|
17-hydroxypregnenolone
|
$306.60 |
$306.60 |
$306.60 |
$89.25
|
|
5' nucleotidase - sendout
|
$134.40 |
$134.40 |
$134.40 |
$50.40
|
|
99397 periodic comp preventive med 65+ years est
|
$131.40 |
$131.40 |
$131.40 |
$160.73
|
|
Abdominal CT scan (with and without contrast)
|
$2,644.20 |
$2,644.20 |
$2,644.20 |
$2,009.80
|
|
Abdominal CT scan (with contrast)
|
$2,214.60 |
$2,214.60 |
$2,214.60 |
$1,680.60
|
|
Abdominal CT scan (without contrast)
|
$1,794.00 |
$1,794.00 |
$1,794.00 |
$1,358.76
|
|
Abdominal MRI (with and without contrast)
|
$3,188.40 |
$3,188.40 |
$3,188.40 |
$3,015.94
|
|
Abdominal MRI (without contrast)
|
$3,188.40 |
$3,188.40 |
$3,188.40 |
$2,050.14
|
|
Abdominal paracentesis w/image guidance
|
$1,863.00 |
$1,863.00 |
$1,863.00 |
$1,651.20
|
|
Abdominal Ultrasound (complete)
|
$1,003.80 |
$1,003.80 |
$1,003.80 |
$785.55
|
|
Abdominal Ultrasound (limited)
|
$743.40 |
$743.40 |
$743.40 |
$590.00
|
|
Abdominoplasty 15830
|
$3,415.80 |
$3,415.80 |
$3,415.80 |
$6,442.80
|
|
Abd paracentesis/w/o image guide 49082
|
$1,270.20 |
$1,270.20 |
$1,270.20 |
$1,145.40
|
|
Ablate inf turbinate submuc 30802
|
$457.20 |
$457.20 |
$457.20 |
$1,752.89
|
|
Acetaminophen 10 mg/ml soln 100 ml glass cont
|
$49.20 |
$49.20 |
$49.20 |
$74.96
|
|
Acetaminophen 120 mg rectal suppository
|
$3,077.70 |
$3,077.70 |
$3,077.70 |
$75.09
|
|
Acetaminophen level
|
$34.20 |
$34.20 |
$34.20 |
$107.62
|
|
Acetone qualitative
|
$95.40 |
$95.40 |
$95.40 |
$45.65
|
|
Acetylcholine receptor modulating antibody
|
$312.00 |
$312.00 |
$312.00 |
$64.50
|
|
Acne surgery 10040
|
$97.80 |
$97.80 |
$97.80 |
$260.49
|
|
Aco annual medicare visit (awv), subsq g0439aco
|
$114.60 |
$114.60 |
$114.60 |
$167.04
|
|
Acromp/acromionectomy prtl
|
$1,144.20 |
$1,144.20 |
$1,144.20 |
$3,839.54
|
|
Acute hepatitis panel
|
$346.80 |
$346.80 |
$346.80 |
$292.00
|
|
Acyclovir 5 mg/ml in ns IV syringe (neo/ped) - cnr
|
$70.80 |
$70.80 |
$70.80 |
$63.48
|
|
#acylcarnitineprfl
|
$249.00 |
$249.00 |
$249.00 |
$125.40
|
|
Adh-sendout
|
$148.20 |
$148.20 |
$148.20 |
$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
|
$159.00 |
$159.00 |
$159.00 |
$230.35
|
|
Administration chemotherapy IV infusion each addl sequential infusion diff substance/drug >1 hr
|
$142.80 |
$142.80 |
$142.80 |
$294.00
|
|
Administration chemotherapy IV infusion up to 1 hour single/initial substance/drug
|
$489.00 |
$489.00 |
$489.00 |
$657.12
|
|
Administration chemotherapy IV push single/initial substance/drug
|
$204.00 |
$204.00 |
$204.00 |
$439.20
|
|
Administration chemotherapy subcutaneous/im anti neoplastic hormonal
|
$141.00 |
$141.00 |
$141.00 |
$211.09
|
|
Administration chemotherapy subcutaneous/im anti neoplastic non hormonal
|
$141.00 |
$141.00 |
$141.00 |
$257.40
|
|
Administration immunization 1 vaccine
|
$75.00 |
$75.00 |
$75.00 |
$69.21
|
|
Administration immunization each additional vaccine
|
$39.00 |
$39.00 |
$39.00 |
$47.40
|
|
Ado-trastuzumab emtansine 100 mg intravenous solution
|
$9,962.40 |
$9,962.40 |
$9,962.40 |
$11,350.31
|
|
Albumin body fluid quantitative each specimen
|
$5.40 |
$5.40 |
$5.40 |
$46.23
|
|
Albumin (human), 25%, 50ml
|
$257.40 |
$257.40 |
$257.40 |
$244.70
|
|
Albumin (microalbumin) 24 hour urine quantitative
|
$103.20 |
$103.20 |
$103.20 |
$57.00
|
|
Albumin serum plasma or whole blood
|
$75.00 |
$75.00 |
$75.00 |
$40.80
|
|
Alkaline phosphatase
|
$84.60 |
$84.60 |
$84.60 |
$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
|
$17.40 |
$17.40 |
$17.40 |
$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 afp-l3 frac & total
|
$343.80 |
$343.80 |
$343.80 |
$175.20
|
|
Alpha-fetoprotein tumor marker
|
$176.40 |
$176.40 |
$176.40 |
$106.00
|
|
Alteplase 100 mg infusion from pyxis vial
|
$32,310.00 |
$32,310.00 |
$32,310.00 |
$15,857.45
|
|
Alt/sgpt
|
$88.80 |
$88.80 |
$88.80 |
$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
|
$211.80 |
$211.80 |
$211.80 |
$119.70
|
|
Amphetamine confirm urine -sendout
|
$55.80 |
$55.80 |
$55.80 |
$92.61
|
|
Amphotericin b in d5w IV syringe 0.1 mg/ml (neo/ped) - cnr
|
$127.80 |
$127.80 |
$127.80 |
$117.75
|
|
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
|
|
Amp metatarsal w/toe single 28810
|
$750.00 |
$750.00 |
$750.00 |
$4,271.00
|
|
Amputate thigh through femur 27590
|
$1,690.20 |
$1,690.20 |
$1,690.20 |
$3,342.87
|
|
Amputation leg; tib/fib f/u 27886
|
$1,506.60 |
$1,506.60 |
$1,506.60 |
$1,461.89
|
|
Amputation of lower leg
|
$1,344.60 |
$1,344.60 |
$1,344.60 |
$1,417.20
|
|
Amputation thru metatarsal
|
$1,193.40 |
$1,193.40 |
$1,193.40 |
$3,839.54
|
|
Amputation toe metatarsophalangeal joint
|
$780.60 |
$780.60 |
$780.60 |
$3,839.54
|
|
Amylase
|
$358.20 |
$358.20 |
$358.20 |
$89.04
|
|
Analysis gene f2 20210g>a variant
|
$303.00 |
$303.00 |
$303.00 |
$219.60
|
|
Analysis gene f5 leiden variant
|
$252.60 |
$252.60 |
$252.60 |
$230.40
|
|
An fluoro guide for cvp
|
$43.80 |
$43.80 |
$43.80 |
$515.00
|
|
Angiotensin ii 0.5 mg/ml soln 1 ml vial
|
$853.20 |
$853.20 |
$853.20 |
$3,080.85
|
|
Ankle X-ray
|
$726.60 |
$726.60 |
$726.60 |
$353.60
|
|
Annual Physical, Established Patient (age 40-64)
|
$121.20 |
$121.20 |
$121.20 |
$158.76
|
|
Anora (draw only)
|
$19.20 |
$19.20 |
$19.20 |
$33.58
|
|
Anoscopy ablation lesion 46615
|
$314.40 |
$314.40 |
$314.40 |
$3,245.23
|
|
Antibody bacterium, not elsewhere specified
|
$22.80 |
$22.80 |
$22.80 |
$57.81
|
|
Antibody elution rbc reference
|
$111.60 |
$111.60 |
$111.60 |
$175.50
|
|
Antibody htlv-i
|
$127.80 |
$127.80 |
$127.80 |
$49.53
|
|
Antibody identification platelet antibodies heparin-pf4 igg
|
$334.20 |
$334.20 |
$334.20 |
$218.30
|
|
Antibody id rbc panel
|
$108.00 |
$108.00 |
$108.00 |
$274.56
|
|
Antibody screen rbc
|
$55.20 |
$55.20 |
$55.20 |
$100.00
|
|
Antidepressant not specified
|
$31.80 |
$31.80 |
$31.80 |
$61.80
|
|
Antinuclear antibodies
|
$82.80 |
$82.80 |
$82.80 |
$89.40
|
|
Antipsychotics nos 1-3
|
$31.80 |
$31.80 |
$31.80 |
$142.42
|
|
Antistreptolysin o titer
|
$26.40 |
$26.40 |
$26.40 |
$51.45
|
|
Antithrombin iii activity
|
$96.60 |
$96.60 |
$96.60 |
$114.00
|
|
Appendectomy add-on 44955
|
$728.40 |
$728.40 |
$728.40 |
$189.55
|
|
Appendix Removal (Laparoscopic)
|
$1,398.60 |
$1,398.60 |
$1,398.60 |
$6,870.89
|
|
App high cost ss f/n/g/h/f <100sq cm addl <25sq cm
|
$58.20 |
$58.20 |
$58.20 |
$463.65
|
|
App high cost ss t/a/l >100sq cm 1st 100sq cm
|
$541.20 |
$541.20 |
$541.20 |
$3,345.60
|
|
App high cost ss t/a/l >100sq cm addl 100sq cm
|
$136.80 |
$136.80 |
$136.80 |
$1,091.30
|
|
App high cost ss t/a/l <100sq cm addl <25sq cm
|
$610.20 |
$610.20 |
$610.20 |
$498.81
|
|
Application finger splntstatic 29130
|
$236.40 |
$236.40 |
$236.40 |
$208.16
|
|
Application long leg splint 29505
|
$236.40 |
$236.40 |
$236.40 |
$338.25
|
|
Application lower leg splint 29515
|
$472.80 |
$472.80 |
$472.80 |
$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
|
