|
17-ketosteroids
|
$137.40 |
$137.40 |
$137.40 |
$57.20
|
|
3-d radiotherapy plan
|
$6,682.20 |
$6,682.20 |
$6,682.20 |
$4,886.50
|
|
3d recon without postprocess indpndt
|
$418.80 |
$418.80 |
$418.80 |
$443.20
|
|
5' nucleotidase - sendout
|
$144.60 |
$144.60 |
$144.60 |
$64.80
|
|
88334 ap bill cytologic exam each additional site
|
$79.80 |
$79.80 |
$79.80 |
$93.00
|
|
#a/b/c/c/h pnl-candida albicans ab
|
$124.20 |
$124.20 |
$124.20 |
$53.95
|
|
Abciximab injection
|
$2,432.72 |
$2,432.72 |
$2,432.72 |
$1,084.06
|
|
Abd aorta w/runoff s&i
|
$2,476.20 |
$2,476.20 |
$2,476.20 |
$3,483.84
|
|
Abd/low ext cath 1st
|
$3,697.20 |
$3,697.20 |
$3,697.20 |
$2,954.86
|
|
Abd/low ext cath 2nd
|
$4,105.80 |
$4,105.80 |
$4,105.80 |
$2,941.25
|
|
Abd/low ext cath 3rd
|
$4,621.80 |
$4,621.80 |
$4,621.80 |
$3,522.75
|
|
Abd/low ext cath addl
|
$3,919.20 |
$3,919.20 |
$3,919.20 |
$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
|
$2,548.20 |
$2,548.20 |
$2,548.20 |
$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
|
$1,672.80 |
$1,672.80 |
$1,672.80 |
$1,144.26
|
|
Abrasion lesion single
|
$350.40 |
$350.40 |
$350.40 |
$340.86
|
|
Abscess drain retroperitoneal surg code
|
$3,676.80 |
$3,676.80 |
$3,676.80 |
$3,053.18
|
|
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
|
$103.20 |
$103.20 |
$103.20 |
$43.80
|
|
Acetylcholinesterase assay
|
$246.60 |
$246.60 |
$246.60 |
$104.40
|
|
Acetylcysteine non-comp unit
|
$29.01 |
$29.01 |
$29.01 |
$29.01
|
|
Aco med nutria tx/group, ea 30 min 97804aco
|
$43.80 |
$43.80 |
$43.80 |
$45.60
|
|
Acup 1/> wo estim 1st 15 min
|
$142.20 |
$142.20 |
$142.20 |
$42.90
|
|
Acute hepatitis panel
|
$724.20 |
$724.20 |
$724.20 |
$294.45
|
|
Acyclovir 5 mg/ml in ns IV syringe (neo/ped) - cnr
|
$48.72 |
$48.72 |
$48.72 |
$48.72
|
|
#acylcarnitineprfl
|
$311.40 |
$311.40 |
$311.40 |
$110.25
|
|
Acylcarnitines qual
|
$77.40 |
$77.40 |
$77.40 |
$45.60
|
|
Adenosine 3 mg/250 ml bag for osm
|
$209.40 |
$209.40 |
$209.40 |
$97.50
|
|
Adenovirus ag ia
|
$175.20 |
$175.20 |
$175.20 |
$31.20
|
|
Adenovirus antibody,serum - quest
|
$127.20 |
$127.20 |
$127.20 |
$63.00
|
|
Adh-sendout
|
$207.60 |
$207.60 |
$207.60 |
$152.10
|
|
Admelog u-100 insulin lispro 100 unit/ml subcutaneous solution
|
$639.08 |
$639.08 |
$639.08 |
$163.25
|
|
Administration chemotherapy IV infusion each additional hour
|
$210.00 |
$210.00 |
$210.00 |
$230.35
|
|
Administration chemotherapy IV infusion each addl sequential infusion diff substance/drug >1 hr
|
$250.20 |
$250.20 |
$250.20 |
$308.10
|
|
Administration chemotherapy IV infusion up to 1 hour single/initial substance/drug
|
$891.60 |
$891.60 |
$891.60 |
$695.37
|
|
Administration chemotherapy IV push single/initial substance/drug
|
$831.60 |
$831.60 |
$831.60 |
$454.00
|
|
Administration chemotherapy subcutaneous/im anti neoplastic hormonal
|
$362.40 |
$362.40 |
$362.40 |
$220.00
|
|
Administration chemotherapy subcutaneous/im anti neoplastic non hormonal
|
$362.40 |
$362.40 |
$362.40 |
$267.43
|
|
Administration immunization 1 vaccine
|
$78.60 |
$78.60 |
$78.60 |
$65.00
|
|
Administration immunization each additional vaccine
|
$81.60 |
$81.60 |
$81.60 |
$45.50
|
|
Ado-trastuzumab emtansine 100 mg intravenous solution
|
$59.76 |
$59.76 |
$59.76 |
$59.76
|
|
_afb id by dna probe rflx ast
|
$216.00 |
$216.00 |
$216.00 |
$105.00
|
|
#afb mycobacteria suscep. #1
|
$112.20 |
$112.20 |
$112.20 |
$38.58
|
|
Albumin body fluid quantitative each specimen
|
$99.60 |
$99.60 |
$99.60 |
$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, human 5 % intravenous solution
|
$470.97 |
$470.97 |
$470.97 |
$196.74
|
|
Albumin (microalbumin) 24 hour urine quantitative
|
$111.60 |
$111.60 |
$111.60 |
$60.45
|
|
Albumin serum plasma or whole blood
|
$99.00 |
$99.00 |
$99.00 |
$40.00
|
|
Albuterol ipratrop non-comp
|
$9.18 |
$9.18 |
$9.18 |
$9.18
|
|
Aldesleukin injection
|
$6,446.09 |
$6,446.09 |
$6,446.09 |
$5,301.26
|
|
Alkaline phosphatase
|
$109.20 |
$109.20 |
$109.20 |
$43.80
|
|
Allergen alpha lactalbumin ige
|
$62.40 |
$62.40 |
$62.40 |
$56.35
|
|
Allergen egg white ige
|
$94.80 |
$94.80 |
$94.80 |
$41.00
|
|
Allograft amniotic activebarrier 200 2x2cm-q4100-cost per sheet
|
$2,130.00 |
$2,130.00 |
$2,130.00 |
$1,377.04
|
|
Allograft ecm allopatch hd dehydr thick 0.8-1.7mmx2x5cm-cost per sq cm
|
$15,004.20 |
$15,004.20 |
$15,004.20 |
$30,615.48
|
|
Allograft epieffect 2x3cm-q4186-cost per sq cm
|
$7,189.20 |
$7,189.20 |
$7,189.20 |
$3,035.85
|
|
Allograft graftjacket 2x12cm-q4107-cost per sq cm
|
$5,177.40 |
$5,177.40 |
$5,177.40 |
$4,304.40
|
|
Allograft umbilical epicord 15 sq cm-q4187-cost per sq cm
|
$4,075.20 |
$4,075.20 |
$4,075.20 |
$2,752.20
|
|
All tstg perq&iq drugs/biol
|
$115.80 |
$115.80 |
$115.80 |
$64.80
|
|
Alpha-fetoprotein amniotic
|
$162.60 |
$162.60 |
$162.60 |
$94.25
|
|
Alpha-fetoprotein tumor marker
|
$300.00 |
$300.00 |
$300.00 |
$110.40
|
|
Alprostadil for injection
|
$228.18 |
$228.18 |
$228.18 |
$522.85
|
|
Alteplase 100 mg infusion from pyxis vial
|
$2,680.50 |
$2,680.50 |
$2,680.50 |
$189.60
|
|
Alt/sgpt
|
$99.60 |
$99.60 |
$99.60 |
$43.55
|
|
Aluminum - quest
|
$171.60 |
$171.60 |
$171.60 |
$114.40
|
|
Amikacin 4 mg/ml intravitreal injection - cnr
|
$44.00 |
$44.00 |
$44.00 |
$36.30
|
|
Amino acid screen, urine
|
$77.40 |
$77.40 |
$77.40 |
$64.28
|
|
Aminolevulinic acid delta
|
$171.60 |
$171.60 |
$171.60 |
$95.80
|
|
Aminophylline 25 mg/ml intravenous solution (wrapper)
|
$40.47 |
$40.47 |
$40.47 |
$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
|
$225.60 |
$225.60 |
$225.60 |
$96.53
|
|
Amniocentesisdiagnostic 59000
|
$658.20 |
$658.20 |
$658.20 |
$876.60
|
|
Amniotic fluid scan
|
$160.20 |
$160.20 |
$160.20 |
$33.15
|
|
Amphotericin b in d5w IV syringe 0.1 mg/ml (neo/ped) - cnr
|
$54.24 |
$54.24 |
$54.24 |
$107.46
|
|
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
|
$6,066.60 |
$6,066.60 |
$6,066.60 |
$3,591.33
|
|
Amylase
|
$165.00 |
$165.00 |
$165.00 |
$83.20
|
|
Ana ds-dna
|
$177.00 |
$177.00 |
$177.00 |
$69.03
|
|
Analysis gene f2 20210g>a variant
|
$212.40 |
$212.40 |
$212.40 |
$246.35
|
|
Analysis gene f5 leiden variant
|
$424.80 |
$424.80 |
$424.80 |
$253.11
|
|
Anca screen with reflex to titer -quest
|
$231.00 |
$231.00 |
$231.00 |
$111.20
|
|
An fluoro guide for cvp
|
$276.00 |
$276.00 |
$276.00 |
$469.17
|
|
Angio balloon ctrl dialysis seg add-on
|
$11,611.80 |
$11,611.80 |
$11,611.80 |
$5,935.00
|
|
Angioplasty fem/pop unilat 37224
|
$17,836.80 |
$17,836.80 |
$17,836.80 |
$11,517.60
|
|
Angioplasty/iliac/init ves/unilat 37220
|
$17,319.60 |
$17,319.60 |
$17,319.60 |
$12,766.07
|
|
Angioplasty tib/pero/unilat/ea add 37232
|
$16,943.40 |
$16,943.40 |
$16,943.40 |
$8,640.60
|
|
Angiotensin ii 0.5 mg/ml soln 1 ml vial
|
$186.67 |
$186.67 |
$186.67 |
$44,765.71
|
|
Angio tib/peroneal/init ves/unila 37228
|
$17,437.80 |
$17,437.80 |
$17,437.80 |
$14,806.05
|
|
Angio trnslmnl balloon same artery ea addl
|
$32,064.00 |
$32,064.00 |
$32,064.00 |
$5,855.20
|
