|
3d ech img cgen car anomal
|
$2,041.00 |
$2,041.00 |
$2,041.00 |
$511.60
|
|
3d recon without postprocess indpndt
|
$666.00 |
$666.00 |
$666.00 |
$508.13
|
|
88334 ap bill cytologic exam each additional site
|
$182.00 |
$182.00 |
$182.00 |
$100.10
|
|
Abatacept (with maltose) 250 mg intravenous solution
|
$7,377.95 |
$7,377.95 |
$7,377.95 |
$3,138.72
|
|
Abd/low ext cath 1st
|
$5,338.00 |
$5,338.00 |
$5,338.00 |
$2,015.85
|
|
Abd/low ext cath 2nd
|
$4,498.00 |
$4,498.00 |
$4,498.00 |
$2,016.00
|
|
Abd/low ext cath 3rd
|
$7,755.00 |
$7,755.00 |
$7,755.00 |
$2,475.45
|
|
Abdominal and Pelvic Blood Vessel Ultrasound (complete)
|
$1,829.00 |
$1,829.00 |
$1,829.00 |
$988.00
|
|
Abdominal and Pelvic Blood Vessel Ultrasound (limited)
|
$1,536.00 |
$1,536.00 |
$1,536.00 |
$662.40
|
|
Abdominal CT scan (with and without contrast)
|
$4,983.00 |
$4,983.00 |
$4,983.00 |
$1,976.94
|
|
Abdominal CT scan (with contrast)
|
$4,615.00 |
$4,615.00 |
$4,615.00 |
$1,667.60
|
|
Abdominal CT scan (without contrast)
|
$3,184.00 |
$3,184.00 |
$3,184.00 |
$1,353.32
|
|
Abdominal MRI (with and without contrast)
|
$7,916.00 |
$7,916.00 |
$7,916.00 |
$2,967.00
|
|
Abdominal MRI (without contrast)
|
$5,382.00 |
$5,382.00 |
$5,382.00 |
$2,048.36
|
|
Abdominal paracentesis w/image guidance
|
$10,246.00 |
$10,246.00 |
$10,246.00 |
$1,632.96
|
|
Abdominal Ultrasound (complete)
|
$1,826.00 |
$1,826.00 |
$1,826.00 |
$783.00
|
|
Abdominal Ultrasound (limited)
|
$1,259.00 |
$1,259.00 |
$1,259.00 |
$586.43
|
|
Abdominal X-ray (2 views)
|
$579.00 |
$579.00 |
$579.00 |
$318.20
|
|
Abdominal X-ray (single view)
|
$19,312.13 |
$19,312.13 |
$19,312.13 |
$260.00
|
|
Abdominoplasty 15830
|
$35,112.27 |
$35,112.27 |
$35,112.27 |
$6,442.80
|
|
Ablate heart dysrhythm focus
|
$22,504.00 |
$22,504.00 |
$22,504.00 |
$9,332.05
|
|
Ablation cardiac vagal inputs atrium
|
$3,621.00 |
$3,621.00 |
$3,621.00 |
$2,260.30
|
|
Abscess drain retroperitoneal surg code
|
$670.00 |
$670.00 |
$670.00 |
$3,050.40
|
|
Acetaminophen 120 mg rectal suppository
|
$29,976.80 |
$29,976.80 |
$29,976.80 |
$146.76
|
|
Acetazolamide 500 mg solution for injection
|
$184.00 |
$184.00 |
$184.00 |
$122.55
|
|
Acetylcholine receptor modulating antibody
|
$70.00 |
$70.00 |
$70.00 |
$67.50
|
|
Acetylcysteine 200 mg/ml (20 %) intravenous solution
|
$172.50 |
$172.50 |
$172.50 |
$218.79
|
|
Acute hepatitis panel
|
$927.00 |
$927.00 |
$927.00 |
$284.95
|
|
Acyclovir 400 mg tablet
|
$1.00 |
$1.00 |
$1.00 |
$54.77
|
|
Acyclovir 5 mg/ml in ns IV syringe (neo/ped) - cnr
|
$20.70 |
$20.70 |
$20.70 |
$64.45
|
|
Adapter b 8 channel 10cm
|
$30,555.23 |
$30,555.23 |
$30,555.23 |
$5,109.58
|
|
Adenosine 3 mg/250 ml bag for osm
|
$695.70 |
$695.70 |
$695.70 |
$271.98
|
|
Admelog u-100 insulin lispro 100 unit/ml subcutaneous solution
|
$61.10 |
$61.10 |
$61.10 |
$193.40
|
|
Administration immunization each additional component
|
$32.00 |
$32.00 |
$32.00 |
$29.20
|
|
Administration immunization each additional vaccine
|
$70.00 |
$70.00 |
$70.00 |
$47.40
|
|
Administration immunization first component each vaccine
|
$66.00 |
$66.00 |
$66.00 |
$46.40
|
|
Administration immunization intranasal/oral route 1 vaccine
|
$61.00 |
$61.00 |
$61.00 |
$48.00
|
|
Administration immunization intranasal/oral route each additional vaccine
|
$36.00 |
$36.00 |
$36.00 |
$30.24
|
|
Administration rsv monoclonal ab seasonal dose im w/counseling
|
$60.00 |
$60.00 |
$60.00 |
$44.80
|
|
Administration vaccine hepatitis b
|
$88.00 |
$88.00 |
$88.00 |
$53.00
|
|
Administration vaccine influenza virus
|
$177.00 |
$177.00 |
$177.00 |
$51.07
|
|
Administration vaccine pneumococcal
|
$88.00 |
$88.00 |
$88.00 |
$49.68
|
|
Administration vaccine rsv monoclonal ab seasonal dose im
|
$56.00 |
$56.00 |
$56.00 |
$41.45
|
|
Ado-trastuzumab emtansine 100 mg intravenous solution
|
$19,916.25 |
$19,916.25 |
$19,916.25 |
$11,350.31
|
|
Advance care planning each additional 30 min 99498
|
$178.00 |
$178.00 |
$178.00 |
$110.56
|
|
Agalsidase beta 35 mg intravenous solution
|
$18,756.30 |
$18,756.30 |
$18,756.30 |
$14,475.20
|
|
Albumin body fluid quantitative each specimen
|
$219.00 |
$219.00 |
$219.00 |
$47.45
|
|
Albumin, human 25 % intravenous solution
|
$871.00 |
$871.00 |
$871.00 |
$234.94
|
|
Albumin, human 5 % intravenous solution
|
$332.50 |
$332.50 |
$332.50 |
$275.16
|
|
Albumin (microalbumin) 24 hour urine quantitative
|
$96.00 |
$96.00 |
$96.00 |
$58.17
|
|
Albumin serum plasma or whole blood
|
$40,341.40 |
$40,341.40 |
$40,341.40 |
$43.00
|
|
Alcohol (ethanol) any specimen except urine/breath
|
$146.00 |
$146.00 |
$146.00 |
$96.00
|
|
Alemtuzumab 12 mg/1.2 ml intravenous solution
|
$89,232.75 |
$89,232.75 |
$89,232.75 |
$47,974.31
|
|
Alkaline phosphatase
|
$188.00 |
$188.00 |
$188.00 |
$46.80
|
|
Allergen alpha lactalbumin ige
|
$48.00 |
$48.00 |
$48.00 |
$48.57
|
|
Allergen egg white ige
|
$83.00 |
$83.00 |
$83.00 |
$38.00
|
|
Allograft 160mg placental salera mini membrane
|
$66.55 |
$66.55 |
$66.55 |
$5,835.10
|
|
Allograft allowrap 4x4cm dry 16sqcm
|
$653.33 |
$653.33 |
$653.33 |
$5,399.16
|
|
Allograft amniotic activebarrier 200 2x2cm-q4100-cost per sheet
|
$6,093.98 |
$6,093.98 |
$6,093.98 |
$9,900.02
|
|
Allograft dermis 20x25x1mm decell w/matracell arthroflex
|
$5,636.14 |
$5,636.14 |
$5,636.14 |
$6,285.56
|
|
Allograft ecm allopatch hd dehydr thick 0.8-1.7mmx2x5cm-cost per sq cm
|
$245.37 |
$245.37 |
$245.37 |
$20,311.34
|
|
Allograft epieffect 2x3cm-q4186-cost per sq cm
|
$3,227.12 |
$3,227.12 |
$3,227.12 |
$858.66
|
|
Allograft graftjacket 2x12cm-q4107-cost per sq cm
|
$366.35 |
$366.35 |
$366.35 |
$4,677.40
|
|
Allograft membrn amnio 1x2cm hu ambriodry
|
$8,630.50 |
$8,630.50 |
$8,630.50 |
$5,096.00
|
|
Allograft umbil cord+amniotic membrane-q4148-cost per sq cm
|
$358.06 |
$358.06 |
$358.06 |
$5,278.73
|
|
Allograft umbilical epicord 15 sq cm-q4187-cost per sq cm
|
$1,254.67 |
$1,254.67 |
$1,254.67 |
$1,225.35
|
|
Alpha-1-proteinase inhibitor (human) 1,000 mg (+/-) IV solution
|
$2,450.00 |
$2,450.00 |
$2,450.00 |
$13.14
|
|
Alpha-fetoprotein tumor marker
|
$206.00 |
$206.00 |
$206.00 |
$106.00
|
|
Alteplase 100 mg infusion from pyxis vial
|
$25,477.05 |
$25,477.05 |
$25,477.05 |
$15,857.45
|
|
Alt/sgpt
|
$203.00 |
$203.00 |
$203.00 |
$47.50
|
|
Alys cplx sp/pn npgt w/prgrm
|
$1,640.00 |
$1,640.00 |
$1,640.00 |
$411.45
|
|
Amikacin 4 mg/ml intravitreal injection - cnr
|
$17.05 |
$17.05 |
$17.05 |
$39.84
|
|
Aminocaproic acid 5 g/250 ml 0.9% nacl IV - cnr
|
$47.20 |
$47.20 |
$47.20 |
$37.33
|
|
Aminophylline 25 mg/ml intravenous solution (wrapper)
|
$101.15 |
$101.15 |
$101.15 |
$47.06
|
|
Amiodarone 150 mg/100 ml (1.5 mg/ml) in dextrose, iso-osmotic IV
|
$212.00 |
$212.00 |
$212.00 |
$108.13
|
|
Amiodarone 50 mg/ml intravenous solution
|
$79.05 |
$79.05 |
$79.05 |
$55.86
|
|
Amivantamab-vmjw 50 mg/ml intravenous solution
|
$11,933.95 |
$11,933.95 |
$11,933.95 |
$9,084.45
|
|
Ammonia
|
$338.00 |
$338.00 |
$338.00 |
$119.70
|
|
Amphotericin b in d5w IV syringe 0.1 mg/ml (neo/ped) - cnr
|
$8.75 |
$8.75 |
$8.75 |
$123.53
|
|
Amphotericin b liposomal in d5w IV syringe 1 mg/ml (neo/ped) - cnr
|
$1,507.85 |
$1,507.85 |
$1,507.85 |
$519.03
|
|
Ampicillin 1 gram solution for injection
|
$38.85 |
$38.85 |
$38.85 |
$56.70
|
|
Ampicillin-sulbactam 1.5 gram solution for injection
|
$590.00 |
$590.00 |
$590.00 |
$54.57
|
|
Amplification real-time pcr dna markers infectious disease bacterial vaginosis and vaginitis
|
$789.00 |
$789.00 |
$789.00 |
$262.99
|
|
Amp metatarsal w/toe single 28810
|
$1,460.00 |
$1,460.00 |
$1,460.00 |
$3,986.00
|
|
Amputation toe metatarsophalangeal joint
|
$14,299.20 |
$14,299.20 |
$14,299.20 |
$3,839.54
|
|
Amylase
|
$120.00 |
$120.00 |
$120.00 |
$90.00
|
|
Analgesics non-opioid definitive assay 1 or 2 acetaminophen
|
$628.00 |
$628.00 |
$628.00 |
$117.01
|
|
Analysis gene f2 20210g>a variant
|
$272.00 |
$272.00 |
$272.00 |
$226.85
|
|
Analysis gene f5 leiden variant
|
$365.00 |
$365.00 |
$365.00 |
$249.60
|
|
Analyze neurostimulator simple w/reprogramming 95971
|
$1,100.00 |
$1,100.00 |
$1,100.00 |
$375.00
|
|
Anaplsma phgcytophlm amp prb
|
$127.00 |
$127.00 |
$127.00 |
$85.80
|
|
An cholangiogram percutaneous compl
|
$14,166.00 |
$14,166.00 |
$14,166.00 |
$2,480.94
|
|
Anchor suture 3.5mm pushlock
|
$3,315.38 |
$3,315.38 |
$3,315.38 |
$2,155.00
|
|
An fluoro guide for cvp
|
$1,162.00 |
$1,162.00 |
$1,162.00 |
$525.85
|
|
Angioplasty fem/pop unilat 37224
|
$21,426.00 |
$21,426.00 |
$21,426.00 |
$8,600.40
|
|
Angioplasty tib/pero/unilat/ea add 37232
|
$16,801.00 |
$16,801.00 |
$16,801.00 |
$5,950.50
|
|
Angio trnslmnl balloon same vein ini
|
$18,486.00 |
$18,486.00 |
$18,486.00 |
$8,359.11
|
|
Ankle X-ray
|
$972.00 |
$972.00 |
$972.00 |
$356.32
|
|
Ankle X-ray (2 views, both ankles)
|
$796.00 |
$796.00 |
$796.00 |
$282.96
|
|
Ant colporrhaphy/rpr cyctocele 57240
|
$1,840.00 |
$1,840.00 |
$1,840.00 |
$5,841.60
|
