|
3d ech img cgen car anomal
|
$673.20 |
$673.20 |
$673.20 |
$695.69
|
|
3-d radiotherapy plan
|
$8,299.20 |
$8,299.20 |
$8,299.20 |
$4,886.50
|
|
3d recon without postprocess indpndt
|
$418.80 |
$418.80 |
$418.80 |
$443.20
|
|
5' nucleotidase - sendout
|
$201.00 |
$201.00 |
$201.00 |
$64.80
|
|
88334 ap bill cytologic exam each additional site
|
$147.00 |
$147.00 |
$147.00 |
$93.00
|
|
#a/b/c/c/h pnl-candida albicans ab
|
$32.40 |
$32.40 |
$32.40 |
$53.95
|
|
Abd aorta w/runoff s&i
|
$2,476.20 |
$2,476.20 |
$2,476.20 |
$3,483.84
|
|
Abd/low ext cath 1st
|
$3,991.20 |
$3,991.20 |
$3,991.20 |
$2,954.86
|
|
Abd/low ext cath 2nd
|
$4,428.00 |
$4,428.00 |
$4,428.00 |
$2,941.25
|
|
Abd/low ext cath 3rd
|
$5,380.80 |
$5,380.80 |
$5,380.80 |
$3,522.75
|
|
Abd/low ext cath addl
|
$4,783.20 |
$4,783.20 |
$4,783.20 |
$909.22
|
|
Abdominal CT scan (with and without contrast)
|
$542.40 |
$542.40 |
$542.40 |
$1,906.80
|
|
Abdominal CT scan (with contrast)
|
$542.40 |
$542.40 |
$542.40 |
$1,608.98
|
|
Abdominal CT scan (without contrast)
|
$542.40 |
$542.40 |
$542.40 |
$1,213.74
|
|
Abdominal MRI (with and without contrast)
|
$582.60 |
$582.60 |
$582.60 |
$2,629.50
|
|
Abdominal MRI (with contrast)
|
$582.60 |
$582.60 |
$582.60 |
$2,042.68
|
|
Abdominal MRI (without contrast)
|
$582.60 |
$582.60 |
$582.60 |
$1,789.65
|
|
Abdominal paracentesis w/image guidance
|
$1,842.00 |
$1,842.00 |
$1,842.00 |
$1,637.98
|
|
Abdominal Ultrasound (complete)
|
$520.20 |
$520.20 |
$520.20 |
$732.03
|
|
Abdominal Ultrasound (limited)
|
$329.40 |
$329.40 |
$329.40 |
$574.53
|
|
Abd paracentesis/w/o image guide 49082
|
$1,696.20 |
$1,696.20 |
$1,696.20 |
$1,144.26
|
|
Abl1 gene
|
$740.40 |
$740.40 |
$740.40 |
$600.00
|
|
Ablation cryo retro lymph node
|
$1,914.60 |
$1,914.60 |
$1,914.60 |
$1,948.83
|
|
Abscess drain retroperitoneal surg code
|
$4,204.80 |
$4,204.80 |
$4,204.80 |
$3,053.18
|
|
Acetaminophen 10 mg/ml soln 100 ml glass cont
|
$125.63 |
$125.63 |
$125.63 |
$45.63
|
|
Acetaminophen level
|
$36.00 |
$36.00 |
$36.00 |
$117.01
|
|
Acetazolamide 500 mg solution for injection
|
$55.49 |
$55.49 |
$55.49 |
$94.47
|
|
Acetone qualitative
|
$136.80 |
$136.80 |
$136.80 |
$43.80
|
|
Acetylcysteine non-comp unit
|
$29.01 |
$29.01 |
$29.01 |
$29.01
|
|
Acoustic immitance testing
|
$85.80 |
$85.80 |
$85.80 |
$157.30
|
|
Acoustic refl threshold tst
|
$56.40 |
$56.40 |
$56.40 |
$90.13
|
|
Acute hepatitis panel
|
$570.60 |
$570.60 |
$570.60 |
$294.45
|
|
Acyclovir 5 mg/ml in ns IV syringe (neo/ped) - cnr
|
$48.72 |
$48.72 |
$48.72 |
$48.72
|
|
#acylcarnitineprfl
|
$235.80 |
$235.80 |
$235.80 |
$110.25
|
|
Acylcarnitines qual
|
$45.00 |
$45.00 |
$45.00 |
$45.60
|
|
Adenosine 3 mg/250 ml bag for osm
|
$39.82 |
$39.82 |
$39.82 |
$97.50
|
|
Adenovirus ag ia
|
$169.80 |
$169.80 |
$169.80 |
$31.20
|
|
Adh-sendout
|
$246.00 |
$246.00 |
$246.00 |
$152.10
|
|
Admelog u-100 insulin lispro 100 unit/ml subcutaneous solution
|
$437.94 |
$437.94 |
$437.94 |
$163.25
|
|
Administration chemotherapy IV infusion each additional hour
|
$254.40 |
$254.40 |
$254.40 |
$230.35
|
|
Administration chemotherapy IV infusion each addl sequential infusion diff substance/drug >1 hr
|
$151.80 |
$151.80 |
$151.80 |
$308.10
|
|
Administration chemotherapy IV infusion up to 1 hour single/initial substance/drug
|
$1,020.60 |
$1,020.60 |
$1,020.60 |
$695.37
|
|
Administration chemotherapy IV push single/initial substance/drug
|
$777.00 |
$777.00 |
$777.00 |
$454.00
|
|
Administration chemotherapy subcutaneous/im anti neoplastic hormonal
|
$457.80 |
$457.80 |
$457.80 |
$220.00
|
|
Administration chemotherapy subcutaneous/im anti neoplastic non hormonal
|
$421.80 |
$421.80 |
$421.80 |
$267.43
|
|
Administration immunization 1 vaccine
|
$125.40 |
$125.40 |
$125.40 |
$65.00
|
|
Administration immunization each additional vaccine
|
$136.20 |
$136.20 |
$136.20 |
$45.50
|
|
Ado-trastuzumab emtansine 100 mg intravenous solution
|
$76.42 |
$76.42 |
$76.42 |
$59.76
|
|
Adrenal cortex & medulla img
|
$3,324.60 |
$3,324.60 |
$3,324.60 |
$1,642.08
|
|
Aep hearing status deter i&r
|
$375.00 |
$375.00 |
$375.00 |
$308.40
|
|
Aep neurodiagnostic i&r
|
$699.60 |
$699.60 |
$699.60 |
$570.16
|
|
Aep thrshld est mlt freq i&r
|
$699.60 |
$699.60 |
$699.60 |
$573.65
|
|
_afb id by dna probe rflx ast
|
$176.40 |
$176.40 |
$176.40 |
$105.00
|
|
#afb mycobacteria suscep. #1
|
$18.00 |
$18.00 |
$18.00 |
$38.58
|
|
Aflibercept injection
|
$5,101.40 |
$5,101.40 |
$5,101.40 |
$2,738.00
|
|
Air conduction bilat
|
$97.80 |
$97.80 |
$97.80 |
$140.87
|
|
Albumin body fluid quantitative each specimen
|
$104.40 |
$104.40 |
$104.40 |
$42.40
|
|
Albumin (human), 25%, 50ml
|
$481.30 |
$481.30 |
$481.30 |
$277.87
|
|
Albumin (human), 5%, 250 ml
|
$465.69 |
$465.69 |
$465.69 |
$253.48
|
|
Albumin (microalbumin) 24 hour urine quantitative
|
$184.80 |
$184.80 |
$184.80 |
$60.45
|
|
Albumin serum plasma or whole blood
|
$84.60 |
$84.60 |
$84.60 |
$40.00
|
|
Albuterol ipratrop non-comp
|
$9.18 |
$9.18 |
$9.18 |
$9.18
|
|
Alemtuzumab 12 mg/1.2 ml intravenous solution
|
$1,513.25 |
$1,513.25 |
$1,513.25 |
$27,257.23
|
|
Alkaline phosphatase
|
$91.20 |
$91.20 |
$91.20 |
$43.80
|
|
Allergen alpha lactalbumin ige
|
$62.40 |
$62.40 |
$62.40 |
$56.35
|
|
Allergen egg white ige
|
$56.40 |
$56.40 |
$56.40 |
$41.00
|
|
Allograft dermis 20x25x1mm decell w/matracell arthroflex
|
$12,086.40 |
$12,086.40 |
$12,086.40 |
$9,702.00
|
|
Allograft epieffect 2x3cm-q4186-cost per sq cm
|
$6,310.20 |
$6,310.20 |
$6,310.20 |
$3,035.85
|
|
Allograft umbilical epicord 15 sq cm-q4187-cost per sq cm
|
$3,161.40 |
$3,161.40 |
$3,161.40 |
$2,752.20
|
|
All tstg perq&iq drugs/biol
|
$115.80 |
$115.80 |
$115.80 |
$64.80
|
|
Alpha-fetoprotein tumor marker
|
$209.40 |
$209.40 |
$209.40 |
$110.40
|
|
Alprostadil for injection
|
$122.57 |
$122.57 |
$122.57 |
$522.85
|
|
Alteplase 100 mg infusion from pyxis vial
|
$1,611.20 |
$1,611.20 |
$1,611.20 |
$189.60
|
|
Alt/sgpt
|
$105.60 |
$105.60 |
$105.60 |
$43.55
|
|
Aluminum - quest
|
$180.60 |
$180.60 |
$180.60 |
$114.40
|
|
Alys cplx sp/pn npgt w/prgrm
|
$799.20 |
$799.20 |
$799.20 |
$417.47
|
|
Amino acid screen, urine
|
$100.20 |
$100.20 |
$100.20 |
$64.28
|
|
Aminolevulinic acid delta
|
$60.00 |
$60.00 |
$60.00 |
$95.80
|
|
Aminophylline 25 mg/ml intravenous solution (wrapper)
|
$66.62 |
$66.62 |
$66.62 |
$40.47
|
|
Amiodarone 150 mg/100 ml (1.5 mg/ml) in dextrose, iso-osmotic IV
|
$264.58 |
$264.58 |
$264.58 |
$202.10
|
|
Amiodarone 50 mg/ml intravenous solution
|
$269.76 |
$269.76 |
$269.76 |
$15.32
|
|
Ammonia
|
$217.80 |
$217.80 |
$217.80 |
$96.53
|
|
Amniocentesisdiagnostic 59000
|
$457.80 |
$457.80 |
$457.80 |
$876.60
|
|
Amphotericin b in d5w IV syringe 0.1 mg/ml (neo/ped) - cnr
|
$54.24 |
$54.24 |
$54.24 |
$107.46
|
|
Amphotericin b liposomal in d5w IV syringe 1 mg/ml (neo/ped) - cnr
|
$178.45 |
$178.45 |
$178.45 |
$94.57
|
|
Ampicillin 1 gram solution for injection
|
$154.67 |
$154.67 |
$154.67 |
$30.28
|
|
Ampicillin-sulbactam 1.5 gram solution for injection
|
$66.51 |
$66.51 |
$66.51 |
$37.60
|
|
Amputation toe interphalangeal joint
|
$3,616.20 |
$3,616.20 |
$3,616.20 |
$3,591.33
|
|
Amputation toe metatarsophalangeal joint
|
$3,616.20 |
$3,616.20 |
$3,616.20 |
$3,743.15
|
|
Amylase
|
$174.00 |
$174.00 |
$174.00 |
$83.20
|
|
Ana ds-dna
|
$192.60 |
$192.60 |
$192.60 |
$69.03
|
|
Anal pressure record
|
$1,140.00 |
$1,140.00 |
$1,140.00 |
$1,077.44
|
|
Analysis gene f2 20210g>a variant
|
$223.80 |
$223.80 |
$223.80 |
$246.35
|
|
Analysis gene f5 leiden variant
|
$452.40 |
$452.40 |
$452.40 |
$253.11
|
|
Analysis tumor
|
$675.00 |
$675.00 |
$675.00 |
$248.80
|
|
Anca screen with reflex to titer -quest
|
$469.80 |
$469.80 |
$469.80 |
$111.20
|
|
An cholangiogram percutaneous compl
|
$2,397.60 |
$2,397.60 |
$2,397.60 |
$2,417.63
|
|
An fluoro guide for cvp
|
$276.00 |
$276.00 |
$276.00 |
$469.17
|
|
Angio balloon ctrl dialysis seg add-on
|
$19,045.20 |
$19,045.20 |
$19,045.20 |
$5,935.00
|
|
Angioplasty fem/pop unilat 37224
|
$19,708.80 |
$19,708.80 |
$19,708.80 |
$11,517.60
|
