|
Administration chemotherapy IV infusion each additional hour
|
$120.00 |
$120.00 |
$131.40 |
$230.35
|
|
Administration chemotherapy IV infusion each addl sequential infusion diff substance/drug >1 hr
|
$100.20 |
$100.20 |
$109.80 |
$298.98
|
|
Administration chemotherapy IV infusion up to 1 hour single/initial substance/drug
|
$367.80 |
$367.80 |
$386.40 |
$668.98
|
|
Administration chemotherapy IV push single/initial substance/drug
|
$141.00 |
$141.00 |
$154.20 |
$439.20
|
|
Administration chemotherapy subcutaneous/im anti neoplastic hormonal
|
$117.00 |
$117.00 |
$128.40 |
$212.80
|
|
Administration chemotherapy subcutaneous/im anti neoplastic non hormonal
|
$159.60 |
$159.60 |
$174.60 |
$256.49
|
|
Administration immunization each additional component
|
$20.40 |
$20.40 |
$24.60 |
$29.20
|
|
Administration immunization each additional vaccine
|
$25.20 |
$25.20 |
$52.80 |
$47.40
|
|
Administration immunization first component each vaccine
|
$38.40 |
$38.40 |
$40.20 |
$46.40
|
|
Administration immunization intranasal/oral route 1 vaccine
|
$37.20 |
$37.20 |
$39.00 |
$48.00
|
|
Administration immunization intranasal/oral route each additional vaccine
|
$19.20 |
$19.20 |
$20.40 |
$30.24
|
|
Administration rsv monoclonal ab seasonal dose im w/counseling
|
$33.00 |
$33.00 |
$33.00 |
$44.80
|
|
Administration vaccine hepatitis b
|
$31.20 |
$31.20 |
$33.00 |
$53.00
|
|
Administration vaccine influenza virus
|
$31.20 |
$31.20 |
$33.00 |
$51.07
|
|
Administration vaccine pneumococcal
|
$31.20 |
$31.20 |
$33.00 |
$49.68
|
|
Administration vaccine rsv monoclonal ab seasonal dose im
|
$28.20 |
$28.20 |
$28.20 |
$41.45
|
|
Ado-trastuzumab emtansine 100 mg intravenous solution
|
$10,646.11 |
$10,646.11 |
$11,347.68 |
$11,350.31
|
|
Adrenalectomy expl w/exc retro tumor 60545
|
$2,211.00 |
$2,211.00 |
$2,321.40 |
$5,441.80
|
|
Adrenalin epinephrine inject
|
$551.41 |
$551.41 |
$551.41 |
$231.47
|
|
Advance care planning each additional 30 min 99498
|
$141.60 |
$141.60 |
$148.80 |
$110.56
|
|
_afb id by dna probe rflx ast
|
$99.00 |
$99.00 |
$110.40 |
$104.50
|
|
#afb mycobacteria suscep. #1
|
$28.20 |
$28.20 |
$31.80 |
$34.72
|
|
_afb org id by sequencing rflx ast-sendout
|
$366.00 |
$366.00 |
$408.00 |
$300.00
|
|
Afo sing upright with adjust s
|
$16.20 |
$16.20 |
$16.80 |
$740.16
|
|
Afo tib fx semi-rigid l2114
|
$15.60 |
$15.60 |
$16.20 |
$817.60
|
|
Afo tibial fracture rigid
|
$6.00 |
$6.00 |
$6.60 |
$1,489.57
|
|
Afo tibial fracture soft
|
$7.20 |
$7.20 |
$7.80 |
$1,060.02
|
|
After cataract laser surgery
|
$586.80 |
$586.80 |
$678.00 |
$1,373.11
|
|
Agalsidase beta 35 mg intravenous solution
|
$12,831.66 |
$12,831.66 |
$13,216.24 |
$14,475.20
|
|
Air conduction bilat
|
$52.80 |
$52.80 |
$55.20 |
$134.00
|
|
Air injection into abdomen 49400
|
$224.40 |
$224.40 |
$235.80 |
$525.60
|
|
Airway resistance by impulse oscillometry 94728
|
$103.80 |
$103.80 |
$114.60 |
$297.00
|
|
Albumin body fluid quantitative each specimen
|
$77.40 |
$77.40 |
$86.40 |
$47.45
|
|
Albumin (human), 25%, 50ml
|
$322.92 |
$322.92 |
$347.15 |
$244.70
|
|
Albumin (human), 5%, 250 ml
|
$322.92 |
$322.92 |
$322.92 |
$252.77
|
|
Albumin, human 5 % intravenous solution
|
$87.35 |
$87.35 |
$87.35 |
$275.16
|
|
Albumin (microalbumin) 24 hour urine quantitative
|
$175.20 |
$175.20 |
$184.20 |
$58.17
|
|
Albumin serum plasma or whole blood
|
$92.40 |
$92.40 |
$97.20 |
$43.00
|
|
Albuterol ipratrop non-comp
|
$6.62 |
$6.62 |
$6.62 |
$5.67
|
|
Albuterol non-comp unit
|
$5.83 |
$5.83 |
$5.83 |
$5.40
|
|
Alcohol (ethanol) any specimen except urine/breath
|
$96.00 |
$96.00 |
$107.40 |
$96.00
|
|
Aldesleukin injection
|
$1,496.81 |
$1,496.81 |
$1,496.81 |
$9,030.11
|
|
Alginate drsg wound filler
|
$9.00 |
$9.00 |
$9.00 |
$15.79
|
|
Alkaline phosphatase
|
$42.60 |
$42.60 |
$47.40 |
$46.80
|
|
Allergen alpha lactalbumin ige
|
$65.40 |
$65.40 |
$259.20 |
$48.57
|
|
Allergen egg white ige
|
$75.00 |
$75.00 |
$79.20 |
$38.00
|
|
Allergy injections; 2 or more 95117
|
$21.60 |
$21.60 |
$22.80 |
$45.00
|
|
Allergy injection; single 95115
|
$18.00 |
$18.00 |
$19.20 |
$46.80
|
|
Allg patch or app # of tests 95044
|
$8.40 |
$8.40 |
$9.00 |
$423.37
|
|
Allograft amniotic activebarrier 200 2x2cm-q4100-cost per sheet
|
$12,402.00 |
$12,402.00 |
$12,402.00 |
$9,900.02
|
|
Allograft dermis 20x25x1mm decell w/matracell arthroflex
|
$4,303.20 |
$4,303.20 |
$4,303.20 |
$6,285.56
|
|
Allograft ecm allopatch hd dehydr thick 0.8-1.7mmx2x5cm-cost per sq cm
|
$23,373.60 |
$23,373.60 |
$23,373.60 |
$20,311.34
|
|
Alloskin
|
$1,033.80 |
$1,033.80 |
$1,086.00 |
$582.40
|
|
Alpha-1-proteinase inhibitor (human) 1,000 mg (+/-) IV solution
|
$38.29 |
$38.29 |
$38.29 |
$13.14
|
|
Alpha-fetoprotein amniotic
|
$189.00 |
$189.00 |
$210.60 |
$89.04
|
|
Alpha-fetoprotein tumor marker
|
$132.60 |
$132.60 |
$139.80 |
$106.00
|
|
Alprostadil for injection
|
$263.30 |
$263.30 |
$313.41 |
$511.41
|
|
Alteplase 100 mg infusion from pyxis vial
|
$15,616.81 |
$15,616.81 |
$15,616.81 |
$15,857.45
|
|
Alt/sgpt
|
$47.40 |
$47.40 |
$49.80 |
$47.50
|
|
Aluminum - quest
|
$136.20 |
$136.20 |
$152.40 |
$83.05
|
|
Amantadine (symmetrel)-sendout
|
$294.60 |
$294.60 |
$327.60 |
$179.70
|
|
Ambl bp mntr w/software
|
$178.20 |
$178.20 |
$187.20 |
$178.20
|
|
Amifostine
|
$1,989.17 |
$1,989.17 |
$1,989.17 |
$2,121.39
|
|
Amikacin 4 mg/ml intravitreal injection - cnr
|
$129.55 |
$129.55 |
$129.55 |
$39.84
|
|
Amino acid screen, urine
|
$91.80 |
$91.80 |
$102.60 |
$77.00
|
|
Amino acids quant 2-5
|
$249.60 |
$249.60 |
$278.40 |
$112.00
|
|
Aminocaproic acid 5 g/250 ml 0.9% nacl IV - cnr
|
$25.31 |
$25.31 |
$25.31 |
$37.33
|
|
Aminolevulinic acid delta
|
$252.00 |
$252.00 |
$264.60 |
$87.12
|
|
Aminophylline 25 mg/ml intravenous solution (wrapper)
|
$53.09 |
$53.09 |
$63.16 |
$47.06
|
|
Amiodarone 50 mg/ml intravenous solution
|
$168.45 |
$168.45 |
$174.85 |
$55.86
|
|
Amitriptyline (elavil) -sendout
|
$186.60 |
$186.60 |
$208.20 |
$87.45
|
|
Amitriptyline injection
|
$31.10 |
$31.10 |
$31.10 |
$31.10
|
|
Amivantamab-vmjw 50 mg/ml intravenous solution
|
$5,856.34 |
$5,856.34 |
$6,499.82 |
$9,084.45
|
|
Ammonia
|
$85.20 |
$85.20 |
$95.40 |
$119.70
|
|
Amniocentesisdiagnostic 59000
|
$571.20 |
$571.20 |
$660.00 |
$942.60
|
|
Amniotic fluid scan
|
$37.20 |
$37.20 |
$42.00 |
$49.01
|
|
Amphetamine confirm urine -sendout
|
$192.00 |
$192.00 |
$213.60 |
$93.61
|
|
Amphotericin b in d5w IV syringe 0.1 mg/ml (neo/ped) - cnr
|
$93.05 |
$93.05 |
$100.98 |
$123.53
|
|
Amphotericin b lipid complex
|
$366.66 |
$366.66 |
$366.66 |
$226.80
|
|
Amphotericin b liposomal in d5w IV syringe 1 mg/ml (neo/ped) - cnr
|
$543.85 |
$543.85 |
$576.21 |
$519.03
|
|
Ampicillin 1 gram solution for injection
|
$54.34 |
$54.34 |
$83.81 |
$56.70
|
|
Ampicillin-sulbactam 1.5 gram solution for injection
|
$87.97 |
$87.97 |
$87.97 |
$54.57
|
|
Amp metatarsal w/toe single 28810
|
$808.80 |
$808.80 |
$849.00 |
$3,986.00
|
|
Amp thigh through femur re-amp 27596
|
$1,331.40 |
$1,331.40 |
$1,398.00 |
$3,494.40
|
|
Amputate metacarpal bone 26910
|
$1,287.00 |
$1,287.00 |
$1,351.20 |
$3,839.54
|
|
Amputate thigh through femur 27590
|
$1,494.60 |
$1,494.60 |
$1,569.60 |
$3,370.00
|
|
Amputation leg thr tib/fib 27880
|
$1,691.40 |
$1,691.40 |
$1,776.00 |
$3,870.00
|
|
Amputation leg; tib/fib f/u 27886
|
$957.00 |
$957.00 |
$1,005.00 |
$1,506.60
|
|
Amputation of midtarsal 28800
|
$1,020.60 |
$1,020.60 |
$1,071.60 |
$2,285.40
|
|
Amputation thru metatarsal
|
$1,382.40 |
$1,382.40 |
$1,451.40 |
$3,839.54
|
|
Amputation toe interphalangeal joint
|
$3,195.60 |
$3,195.60 |
$3,691.20 |
$4,196.50
|
|
Amputation toe metatarsophalangeal joint
|
$1,039.80 |
$1,039.80 |
$1,092.00 |
$3,839.54
|
|
Amylase
|
$115.20 |
$115.20 |
$121.20 |
$90.00
|
|
Ana ds-dna
|
$225.60 |
$225.60 |
$251.40 |
$55.24
|
|
Analgesics non-opioid definitive assay 1 or 2 acetaminophen
|
$186.60 |
$186.60 |
$208.20 |
$117.01
|
|
Anal/urinary muscle study
|
$90.00 |
$90.00 |
$90.00 |
$407.00
|
|
Analysis complx cranial nerve pulse gen prgrmg 95977
|
$322.20 |
$322.20 |
$338.40 |
$320.40
|
|
Analysis gene f2 20210g>a variant
|
$195.00 |
$195.00 |
$217.80 |
$226.85
|
|
Analysis gene f5 leiden variant
|
$216.00 |
$216.00 |
$241.20 |
$249.60
|
|
Analysis; simple cranial nerv pulse gen prgrmg 95976
|
$243.00 |
$243.00 |
$255.00 |
$122.20
|
