|
17-hydroxypregnenolone
|
$236.55 |
$236.55 |
$236.55 |
$92.65
|
|
1st inpatient critical care pr day age 28 days/less than 99468
|
$1,780.50 |
$1,780.50 |
$1,780.50 |
$1,656.80
|
|
3d recon without postprocess indpndt
|
$167.35 |
$167.35 |
$167.35 |
$508.13
|
|
5' nucleotidase - sendout
|
$125.95 |
$125.95 |
$125.95 |
$50.05
|
|
Abatacept (with maltose) 250 mg intravenous solution
|
$3,984.29 |
$3,984.29 |
$3,984.29 |
$3,138.72
|
|
#a/b/c/c/h pnl-candida albicans ab
|
$40.45 |
$40.45 |
$40.45 |
$53.95
|
|
Abdominal and Pelvic Blood Vessel Ultrasound (limited)
|
$1,166.15 |
$1,166.15 |
$1,166.15 |
$662.40
|
|
Abdominal CT scan (with and without contrast)
|
$3,248.75 |
$3,248.75 |
$3,248.75 |
$1,976.94
|
|
Abdominal CT scan (with contrast)
|
$3,251.40 |
$3,251.40 |
$3,251.40 |
$1,667.60
|
|
Abdominal CT scan (without contrast)
|
$1,382.10 |
$1,382.10 |
$1,382.10 |
$1,353.32
|
|
Abdominal MRI (with and without contrast)
|
$3,347.25 |
$3,347.25 |
$3,347.25 |
$2,967.00
|
|
Abdominal MRI (with contrast)
|
$2,822.25 |
$2,822.25 |
$2,822.25 |
$2,240.00
|
|
Abdominal MRI (without contrast)
|
$2,181.10 |
$2,181.10 |
$2,181.10 |
$2,048.36
|
|
Abdominal paracentesis w/image guidance
|
$746.40 |
$746.40 |
$746.40 |
$1,632.96
|
|
Abdominal Ultrasound (complete)
|
$858.35 |
$858.35 |
$858.35 |
$783.00
|
|
Abdominal Ultrasound (limited)
|
$858.35 |
$858.35 |
$858.35 |
$586.43
|
|
Abdominal X-ray (2 views)
|
$473.75 |
$473.75 |
$473.75 |
$318.20
|
|
Abdominal X-ray Series (acute, with chest view)
|
$645.15 |
$645.15 |
$645.15 |
$418.63
|
|
Abdominal X-ray (single view)
|
$473.75 |
$473.75 |
$473.75 |
$260.00
|
|
Abd paracentesis/w/o image guide 49082
|
$699.20 |
$699.20 |
$699.20 |
$1,148.40
|
|
Ablation cryo thigh/knee
|
$1,041.10 |
$1,041.10 |
$1,041.10 |
$531.95
|
|
Ablation of upper extremity nerves rf
|
$1,609.00 |
$1,609.00 |
$1,609.00 |
$832.50
|
|
Acetaminophen level
|
$226.75 |
$226.75 |
$226.75 |
$116.80
|
|
Acetazolamide 500 mg solution for injection
|
$382.69 |
$382.69 |
$382.69 |
$122.55
|
|
Acetone qualitative
|
$93.15 |
$93.15 |
$93.15 |
$46.80
|
|
Acetylcholine receptor modulating antibody
|
$334.65 |
$334.65 |
$334.65 |
$67.50
|
|
Acetylcysteine 200 mg/ml (20 %) intravenous solution
|
$389.81 |
$389.81 |
$389.81 |
$218.79
|
|
Acne surgery 10040
|
$209.15 |
$209.15 |
$209.15 |
$265.20
|
|
Aco cont gluc mnt phys/qhp eqp 95250aco
|
$423.80 |
$423.80 |
$423.80 |
$341.00
|
|
Aco med nutria tx/group, ea 30 min 97804aco
|
$99.90 |
$99.90 |
$99.90 |
$38.50
|
|
Acup 1/> without estim ea add 15
|
$80.95 |
$80.95 |
$80.95 |
$43.00
|
|
Acup 1/> wo estim 1st 15 min
|
$94.50 |
$94.50 |
$94.50 |
$53.50
|
|
Acute hepatitis panel
|
$434.55 |
$434.55 |
$434.55 |
$284.95
|
|
Acyclovir 5 mg/ml in ns IV syringe (neo/ped) - cnr
|
$255.13 |
$255.13 |
$255.13 |
$64.45
|
|
#acylcarnitineprfl
|
$118.85 |
$118.85 |
$118.85 |
$121.55
|
|
Adapter b 8 channel 10cm
|
$100.00 |
$100.00 |
$100.00 |
$5,109.58
|
|
Adh-sendout
|
$267.40 |
$267.40 |
$267.40 |
$118.79
|
|
Admelog u-100 insulin lispro 100 unit/ml subcutaneous solution
|
$541.96 |
$541.96 |
$541.96 |
$193.40
|
|
Administration chemotherapy IV infusion each additional hour
|
$178.15 |
$178.15 |
$178.15 |
$230.35
|
|
Administration chemotherapy IV infusion each addl sequential infusion diff substance/drug >1 hr
|
$178.15 |
$178.15 |
$178.15 |
$298.98
|
|
Administration chemotherapy IV infusion up to 1 hour single/initial substance/drug
|
$533.10 |
$533.10 |
$533.10 |
$668.98
|
|
Administration chemotherapy IV push single/initial substance/drug
|
$120.05 |
$120.05 |
$120.05 |
$439.20
|
|
Administration chemotherapy subcutaneous/im anti neoplastic hormonal
|
$120.05 |
$120.05 |
$120.05 |
$212.80
|
|
Administration chemotherapy subcutaneous/im anti neoplastic non hormonal
|
$157.90 |
$157.90 |
$157.90 |
$256.49
|
|
Administration immunization each additional vaccine
|
$39.10 |
$39.10 |
$39.10 |
$47.40
|
|
Administration vaccine hepatitis b
|
$39.10 |
$39.10 |
$39.10 |
$53.00
|
|
Administration vaccine rsv monoclonal ab seasonal dose im
|
$39.10 |
$39.10 |
$39.10 |
$41.45
|
|
Ado-trastuzumab emtansine 100 mg intravenous solution
|
$16,802.39 |
$16,802.39 |
$16,802.39 |
$11,350.31
|
|
Adrenalin epinephrine inject
|
$1,078.28 |
$1,078.28 |
$1,078.28 |
$231.47
|
|
Advance care planning each additional 30 min 99498
|
$286.10 |
$286.10 |
$286.10 |
$110.56
|
|
_afb id by dna probe rflx ast
|
$209.15 |
$209.15 |
$209.15 |
$104.50
|
|
Aflibercept injection
|
$4,991.31 |
$4,991.31 |
$4,991.31 |
$2,738.00
|
|
Agalsidase beta 35 mg intravenous solution
|
$20,603.47 |
$20,603.47 |
$20,603.47 |
$14,475.20
|
|
Albumin body fluid quantitative each specimen
|
$98.55 |
$98.55 |
$98.55 |
$47.45
|
|
Albumin (human), 25%, 50ml
|
$329.90 |
$329.90 |
$329.90 |
$244.70
|
|
Albumin (microalbumin) 24 hour urine quantitative
|
$99.90 |
$99.90 |
$99.90 |
$58.17
|
|
Albumin serum plasma or whole blood
|
$80.95 |
$80.95 |
$80.95 |
$43.00
|
|
Alginate dressing <=16 sq in
|
$9.00 |
$9.00 |
$9.00 |
$16.56
|
|
Alginate drsg >16 <=48 sq in
|
$47.00 |
$47.00 |
$47.00 |
$43.72
|
|
Alginate drsg wound filler
|
$47.00 |
$47.00 |
$47.00 |
$15.79
|
|
Alkaline phosphatase
|
$88.95 |
$88.95 |
$88.95 |
$46.80
|
|
Allergen alpha lactalbumin ige
|
$53.60 |
$53.60 |
$53.60 |
$48.57
|
|
Allergen egg white ige
|
$98.75 |
$98.75 |
$98.75 |
$38.00
|
|
Allergen specific ige qual multi scrn ea
|
$116.05 |
$116.05 |
$116.05 |
$24.00
|
|
Allergy injections; 2 or more 95117
|
$89.95 |
$89.95 |
$89.95 |
$45.00
|
|
Allograft amniotic activebarrier 200 2x2cm-q4100-cost per sheet
|
$258.00 |
$258.00 |
$258.00 |
$9,900.02
|
|
Allograft dermis 20x25x1mm decell w/matracell arthroflex
|
$3,986.00 |
$3,986.00 |
$3,986.00 |
$6,285.56
|
|
Allograft ecm allopatch hd dehydr thick 0.8-1.7mmx2x5cm-cost per sq cm
|
$750.00 |
$750.00 |
$750.00 |
$20,311.34
|
|
Allograft umbilical epicord 15 sq cm-q4187-cost per sq cm
|
$415.63 |
$415.63 |
$415.63 |
$1,225.35
|
|
Alpha-1-proteinase inhibitor (human) 1,000 mg (+/-) IV solution
|
$71.68 |
$71.68 |
$71.68 |
$13.14
|
|
Alpha-fetoprotein tumor marker
|
$160.05 |
$160.05 |
$160.05 |
$106.00
|
|
Alprostadil for injection
|
$571.48 |
$571.48 |
$571.48 |
$511.41
|
|
Alteplase 100 mg infusion from pyxis vial
|
$23,164.31 |
$23,164.31 |
$23,164.31 |
$15,857.45
|
|
Alt/sgpt
|
$99.90 |
$99.90 |
$99.90 |
$47.50
|
|
Aluminum - quest
|
$229.35 |
$229.35 |
$229.35 |
$83.05
|
|
Amantadine (symmetrel)-sendout
|
$158.65 |
$158.65 |
$158.65 |
$179.70
|
|
Aminolevulinic acid delta
|
$162.80 |
$162.80 |
$162.80 |
$87.12
|
|
Aminophylline 25 mg/ml intravenous solution (wrapper)
|
$142.15 |
$142.15 |
$142.15 |
$47.06
|
|
Amiodarone 150 mg/100 ml (1.5 mg/ml) in dextrose, iso-osmotic IV
|
$561.28 |
$561.28 |
$561.28 |
$108.13
|
|
Amiodarone 50 mg/ml intravenous solution
|
$24.31 |
$24.31 |
$24.31 |
$55.86
|
|
Amitriptyline (elavil) -sendout
|
$286.40 |
$286.40 |
$286.40 |
$87.45
|
|
Ammonia
|
$179.50 |
$179.50 |
$179.50 |
$119.70
|
|
Amphetamine confirm urine -sendout
|
$284.10 |
$284.10 |
$284.10 |
$93.61
|
|
Amphetamines 5 or more
|
$166.40 |
$166.40 |
$166.40 |
$90.48
|
|
Ampicillin 1 gram solution for injection
|
$86.30 |
$86.30 |
$86.30 |
$56.70
|
|
Ampicillin-sulbactam 1.5 gram solution for injection
|
$176.89 |
$176.89 |
$176.89 |
$54.57
|
|
Amputation toe interphalangeal joint
|
$888.05 |
$888.05 |
$888.05 |
$4,196.50
|
|
Amylase
|
$113.40 |
$113.40 |
$113.40 |
$90.00
|
|
Anabolic steroid 1 or 2
|
$231.75 |
$231.75 |
$231.75 |
$80.08
|
|
Analysis gene f2 20210g>a variant
|
$233.50 |
$233.50 |
$233.50 |
$226.85
|
|
Analysis gene f5 leiden variant
|
$746.40 |
$746.40 |
$746.40 |
$249.60
|
|
Analysis nerve
|
$242.75 |
$242.75 |
$242.75 |
$262.40
|
|
Anaplsma phgcytophlm amp prb
|
$120.55 |
$120.55 |
$120.55 |
$85.80
|
|
Anca screen with reflex to titer -quest
|
$145.05 |
$145.05 |
$145.05 |
$101.50
|
|
An fluoro guide for cvp
|
$866.55 |
$866.55 |
$866.55 |
$525.85
|
|
Angiotensin ii 0.5 mg/ml soln 1 ml vial
|
$482.40 |
$482.40 |
$482.40 |
$2,979.43
|
|
Ankle X-ray
|
$473.75 |
$473.75 |
$473.75 |
$356.32
|
|
Ankle X-ray (2 views, both ankles)
|
$473.75 |
$473.75 |
$473.75 |
$282.96
|
|
Antibody bacterium, not elsewhere specified
|
$184.25 |
$184.25 |
$184.25 |
$57.85
|
|
Antibody elution rbc reference
|
$699.80 |
$699.80 |
$699.80 |
$177.29
|
