|
11-desoxycortisol - sendout
|
$220.80 |
$220.80 |
$220.80 |
$87.50
|
|
17-hydroxypregnenolone
|
$333.00 |
$333.00 |
$333.00 |
$89.25
|
|
17-ketosteroids
|
$87.60 |
$87.60 |
$87.60 |
$55.00
|
|
1st hosp/birthing center care per day nml nb 99460
|
$136.80 |
$136.80 |
$136.80 |
$161.60
|
|
3-d radiotherapy plan
|
$4,527.60 |
$4,527.60 |
$4,527.60 |
$5,002.69
|
|
3d recon without postprocess indpndt
|
$155.40 |
$155.40 |
$155.40 |
$485.00
|
|
99381 initial comp preventive med less than 1 year new
|
$94.80 |
$94.80 |
$94.80 |
$132.00
|
|
99382 initial comp preventive med 1 to 4 years new
|
$93.60 |
$93.60 |
$93.60 |
$126.00
|
|
99383 initial comp preventive med 5 to 11 years new
|
$90.00 |
$90.00 |
$90.00 |
$111.00
|
|
99391 periodic comp preventive med less than 1 year est
|
$86.40 |
$86.40 |
$86.40 |
$107.10
|
|
99392 periodic comp preventive med 1 to 4 years est
|
$87.60 |
$87.60 |
$87.60 |
$115.50
|
|
99393 periodic comp preventive med 5 to 11 years est
|
$90.60 |
$90.60 |
$90.60 |
$113.40
|
|
99394 periodic comp preventive med 12 to 17 years est
|
$101.40 |
$101.40 |
$101.40 |
$127.20
|
|
99397 periodic comp preventive med 65+ years est
|
$131.40 |
$131.40 |
$131.40 |
$160.73
|
|
Abatacept (with maltose) 250 mg intravenous solution
|
$3,489.00 |
$3,489.00 |
$3,489.00 |
$3,128.29
|
|
#a/b/c/c/h pnl-candida albicans ab
|
$108.00 |
$108.00 |
$108.00 |
$53.95
|
|
Abd aorta w/runoff s&i
|
$3,111.60 |
$3,111.60 |
$3,111.60 |
$3,569.56
|
|
Abd/low ext cath 1st
|
$1,258.80 |
$1,258.80 |
$1,258.80 |
$2,015.85
|
|
Abd/low ext cath 2nd
|
$1,254.60 |
$1,254.60 |
$1,254.60 |
$2,015.85
|
|
Abd/low ext cath 3rd
|
$1,254.60 |
$1,254.60 |
$1,254.60 |
$2,486.97
|
|
Abdominal CT scan (with and without contrast)
|
$2,446.80 |
$2,446.80 |
$2,446.80 |
$2,009.80
|
|
Abdominal CT scan (with contrast)
|
$2,048.40 |
$2,048.40 |
$2,048.40 |
$1,680.60
|
|
Abdominal CT scan (without contrast)
|
$1,663.20 |
$1,663.20 |
$1,663.20 |
$1,358.76
|
|
Abdominal MRI (with and without contrast)
|
$2,704.80 |
$2,704.80 |
$2,704.80 |
$3,015.94
|
|
Abdominal MRI (with contrast)
|
$2,704.80 |
$2,704.80 |
$2,704.80 |
$2,268.20
|
|
Abdominal MRI (without contrast)
|
$2,552.40 |
$2,552.40 |
$2,552.40 |
$2,050.14
|
|
Abdominal paracentesis w/image guidance
|
$1,428.00 |
$1,428.00 |
$1,428.00 |
$1,651.20
|
|
Abdominal Ultrasound (complete)
|
$933.00 |
$933.00 |
$933.00 |
$785.55
|
|
Abdominal Ultrasound (limited)
|
$565.20 |
$565.20 |
$565.20 |
$590.00
|
|
Abd paracentesis/w/o image guide 49082
|
$1,148.40 |
$1,148.40 |
$1,148.40 |
$1,145.40
|
|
Abl1 gene
|
$1,226.40 |
$1,226.40 |
$1,226.40 |
$682.50
|
|
Ablate arrhythmia add on
|
$13,335.60 |
$13,335.60 |
$13,335.60 |
$6,898.92
|
|
Ablate heart dysrhythm focus
|
$9,182.40 |
$9,182.40 |
$9,182.40 |
$9,522.05
|
|
Ablation cryo adrenal tumor
|
$7,728.00 |
$7,728.00 |
$7,728.00 |
$6,904.15
|
|
Abscess drain retroperitoneal surg code
|
$3,439.80 |
$3,439.80 |
$3,439.80 |
$2,957.17
|
|
Absorpt drg >16 <=48 without bdr
|
$4.97 |
$4.97 |
$4.97 |
$6.40
|
|
Access & clsr pq fem art endogft dlvry w/img uni
|
$3,339.60 |
$3,339.60 |
$3,339.60 |
$2,314.00
|
|
Acetaminophen 10 mg/ml soln 100 ml glass cont
|
$49.20 |
$49.20 |
$49.20 |
$74.96
|
|
Acetaminophen 120 mg rectal suppository
|
$2,440.80 |
$2,440.80 |
$2,440.80 |
$75.09
|
|
Acetaminophen level
|
$34.20 |
$34.20 |
$34.20 |
$107.62
|
|
Acetazolamide 500 mg solution for injection
|
$150.00 |
$150.00 |
$150.00 |
$122.55
|
|
Acetone qualitative
|
$96.60 |
$96.60 |
$96.60 |
$45.65
|
|
Acetylcholine receptor modulating antibody
|
$1,156.80 |
$1,156.80 |
$1,156.80 |
$64.50
|
|
Aco annual medicare visit (awv), subsq g0439aco
|
$114.60 |
$114.60 |
$114.60 |
$167.04
|
|
Acute hepatitis panel
|
$348.60 |
$348.60 |
$348.60 |
$292.00
|
|
Acyclovir 400 mg tablet
|
$902.40 |
$902.40 |
$902.40 |
$45.06
|
|
Acyclovir 5 mg/ml in ns IV syringe (neo/ped) - cnr
|
$37.80 |
$37.80 |
$37.80 |
$63.48
|
|
#acylcarnitineprfl
|
$174.00 |
$174.00 |
$174.00 |
$125.40
|
|
Adapter b 8 channel 10cm
|
$3,528.00 |
$3,528.00 |
$3,528.00 |
$5,695.04
|
|
Adenosine 3 mg/250 ml bag for osm
|
$426.00 |
$426.00 |
$426.00 |
$255.41
|
|
Adh-sendout
|
$159.00 |
$159.00 |
$159.00 |
$109.28
|
|
Admelog u-100 insulin lispro 100 unit/ml subcutaneous solution
|
$1.20 |
$1.20 |
$1.20 |
$181.12
|
|
Administration chemotherapy IV infusion each additional hour
|
$156.60 |
$156.60 |
$156.60 |
$230.35
|
|
Administration chemotherapy IV infusion each addl sequential infusion diff substance/drug >1 hr
|
$136.80 |
$136.80 |
$136.80 |
$294.00
|
|
Administration chemotherapy IV infusion up to 1 hour single/initial substance/drug
|
$477.00 |
$477.00 |
$477.00 |
$657.12
|
|
Administration chemotherapy IV push single/initial substance/drug
|
$223.20 |
$223.20 |
$223.20 |
$439.20
|
|
Administration chemotherapy subcutaneous/im anti neoplastic hormonal
|
$162.60 |
$162.60 |
$162.60 |
$211.09
|
|
Administration chemotherapy subcutaneous/im anti neoplastic non hormonal
|
$150.00 |
$150.00 |
$150.00 |
$257.40
|
|
Administration immunization 1 vaccine
|
$77.40 |
$77.40 |
$77.40 |
$69.21
|
|
Administration immunization each additional vaccine
|
$37.80 |
$37.80 |
$37.80 |
$47.40
|
|
Administration vaccine hepatitis b
|
$55.80 |
$55.80 |
$55.80 |
$54.40
|
|
Ado-trastuzumab emtansine 100 mg intravenous solution
|
$9,962.40 |
$9,962.40 |
$9,962.40 |
$11,350.31
|
|
Advance care planning each additional 30 min 99498
|
$99.00 |
$99.00 |
$99.00 |
$108.00
|
|
Airway resistance by impulse oscillometry 94728
|
$293.40 |
$293.40 |
$293.40 |
$270.50
|
|
Albumin body fluid quantitative each specimen
|
$5.40 |
$5.40 |
$5.40 |
$46.23
|
|
Albumin (human), 25%, 50ml
|
$294.00 |
$294.00 |
$294.00 |
$244.70
|
|
Albumin, human 25 % intravenous solution
|
$246.00 |
$246.00 |
$246.00 |
$234.94
|
|
Albumin (human), 5%, 250 ml
|
$181.20 |
$181.20 |
$181.20 |
$243.59
|
|
Albumin (microalbumin) 24 hour urine quantitative
|
$105.00 |
$105.00 |
$105.00 |
$57.00
|
|
Albumin serum plasma or whole blood
|
$96.60 |
$96.60 |
$96.60 |
$40.80
|
|
Alginate dressing <=16 sq in
|
$6.97 |
$6.97 |
$6.97 |
$18.20
|
|
Alkaline phosphatase
|
$86.40 |
$86.40 |
$86.40 |
$46.40
|
|
Allergen alpha lactalbumin ige
|
$112.80 |
$112.80 |
$112.80 |
$48.00
|
|
Allergen egg white ige
|
$39.60 |
$39.60 |
$39.60 |
$38.00
|
|
Allergen specific ige qual multi scrn ea
|
$19.20 |
$19.20 |
$19.20 |
$24.01
|
|
Allergy injections; 2 or more 95117
|
$18.60 |
$18.60 |
$18.60 |
$43.75
|
|
Allograft allowrap 4x4cm dry 16sqcm
|
$635.04 |
$635.04 |
$635.04 |
$5,401.92
|
|
Allograft epieffect 2x3cm-q4186-cost per sq cm
|
$1,313.47 |
$1,313.47 |
$1,313.47 |
$874.65
|
|
Allograft graftjacket 2x12cm-q4107-cost per sq cm
|
$284.00 |
$284.00 |
$284.00 |
$4,677.40
|
|
Allograft umbilical epicord 15 sq cm-q4187-cost per sq cm
|
$380.73 |
$380.73 |
$380.73 |
$1,495.63
|
|
Alpha-1-proteinase inhibitor (human) 1,000 mg (+/-) IV solution
|
$3.60 |
$3.60 |
$3.60 |
$12.50
|
|
Alpha-fetoprotein afp-l3 frac & total
|
$370.80 |
$370.80 |
$370.80 |
$175.20
|
|
Alpha-fetoprotein tumor marker
|
$181.20 |
$181.20 |
$181.20 |
$106.00
|
|
Alteplase 100 mg infusion from pyxis vial
|
$32,310.00 |
$32,310.00 |
$32,310.00 |
$15,857.45
|
|
Alt/sgpt
|
$133.80 |
$133.80 |
$133.80 |
$47.45
|
|
Aluminum - quest
|
$273.00 |
$273.00 |
$273.00 |
$83.05
|
|
Amantadine (symmetrel)-sendout
|
$247.20 |
$247.20 |
$247.20 |
$169.80
|
|
Aminocaproic acid 5 g/250 ml 0.9% nacl IV - cnr
|
$29.10 |
$29.10 |
$29.10 |
$37.14
|
|
Amiodarone 150 mg/100 ml (1.5 mg/ml) in dextrose, iso-osmotic IV
|
$154.80 |
$154.80 |
$154.80 |
$119.07
|
|
Amiodarone 50 mg/ml intravenous solution
|
$8.10 |
$8.10 |
$8.10 |
$55.86
|
|
Ammonia
|
$214.20 |
$214.20 |
$214.20 |
$119.70
|
|
Amphetamine confirm urine -sendout
|
$12.00 |
$12.00 |
$12.00 |
$92.61
|
|
Amphotericin b in d5w IV syringe 0.1 mg/ml (neo/ped) - cnr
|
$127.80 |
$127.80 |
$127.80 |
$117.75
|
|
Amphotericin b liposomal in d5w IV syringe 1 mg/ml (neo/ped) - cnr
|
$825.00 |
$825.00 |
$825.00 |
$543.85
|
|
Ampicillin 1 gram solution for injection
|
$49.20 |
$49.20 |
$49.20 |
$56.70
|
|
Ampicillin-sulbactam 1.5 gram solution for injection
|
$55.20 |
$55.20 |
$55.20 |
$53.86
|
|
Amylase
|
$387.60 |
$387.60 |
$387.60 |
$89.04
|
|
Analysis gene f2 20210g>a variant
|
$327.60 |
$327.60 |
$327.60 |
$219.60
|
|
Analysis gene f5 leiden variant
|
$273.00 |
$273.00 |
$273.00 |
$230.40
|
|
An cholangiogram percutaneous compl
|
$4,342.80 |
$4,342.80 |
$4,342.80 |
$2,626.65
|
