|
Allograft graftjacket 2x12cm-q4107-cost per sq cm
|
$4,304.40 |
$4,304.40 |
$4,304.40 |
$4,304.40
|
|
Allograft membrn amnio 1x2cm hu ambriodry
|
$5,381.40 |
$5,381.40 |
$5,381.40 |
$2,715.00
|
|
Allograft umbil cord+amniotic membrane-q4148-cost per sq cm
|
$4,744.80 |
$4,744.80 |
$4,744.80 |
$6,075.00
|
|
Allograft umbilical epicord 15 sq cm-q4187-cost per sq cm
|
$2,752.20 |
$2,752.20 |
$2,752.20 |
$2,752.20
|
|
Alloskin
|
$826.80 |
$826.80 |
$826.80 |
$4,094.96
|
|
All tstg perq&iq drugs/biol
|
$73.80 |
$73.80 |
$73.80 |
$64.80
|
|
Alpha-fetoprotein amniotic
|
$169.80 |
$169.80 |
$169.80 |
$94.25
|
|
Alpha-fetoprotein tumor marker
|
$352.80 |
$352.80 |
$352.80 |
$110.40
|
|
Alprostadil for injection
|
$228.18 |
$228.18 |
$228.18 |
$522.85
|
|
Alteplase 100 mg infusion from pyxis vial
|
$1,611.20 |
$2,680.50 |
$2,680.50 |
$189.60
|
|
Alt/sgpt
|
$105.00 |
$105.00 |
$105.00 |
$43.55
|
|
Altuviiio per factor viii iu
|
$8.21 |
$8.21 |
$8.21 |
$4.67
|
|
Aluminum - quest
|
$177.00 |
$177.00 |
$177.00 |
$114.40
|
|
Alys cplx sp/pn npgt w/prgrm
|
$799.20 |
$799.20 |
$799.20 |
$417.47
|
|
Amikacin 4 mg/ml intravitreal injection - cnr
|
$47.58 |
$47.58 |
$47.58 |
$36.30
|
|
Amino acid screen, urine
|
$52.80 |
$52.80 |
$102.00 |
$64.28
|
|
Aminolevulinic acid delta
|
$61.20 |
$61.20 |
$122.40 |
$95.80
|
|
Aminophylline 25 mg/ml intravenous solution (wrapper)
|
$41.59 |
$41.59 |
$41.59 |
$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 |
$273.46 |
$273.46 |
$15.32
|
|
Amivantamab-vmjw 50 mg/ml intravenous solution
|
$16.14 |
$16.14 |
$16.14 |
$22.21
|
|
Ammonia
|
$244.80 |
$244.80 |
$244.80 |
$96.53
|
|
Amniocentesisdiagnostic 59000
|
$319.20 |
$319.20 |
$319.20 |
$876.60
|
|
Amniocentesis therapeutic
|
$2,382.00 |
$2,382.00 |
$2,382.00 |
$747.75
|
|
Amniotic fluid scan
|
$177.60 |
$177.60 |
$177.60 |
$33.15
|
|
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
|
$3,591.00 |
$3,591.00 |
$3,591.00 |
$3,591.33
|
|
Amputation toe metatarsophalangeal joint
|
$3,591.00 |
$3,591.00 |
$3,591.00 |
$3,743.15
|
|
Amylase
|
$184.80 |
$184.80 |
$184.80 |
$83.20
|
|
Ana ds-dna
|
$186.00 |
$186.00 |
$186.00 |
$69.03
|
|
Anal pressure record
|
$1,116.00 |
$1,116.00 |
$1,116.00 |
$1,077.44
|
|
Analysis gene f2 20210g>a variant
|
$219.60 |
$219.60 |
$219.60 |
$246.35
|
|
Analysis gene f5 leiden variant
|
$435.60 |
$435.60 |
$435.60 |
$253.11
|
|
Analysis tumor
|
$909.00 |
$909.00 |
$909.00 |
$248.80
|
|
Anca screen with reflex to titer -quest
|
$563.40 |
$563.40 |
$563.40 |
$111.20
|
|
An cholangiogram percutaneous compl
|
$2,238.00 |
$2,238.00 |
$2,238.00 |
$2,417.63
|
|
An fluoro guide for cvp
|
$276.00 |
$276.00 |
$276.00 |
$469.17
|
|
Angio balloon ctrl dialysis seg add-on
|
$16,233.60 |
$16,233.60 |
$16,233.60 |
$5,935.00
|
|
Angioplasty fem/pop unilat 37224
|
$17,977.20 |
$17,977.20 |
$17,977.20 |
$11,517.60
|
|
Angioplasty/iliac/init ves/unilat 37220
|
$17,470.80 |
$17,470.80 |
$17,470.80 |
$12,766.07
|
|
Angioplasty tib/pero/unilat/ea add 37232
|
$17,470.80 |
$17,470.80 |
$17,470.80 |
$8,640.60
|
|
Angiotensin ii 0.5 mg/ml soln 1 ml vial
|
$1,444.89 |
$61,761.00 |
$61,761.00 |
$44,765.71
|
|
Angio tib/peroneal/init ves/unila 37228
|
$17,977.20 |
$17,977.20 |
$17,977.20 |
$14,806.05
|
|
Angio trnslmnl balloon same artery ea addl
|
$30,809.40 |
$30,809.40 |
$30,809.40 |
$5,855.20
|
|
Angio trnslmnl balloon same artery ini
|
$30,846.00 |
$30,846.00 |
$30,846.00 |
$9,966.40
|
|
Angio trnslmnl balloon same vein ea addl
|
$11,962.80 |
$11,962.80 |
$11,962.80 |
$4,390.75
|
|
Angio trnslmnl balloon same vein ini
|
$11,962.80 |
$11,962.80 |
$11,962.80 |
$8,766.15
|
|
Anidulafungin injection
|
$209.79 |
$209.79 |
$209.79 |
$209.79
|
|
Ankle X-ray
|
$392.40 |
$392.40 |
$392.40 |
$311.92
|
|
Anora (draw only)
|
$69.00 |
$69.00 |
$69.00 |
$36.00
|
|
Antibody
|
$29.40 |
$29.40 |
$29.40 |
$29.40
|
|
Antibody bacterium, not elsewhere specified
|
$52.20 |
$100.80 |
$100.80 |
$57.85
|
|
Antibody elution rbc reference
|
$321.00 |
$321.00 |
$321.00 |
$156.24
|
|
Antibody htlv/hiv confirm test
|
$256.20 |
$256.20 |
$256.20 |
$154.85
|
|
Antibody htlv-i
|
$58.20 |
$58.20 |
$58.20 |
$49.53
|
|
Antibody identification platelet antibodies heparin-pf4 igg
|
$506.40 |
$506.40 |
$506.40 |
$216.24
|
|
Antibody id rbc panel
|
$246.00 |
$246.00 |
$246.00 |
$250.90
|
|
Antibody influenza virus
|
$144.00 |
$144.00 |
$144.00 |
$63.33
|
|
Antibody screen rbc
|
$135.00 |
$135.00 |
$135.00 |
$99.99
|
|
Antibody tetanus
|
$177.60 |
$177.60 |
$177.60 |
$74.53
|
|
Antihemophilic factor-vwf 250 unit-600 unit intravenous solution
|
$3.12 |
$3.12 |
$3.12 |
$2.69
|
|
Antihemophilic viii/vwf comp
|
$2.95 |
$2.95 |
$2.95 |
$2.95
|
|
Anti-inhibitor
|
$3.67 |
$3.67 |
$3.67 |
$3.44
|
|
Antinuclear antibodies
|
$306.00 |
$306.00 |
$306.00 |
$97.50
|
|
Antinuclear antibodies titer
|
$213.60 |
$213.60 |
$213.60 |
$78.65
|
|
Antiphosphatidylserine antibody
|
$199.20 |
$199.20 |
$199.20 |
$72.15
|
|
Antistreptolysin o titer
|
$228.00 |
$228.00 |
$228.00 |
$58.50
|
|
Antithrombin iii activity
|
$493.20 |
$493.20 |
$493.20 |
$135.20
|
|
Antithrombin iii injection
|
$6.36 |
$6.36 |
$6.36 |
$6.36
|
|
Anti-thymocyte glob (equine)(1:1000) intradermal test dose
|
$6,946.62 |
$6,946.62 |
$6,946.62 |
$6,946.62
|
|
Antithymocyte globuln rabbit
|
$1,679.21 |
$1,679.21 |
$1,679.21 |
$996.39
|
|
Aortic circulation assist 33971
|
$1,372.80 |
$1,372.80 |
$1,372.80 |
$1,719.20
|
|
Apheresis immunoads slctv
|
$7,230.60 |
$7,230.60 |
$7,230.60 |
$5,517.54
|
|
Apheresis plasma
|
$3,752.40 |
$3,752.40 |
$3,752.40 |
$3,411.50
|
|
Apheresis platelets
|
$1,918.80 |
$1,918.80 |
$1,918.80 |
$2,195.00
|
|
Apheresis rbc
|
$4,411.80 |
$4,411.80 |
$4,411.80 |
$2,884.05
|
|
Apheresis wbc
|
$3,918.60 |
$3,918.60 |
$3,918.60 |
$2,906.15
|
|
Apl(pml-rara) quant - sendout
|
$319.20 |
$319.20 |
$319.20 |
$465.60
|
|
App high cost ss f/n/g/h/f >100sq cm 1st 100sq cm
|
$6,739.20 |
$6,739.20 |
$6,739.20 |
$2,078.20
|
|
App high cost ss f/n/g/h/f >100sq cm addl 100sq cm
|
$867.60 |
$867.60 |
$867.60 |
$1,057.11
|
|
App high cost ss f/n/g/h/f <100sq cm addl <25sq cm
|
$319.20 |
$319.20 |
$319.20 |
$552.00
|
|
App high cost ss t/a/l >100sq cm 1st 100sq cm
|
$7,865.40 |
$7,865.40 |
$7,865.40 |
$2,978.25
|
|
App high cost ss t/a/l >100sq cm addl 100sq cm
|
$867.60 |
$867.60 |
$867.60 |
$1,051.25
|
|
App high cost ss t/a/l <100sq cm addl <25sq cm
|
$319.20 |
$319.20 |
$319.20 |
$549.08
|
|
Application finger splntstatic 29130
|
$177.00 |
$177.00 |
$177.00 |
$208.16
|
|
Application long leg splint 29505
|
$198.60 |
$198.60 |
$198.60 |
$325.60
|
|
Application lower leg splint 29515
|
$172.20 |
$172.20 |
$172.20 |
$345.60
|
|
Application multi layer compression below knee (both sides)
|
$197.40 |
$197.40 |
$610.80 |
$384.80
|
|
Application of paste boot 29580
|
$147.00 |
$147.00 |
$532.80 |
$331.74
|
|
Application short leg cast 29405
|
$378.60 |
$378.60 |
$378.60 |
$388.80
|
|
Application skin substitute graft face/scalp/neck/genit/hnd/ft <100 sq cm 1st 25 sq cm
|
$4,771.80 |
$4,771.80 |
$4,771.80 |
$2,109.00
|
|
Application skin substitute graft trunk/arms/legs <100 sq cm 1st 25 sq cm
|
$4,771.80 |
$4,771.80 |
$4,771.80 |
$2,087.50
|
|
Appl modality 1/> areas paraffin bath 97018
|
$66.00 |
$66.00 |
$66.00 |
$69.44
|
|
Appl modality 1/> areas vasopneumatic devices 97016
|
$78.00 |
$78.00 |
$78.00 |
$71.50
|
|
Appl multlay comprs arm/hand
|
$165.60 |
$165.60 |
$165.60 |
$237.60
|
|
Apply forearm splintdynamic 29126
|
$219.60 |
$219.60 |
$219.60 |
$245.40
|
|
Apply interstit radiat compl
|
$4,170.60 |
$4,170.60 |
$4,170.60 |
$2,910.05
|
