
|
Amputation follow-up surgery
|
$2,504.00 |
$2,504.00 |
$2,504.00 |
|
|
Amputation follow-up surgery
|
$1,034.40 |
$1,034.40 |
$2,801.60 |
|
|
Amputation leg thr tib/fib 27880
|
$1,776.00 |
$1,776.00 |
$4,444.80 |
|
|
Amputation leg; tib/fib f/u 27886
|
$1,005.00 |
$1,005.00 |
$3,206.40 |
|
|
Amputation of foot at ankle
|
$3,144.00 |
$3,144.00 |
$3,144.00 |
|
|
Amputation of forearm
|
$1,770.60 |
$1,770.60 |
$1,770.60 |
|
