|
17-hydroxypregnenolone
|
$292.80 |
$292.80 |
$292.80 |
$89.25
|
|
1st hosp/birthing center care per day nml nb 99460
|
$136.80 |
$136.80 |
$136.80 |
$161.60
|
|
Abd aorta w/runoff s&i
|
$2,695.80 |
$2,695.80 |
$2,695.80 |
$3,569.56
|
|
Abdominal CT scan (with and without contrast)
|
$2,275.80 |
$2,275.80 |
$2,275.80 |
$2,009.80
|
|
Abdominal CT scan (with contrast)
|
$1,906.80 |
$1,906.80 |
$1,906.80 |
$1,680.60
|
|
Abdominal CT scan (without contrast)
|
$1,546.80 |
$1,546.80 |
$1,546.80 |
$1,358.76
|
|
Abdominal MRI (with and without contrast)
|
$2,518.20 |
$2,518.20 |
$2,518.20 |
$3,015.94
|
|
Abdominal MRI (without contrast)
|
$2,376.60 |
$2,376.60 |
$2,376.60 |
$2,050.14
|
|
Abdominal paracentesis w/image guidance
|
$1,819.20 |
$1,819.20 |
$1,819.20 |
$1,651.20
|
|
Abdominal Ultrasound (complete)
|
$857.40 |
$857.40 |
$857.40 |
$785.55
|
|
Abdominal Ultrasound (limited)
|
$519.00 |
$519.00 |
$519.00 |
$590.00
|
|
Abd paracentesis/w/o image guide 49082
|
$1,148.40 |
$1,148.40 |
$1,148.40 |
$1,145.40
|
|
Abl1 gene
|
$1,213.80 |
$1,213.80 |
$1,213.80 |
$682.50
|
|
Acetaminophen 10 mg/ml soln 100 ml glass cont
|
$49.20 |
$49.20 |
$49.20 |
$74.96
|
|
Acetaminophen 120 mg rectal suppository
|
$1,417.80 |
$1,417.80 |
$1,417.80 |
$75.09
|
|
Acetaminophen level
|
$34.20 |
$34.20 |
$34.20 |
$107.62
|
|
Acetone qualitative
|
$85.20 |
$85.20 |
$85.20 |
$45.65
|
|
Acetylcholine receptor modulating antibody
|
$1,070.40 |
$1,070.40 |
$1,070.40 |
$64.50
|
|
Acute hepatitis panel
|
$307.80 |
$307.80 |
$307.80 |
$292.00
|
|
Acyclovir 5 mg/ml in ns IV syringe (neo/ped) - cnr
|
$37.80 |
$37.80 |
$37.80 |
$63.48
|
|
#acylcarnitineprfl
|
$153.60 |
$153.60 |
$153.60 |
$125.40
|
|
Adh-sendout
|
$141.60 |
$141.60 |
$141.60 |
$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
|
$143.40 |
$143.40 |
$143.40 |
$230.35
|
|
Administration chemotherapy IV infusion each addl sequential infusion diff substance/drug >1 hr
|
$136.20 |
$136.20 |
$136.20 |
$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
|
$54.00 |
$54.00 |
$54.00 |
$211.09
|
|
Administration chemotherapy subcutaneous/im anti neoplastic non hormonal
|
$136.20 |
$136.20 |
$136.20 |
$257.40
|
|
Administration immunization 1 vaccine
|
$71.40 |
$71.40 |
$71.40 |
$69.21
|
|
Administration immunization each additional vaccine
|
$34.20 |
$34.20 |
$34.20 |
$47.40
|
|
Administration vaccine hepatitis b
|
$52.20 |
$52.20 |
$52.20 |
$54.40
|
|
Agalsidase beta 35 mg intravenous solution
|
$19,651.20 |
$19,651.20 |
$19,651.20 |
$14,475.20
|
|
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 (microalbumin) 24 hour urine quantitative
|
$73.80 |
$73.80 |
$73.80 |
$57.00
|
|
Albumin serum plasma or whole blood
|
$85.20 |
$85.20 |
$85.20 |
$40.80
|
|
Alkaline phosphatase
|
$75.60 |
$75.60 |
$75.60 |
$46.40
|
|
Allergen alpha lactalbumin ige
|
$112.80 |
$112.80 |
$112.80 |
$48.00
|
|
Allergen egg white ige
|
$10.20 |
$10.20 |
$10.20 |
$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-fetoprotein tumor marker
|
$158.40 |
$158.40 |
$158.40 |
$106.00
|
|
Alteplase 100 mg infusion from pyxis vial
|
$32,310.00 |
$32,310.00 |
$32,310.00 |
$15,857.45
|
|
Alt/sgpt
|
$115.80 |
$115.80 |
$115.80 |
$47.45
|
|
Amantadine (symmetrel)-sendout
|
$129.00 |
$129.00 |
$129.00 |
$169.80
|
|
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
|
$186.60 |
$186.60 |
$186.60 |
$119.70
|
|
Amphetamine confirm urine -sendout
|
$55.80 |
$55.80 |
$55.80 |
$92.61
|
|
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
|
$356.40 |
$356.40 |
$356.40 |
$89.04
|
|
Analysis gene f2 20210g>a variant
|
$304.80 |
$304.80 |
$304.80 |
$219.60
|
|
Analysis gene f5 leiden variant
|
$251.40 |
$251.40 |
$251.40 |
$230.40
|
|
Angiotensin ii 0.5 mg/ml soln 1 ml vial
|
$853.20 |
$853.20 |
$853.20 |
$3,080.85
|
|
Ankle X-ray
|
$502.80 |
$502.80 |
$502.80 |
$353.60
|
|
Anora (draw only)
|
$19.20 |
$19.20 |
$19.20 |
$33.58
|
|
Antibody elution rbc reference
|
$103.20 |
$103.20 |
$103.20 |
$175.50
|
|
Antibody id rbc panel
|
$177.00 |
$177.00 |
$177.00 |
$274.56
|
|
Antibody screen rbc
|
$52.20 |
$52.20 |
$52.20 |
$100.00
|
|
Antinuclear antibodies
|
$267.60 |
$267.60 |
$267.60 |
$89.40
|
|
Antistreptolysin o titer
|
$21.60 |
$21.60 |
$21.60 |
$51.45
|
|
Antithrombin iii activity
|
$192.60 |
$192.60 |
$192.60 |
$114.00
|
|
App high cost ss t/a/l <100sq cm addl <25sq cm
|
$610.20 |
$610.20 |
$610.20 |
$498.81
|
|
Application finger splntstatic 29130
|
$192.60 |
$192.60 |
$192.60 |
$208.16
|
|
Application long leg splint 29505
|
$192.60 |
$192.60 |
$192.60 |
$338.25
|
|
Application lower leg splint 29515
|
$192.60 |
$192.60 |
$192.60 |
$330.48
|
|
Application multi layer compression below knee (both sides)
|
$382.20 |
$382.20 |
$382.20 |
$373.20
|
|
Application of paste boot 29580
|
$196.20 |
$196.20 |
$196.20 |
$331.74
|
|
Application skin substitute graft face/scalp/neck/genit/hnd/ft <100 sq cm 1st 25 sq cm
|
$1,358.40 |
$1,358.40 |
$1,358.40 |
$2,148.25
|
|
Application skin substitute graft trunk/arms/legs <100 sq cm 1st 25 sq cm
|
$860.40 |
$860.40 |
$860.40 |
$2,164.64
|
|
Appl modality 1/> areas paraffin bath 97018
|
$100.80 |
$100.80 |
$100.80 |
$66.00
|
|
Apply rigid leg cast 29445
|
$454.80 |
$454.80 |
$454.80 |
$555.00
|
|
Artery x-rays arm/leg 75710-26
|
$2,695.80 |
$2,695.80 |
$2,695.80 |
$3,480.00
|
|
Artery x-rays arms/legs 75716-26
|
$4,248.60 |
$4,248.60 |
$4,248.60 |
$3,729.00
|
|
Artery xrays of pelvis 75736 26
|
$2,695.80 |
$2,695.80 |
$2,695.80 |
$4,134.14
|
|
Arthrocentesis/aspiration/injection intermediate joint/bursa without ultrasound guidance right
|
$394.80 |
$394.80 |
$394.80 |
$608.40
|
|
Arthrocentesis/aspiration/injection small joint/bursa without ultrasound guidance
|
$109.80 |
$109.80 |
$109.80 |
$465.00
|
|
Arthrocentesis/aspiration/inj major joint/bursa without Ultrasound guidance (both sides)
|
$318.60 |
$318.60 |
$318.60 |
$715.37
|
|
Arthrocentesis aspir+/injection small jt/bursa with Ultrasound 20604
|
$265.80 |
$265.80 |
$265.80 |
$699.00
|
|
Aspirate pleura without imaging 32554
|
$2,589.60 |
$2,589.60 |
$2,589.60 |
$1,196.52
|
|
Aspiration fine needle (fna) biopsy w/ultrasound guidance 1st lesion
|
$933.00 |
$933.00 |
$933.00 |
$1,226.87
|
|
Aspir/inj thyroid cyst 60300
|
$504.00 |
$504.00 |
$504.00 |
$850.78
|
|
Assay of interleukin-6 (il-6)
|
$637.20 |
$637.20 |
$637.20 |
$79.97
|
|
Assay of osteocalcin
|
$184.20 |
$184.20 |
$184.20 |
$92.50
|
|
Assay of prostaglandin
|
$391.20 |
$391.20 |
$391.20 |
$218.50
|
|
Assay toxin or antitoxin
|
$468.60 |
$468.60 |
$468.60 |
$75.90
|
|
Ast/sgot
|
$111.00 |
$111.00 |
$111.00 |
$45.65
|
|
Atezolizumab 60 mg/ml intravenous solution (wrapper)
|
$29,607.60 |
$29,607.60 |
$29,607.60 |
$23,166.53
|
|
Atropine 0.1 mg/ml injection syringe
|
$30.60 |
$30.60 |
$30.60 |
$51.28
|
|
Attn at delivery+ 1 stabilization of newborn 99464
|
$172.80 |
$172.80 |
$172.80 |
$186.60
|
|
Augment injectable kit 3.0cc
|
$6,841.28 |
$6,841.28 |
$6,841.28 |
$7,469.28
|
|
Autoimmune rheumatoid arthr anl 12 mrk ia
|
$1,558.20 |
$1,558.20 |
$1,558.20 |
$925.10
|
|
Avul nail plate addl
|
$265.80 |
$265.80 |
$265.80 |
$194.22
|
|
Avulsion nail plate partial/complete simple single nail plate
|
$260.40 |
$260.40 |
$260.40 |
$318.75
|
