|
Abatacept (with maltose) 250 mg intravenous solution
|
$3,489.00 |
$3,489.00 |
$3,489.00 |
$3,128.29
|
|
Abdominal CT scan (with and without contrast)
|
$2,149.20 |
$2,149.20 |
$2,149.20 |
$2,009.80
|
|
Abdominal CT scan (with contrast)
|
$1,802.40 |
$1,802.40 |
$1,802.40 |
$1,680.60
|
|
Abdominal CT scan (without contrast)
|
$1,459.80 |
$1,459.80 |
$1,459.80 |
$1,358.76
|
|
Abdominal MRI (with and without contrast)
|
$2,539.80 |
$2,539.80 |
$2,539.80 |
$3,015.94
|
|
Abdominal MRI (without contrast)
|
$2,063.40 |
$2,063.40 |
$2,063.40 |
$2,050.14
|
|
Acetaminophen 10 mg/ml soln 100 ml glass cont
|
$49.20 |
$49.20 |
$49.20 |
$74.96
|
|
Acetaminophen level
|
$34.20 |
$34.20 |
$34.20 |
$107.62
|
|
Acyclovir 5 mg/ml in ns IV syringe (neo/ped) - cnr
|
$37.80 |
$37.80 |
$37.80 |
$63.48
|
|
Admelog u-100 insulin lispro 100 unit/ml subcutaneous solution
|
$1.20 |
$1.20 |
$1.20 |
$181.12
|
|
Albumin (human), 25%, 50ml
|
$294.00 |
$294.00 |
$294.00 |
$244.70
|
|
Albumin (microalbumin) 24 hour urine quantitative
|
$88.80 |
$88.80 |
$88.80 |
$57.00
|
|
Albumin serum plasma or whole blood
|
$64.20 |
$64.20 |
$64.20 |
$40.80
|
|
Alkaline phosphatase
|
$57.60 |
$57.60 |
$57.60 |
$46.40
|
|
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
|
|
Alt/sgpt
|
$89.40 |
$89.40 |
$89.40 |
$47.45
|
|
Amiodarone 150 mg/100 ml (1.5 mg/ml) in dextrose, iso-osmotic IV
|
$154.80 |
$154.80 |
$154.80 |
$119.07
|
|
Ampicillin 1 gram solution for injection
|
$45.60 |
$45.60 |
$45.60 |
$56.70
|
|
Ampicillin-sulbactam 1.5 gram solution for injection
|
$55.20 |
$55.20 |
$55.20 |
$53.86
|
|
Amylase
|
$73.20 |
$73.20 |
$73.20 |
$89.04
|
|
Angiotensin ii 0.5 mg/ml soln 1 ml vial
|
$23.40 |
$23.40 |
$23.40 |
$3,080.85
|
|
Antineutrophil cytoplasmic antibody titer each antibody
|
$10.80 |
$10.80 |
$10.80 |
$40.00
|
|
Appl modality 1/> areas paraffin bath 97018
|
$67.20 |
$67.20 |
$67.20 |
$66.00
|
|
Assay of interleukin-6 (il-6)
|
$121.80 |
$121.80 |
$121.80 |
$79.97
|
|
Ast/sgot
|
$89.40 |
$89.40 |
$89.40 |
$45.65
|
|
Atropine 0.1 mg/ml injection syringe
|
$30.60 |
$30.60 |
$30.60 |
$51.28
|
|
Azithromycin 500 mg intravenous solution
|
$25.20 |
$25.20 |
$25.20 |
$35.06
|
|
Aztreonam 1 gram solution for injection
|
$295.20 |
$295.20 |
$295.20 |
$157.30
|
|
Bilirubin total
|
$89.40 |
$89.40 |
$89.40 |
$52.57
|
|
Blood Clotting (PT/INR) Test
|
$55.20 |
$55.20 |
$55.20 |
$53.00
|
|
Blood Count (CBC) Test
|
$82.20 |
$82.20 |
$82.20 |
$74.75
|
|
Blood occult fecal hemoglobin immunoassay qualitative 1-3 simultaneous determinations diagnostic
|
$37.80 |
$37.80 |
$37.80 |
$57.42
|
|
Blood occult peroxidase activity qualitative gastric
|
$22.80 |
$22.80 |
$22.80 |
$34.00
|
|
Borrelia burgdorferi (lyme disease) antibody nonspecific
|
$24.60 |
$24.60 |
$24.60 |
$94.80
|
|
Brain MRA (blood vessel MRI, with and without contrast)
|
$2,646.60 |
$2,646.60 |
$2,646.60 |
$2,785.50
|
|
Brain MRA (blood vessel MRI, without contrast)
|
$2,520.60 |
$2,520.60 |
$2,520.60 |
$1,902.00
|
|
Brain MRI (with and without contrast)
|
$4,602.60 |
$4,602.60 |
$4,602.60 |
$2,854.80
|
|
Brain MRI (without contrast)
|
$3,205.20 |
$3,205.20 |
$3,205.20 |
$1,977.27
|
|
Bumetanide in d5w IV syringe 0.04 mg/ml (neo/ped) - cnr
|
$13.80 |
$13.80 |
$13.80 |
$23.92
|
|
Bupivacaine 0.1 % epidural pca - 1 hour dose limit
|
$7.80 |
$7.80 |
$7.80 |
$32.88
|
|
Calcium acetate(phosphate binders) 667 mg tablet
|
$3.00 |
$3.00 |
$3.00 |
$2.70
|
|
Calcium gluconate 100 mg/ml (10 %) intravenous solution
|
$41.40 |
$41.40 |
$41.40 |
$64.49
|
|
Calcium gluconate 2 gram/100 ml in sodium chloride,iso-osm IV solution
|
$153.00 |
$153.00 |
$153.00 |
$91.60
|
|
Calcium ionized
|
$239.40 |
$239.40 |
$239.40 |
$90.00
|
|
Calcium total
|
$20.40 |
$20.40 |
$20.40 |
$50.00
|
|
Carbamazepine free -sendout
|
$87.00 |
$87.00 |
$87.00 |
$47.94
|
|
Cefazolin 10 mg/10 ml (dilution #2) IV desensitization - cnr
|
$24.00 |
$24.00 |
$24.00 |
$37.70
|
|
Cefepime 1 gram solution for injection
|
$34.20 |
$34.20 |
$34.20 |
$44.03
|
|
Ceftriaxone 1 gram solution for injection
|
$3.90 |
$3.90 |
$3.90 |
$84.18
|
|
Chest CT scan (with and without contrast)
|
$2,761.80 |
$2,761.80 |
$2,761.80 |
$1,975.00
|
|
Chest CT scan (with contrast)
|
$2,307.60 |
$2,307.60 |
$2,307.60 |
$1,689.00
|
|
Chest CT scan (without contrast)
|
$1,688.40 |
$1,688.40 |
$1,688.40 |
$1,350.03
|
|
Chloride
|
$19.20 |
$19.20 |
$19.20 |
$40.95
|
|
Cholesterol
|
$130.80 |
$130.80 |
$130.80 |
$45.76
|
|
Cholesterol (Lipid) Test
|
$114.00 |
$114.00 |
$114.00 |
$115.80
|
|
Clindamycin 600 mg/50 ml in 5 % dextrose intravenous piggyback
|
$58.80 |
$58.80 |
$58.80 |
$55.20
|
|
Covid-19 lab test non-cdc
|
$93.00 |
$93.00 |
$93.00 |
$80.50
|
|
#covid19rsv-rsv
|
$85.20 |
$85.20 |
$85.20 |
$145.60
|
|
Creatine kinase
|
$93.60 |
$93.60 |
$93.60 |
$66.30
|
|
Creatinine
|
$20.40 |
$20.40 |
$20.40 |
$44.72
|
|
Creatinine 24 hour urine
|
$89.40 |
$89.40 |
$89.40 |
$58.85
|
|
Crotalidae poly immune fab
|
$10,873.20 |
$10,873.20 |
$10,873.20 |
$5,590.35
|
|
Cta abdomen without & /or w/contrast
|
$1,998.00 |
$1,998.00 |
$1,998.00 |
$2,050.23
|
|
Cta neck without &/or w/contrast
|
$1,998.00 |
$1,998.00 |
$1,998.00 |
$1,931.40
|
|
CT Angiogram of Abdomen and Pelvis
|
$3,995.40 |
$3,995.40 |
$3,995.40 |
$2,849.55
|
|
CT Angiogram of the Chest (for blood clot)
|
$2,565.00 |
$2,565.00 |
$2,565.00 |
$1,940.00
|
|
CT Angiogram of the Head
|
$1,998.00 |
$1,998.00 |
$1,998.00 |
$1,996.80
|
|
CT lower extremity w/contrast (both sides)
|
$1,969.20 |
$1,969.20 |
$1,969.20 |
$1,652.00
|
|
CT lower extremity without contrast (both sides)
|
$3,024.60 |
$3,024.60 |
$3,024.60 |
$1,421.85
|
|
CT neck soft tissue w/contrast
|
$1,969.20 |
$1,969.20 |
$1,969.20 |
$1,652.00
|
|
CT neck soft tissue without contrast
|
$1,558.20 |
$1,558.20 |
$1,558.20 |
$1,327.95
|
|
CT neck soft tissue without & w/contrast
|
$2,235.00 |
$2,235.00 |
$2,235.00 |
$1,959.75
|
|
CT orbit/sella/ or posterior outer inner or middle ear w/contrast
|
$1,969.20 |
$1,969.20 |
$1,969.20 |
$1,543.83
|
|
CT orbit/sella/ or posterior outer inner or middle ear without contrast
|
$1,558.20 |
$1,558.20 |
$1,558.20 |
$1,360.00
|
|
CT Scan of Abdomen and Pelvis (with and without contrast)
|
$5,019.60 |
$5,019.60 |
$5,019.60 |
$3,493.80
|
|
CT Scan of Abdomen and Pelvis (with contrast)
|
$4,045.20 |
$4,045.20 |
$4,045.20 |
$2,971.80
|
|
CT Scan of Abdomen and Pelvis (without contrast)
|
$3,077.40 |
$3,077.40 |
$3,077.40 |
$2,370.63
|
|
CT thoracic spine w/contrast
|
$2,344.80 |
$2,344.80 |
$2,344.80 |
$1,690.32
|
|
CT thoracic spine without contrast
|
$2,140.20 |
$2,140.20 |
$2,140.20 |
$1,464.00
|
|
CT thorax low dose for lung screening without contrast
|
$1,688.40 |
$1,688.40 |
$1,688.40 |
$331.50
|
|
CT upper extremity without contrast (both sides)
|
$1,558.20 |
$1,558.20 |
$1,558.20 |
$1,430.20
|
|
CT uppr extremity w/o&w/dye
|
$2,235.00 |
$2,235.00 |
$2,235.00 |
$1,845.36
|
|
Culture aerobic additional method definitive id each
|
$110.40 |
$110.40 |
$110.40 |
$68.64
|
|
Culture typing nucleic acid probe amplified per culture/isolate 6 or more targets
|
$25.80 |
$25.80 |
$25.80 |
$392.50
|
|
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution
|
$24.00 |
$24.00 |
$24.00 |
$25.20
|
|
Daptomycin 500 mg/10 ml intravenous solution
|
$116.40 |
$116.40 |
$116.40 |
$168.53
|
|
Deamidated gliadin antibody iga
|
$11.40 |
$11.40 |
$11.40 |
$43.60
|
|
Denosumab 120 mg/1.7 ml (70 mg/ml) subcutaneous solution
|
$3,946.80 |
$3,946.80 |
$3,946.80 |
$6,324.98
|
|
Dexamethasone 4 mg tablet
|
$4.20 |
$4.20 |
$4.20 |
$5.85
|
|
Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr
|
$5.40 |
$5.40 |
$5.40 |
$21.17
|
|
Diabetes (HbA1c) Test
|
$80.40 |
$80.40 |
$80.40 |
$79.20
|
|
Diagnostic Mammogram (both breasts)
|
$540.60 |
$540.60 |
$540.60 |
$399.30
|
|
Diagnostic Mammogram (one breast)
|
$540.60 |
$540.60 |
$540.60 |
$301.55
|
|
Diazepam 5 mg/ml injection solution (wrapper)
|
$91.80 |
$91.80 |
$91.80 |
$74.76
|
|
Dicyclomine injection
|
$268.20 |
$268.20 |
$268.20 |
$153.29
|
|
Digoxin 250 mcg/ml (0.25 mg/ml) injection solution
|
$19.20 |
$19.20 |
$19.20 |
$69.03
|
|
Diltiazem 5 mg/ml intravenous solution
|
$24.90 |
$24.90 |
$24.90 |
$47.94
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$4.80 |
$4.80 |
$4.80 |
$17.75
|