|
17-hydroxypregnenolone
|
$69.60 |
$69.60 |
$69.60 |
$92.65
|
|
5% dextrose and 0.45% saline
|
$70.79 |
$70.79 |
$70.79 |
$48.00
|
|
88334 ap bill cytologic exam each additional site
|
$86.40 |
$86.40 |
$86.40 |
$100.10
|
|
Abatacept (with maltose) 250 mg intravenous solution
|
$2,522.26 |
$2,522.26 |
$2,522.26 |
$3,138.72
|
|
Abdominal and Pelvic Blood Vessel Ultrasound (complete)
|
$1,468.80 |
$1,468.80 |
$1,468.80 |
$988.00
|
|
Abdominal and Pelvic Blood Vessel Ultrasound (limited)
|
$867.20 |
$867.20 |
$867.20 |
$662.40
|
|
Abdominal CT scan (with and without contrast)
|
$3,138.40 |
$3,138.40 |
$3,138.40 |
$1,976.94
|
|
Abdominal CT scan (with contrast)
|
$3,021.60 |
$3,021.60 |
$3,021.60 |
$1,667.60
|
|
Abdominal CT scan (without contrast)
|
$1,968.80 |
$1,968.80 |
$1,968.80 |
$1,353.32
|
|
Abdominal MRI (with and without contrast)
|
$4,222.40 |
$4,222.40 |
$4,222.40 |
$2,967.00
|
|
Abdominal MRI (without contrast)
|
$2,846.40 |
$2,846.40 |
$2,846.40 |
$2,048.36
|
|
Abdominal paracentesis w/image guidance
|
$1,156.80 |
$1,156.80 |
$1,156.80 |
$1,632.96
|
|
Abdominal Ultrasound (complete)
|
$803.20 |
$803.20 |
$803.20 |
$783.00
|
|
Abdominal Ultrasound (limited)
|
$604.80 |
$604.80 |
$604.80 |
$586.43
|
|
Abdominal X-ray (2 views)
|
$319.20 |
$319.20 |
$319.20 |
$318.20
|
|
Abdominal X-ray Series (acute, with chest view)
|
$275.20 |
$275.20 |
$275.20 |
$418.63
|
|
Abdominal X-ray (single view)
|
$260.00 |
$260.00 |
$260.00 |
$260.00
|
|
Abd paracentesis/w/o image guide 49082
|
$1,123.20 |
$1,123.20 |
$1,123.20 |
$1,148.40
|
|
Acetaminophen 10 mg/ml soln 100 ml glass cont
|
$154.96 |
$154.96 |
$154.96 |
$72.74
|
|
Acetaminophen level
|
$49.60 |
$49.60 |
$49.60 |
$116.80
|
|
Acetazolamide 500 mg solution for injection
|
$79.87 |
$79.87 |
$79.87 |
$122.55
|
|
Acetone qualitative
|
$27.20 |
$27.20 |
$27.20 |
$46.80
|
|
Acetylcholine receptor modulating antibody
|
$95.20 |
$95.20 |
$95.20 |
$67.50
|
|
Acetylcysteine 200 mg/ml (20 %) intravenous solution
|
$91.35 |
$91.35 |
$91.35 |
$218.79
|
|
Acetylcysteine non-comp unit
|
$24.94 |
$24.94 |
$24.94 |
$31.21
|
|
Aco med nutria tx/group, ea 30 min 97804aco
|
$47.20 |
$47.20 |
$47.20 |
$38.50
|
|
Acute hepatitis panel
|
$275.20 |
$275.20 |
$275.20 |
$284.95
|
|
Acyclovir 400 mg tablet
|
$355.80 |
$355.80 |
$355.80 |
$54.77
|
|
Acyclovir 5 mg/ml in ns IV syringe (neo/ped) - cnr
|
$61.83 |
$61.83 |
$61.83 |
$64.45
|
|
Adenosine 3 mg/250 ml bag for osm
|
$61.89 |
$61.89 |
$61.89 |
$271.98
|
|
Admelog u-100 insulin lispro 100 unit/ml subcutaneous solution
|
$33.88 |
$33.88 |
$33.88 |
$193.40
|
|
Administration chemotherapy IV infusion each additional hour
|
$319.20 |
$319.20 |
$319.20 |
$230.35
|
|
Administration chemotherapy IV infusion each addl sequential infusion diff substance/drug >1 hr
|
$353.60 |
$353.60 |
$353.60 |
$298.98
|
|
Administration chemotherapy IV infusion up to 1 hour single/initial substance/drug
|
$717.60 |
$717.60 |
$717.60 |
$668.98
|
|
Administration chemotherapy IV push single/initial substance/drug
|
$546.40 |
$546.40 |
$546.40 |
$439.20
|
|
Administration chemotherapy subcutaneous/im anti neoplastic hormonal
|
$239.20 |
$239.20 |
$239.20 |
$212.80
|
|
Administration chemotherapy subcutaneous/im anti neoplastic non hormonal
|
$346.40 |
$346.40 |
$346.40 |
$256.49
|
|
Administration immunization each additional vaccine
|
$60.00 |
$60.00 |
$60.00 |
$47.40
|
|
Administration immunization intranasal/oral route 1 vaccine
|
$56.00 |
$56.00 |
$56.00 |
$48.00
|
|
Administration immunization intranasal/oral route each additional vaccine
|
$59.20 |
$59.20 |
$59.20 |
$30.24
|
|
_afb id by dna probe rflx ast
|
$72.80 |
$72.80 |
$72.80 |
$104.50
|
|
Albumin body fluid quantitative each specimen
|
$28.80 |
$28.80 |
$28.80 |
$47.45
|
|
Albumin (human), 25%, 50ml
|
$147.84 |
$147.84 |
$147.84 |
$244.70
|
|
Albumin (human), 5%, 250 ml
|
$248.58 |
$248.58 |
$248.58 |
$252.77
|
|
Albumin (microalbumin) 24 hour urine quantitative
|
$45.60 |
$45.60 |
$45.60 |
$58.17
|
|
Albumin serum plasma or whole blood
|
$28.80 |
$28.80 |
$28.80 |
$43.00
|
|
Albuterol ipratrop non-comp
|
$4.92 |
$4.92 |
$4.92 |
$5.67
|
|
Albuterol non-comp con
|
$3.97 |
$3.97 |
$3.97 |
$6.07
|
|
Albuterol non-comp unit
|
$3.97 |
$3.97 |
$3.97 |
$5.40
|
|
Alcohol (ethanol) any specimen except urine/breath
|
$104.00 |
$104.00 |
$104.00 |
$96.00
|
|
Alkaline phosphatase
|
$28.80 |
$28.80 |
$28.80 |
$46.80
|
|
Allergen egg white ige
|
$27.20 |
$27.20 |
$27.20 |
$38.00
|
|
Alpha-fetoprotein tumor marker
|
$96.80 |
$96.80 |
$96.80 |
$106.00
|
|
Alprostadil for injection
|
$252.21 |
$252.21 |
$252.21 |
$511.41
|
|
Als 1
|
$1,388.00 |
$1,388.00 |
$1,388.00 |
$853.44
|
|
Als1-emergency
|
$1,500.80 |
$1,500.80 |
$1,500.80 |
$1,103.37
|
|
Als 2
|
$1,887.20 |
$1,887.20 |
$1,887.20 |
$1,288.56
|
|
Alteplase 100 mg infusion from pyxis vial
|
$13,238.02 |
$13,238.02 |
$13,238.02 |
$15,857.45
|
|
Alt/sgpt
|
$28.80 |
$28.80 |
$28.80 |
$47.50
|
|
Amiodarone 150 mg/100 ml (1.5 mg/ml) in dextrose, iso-osmotic IV
|
$225.12 |
$225.12 |
$225.12 |
$108.13
|
|
Amiodarone 50 mg/ml intravenous solution
|
$62.90 |
$62.90 |
$62.90 |
$55.86
|
|
Amitriptyline (elavil) -sendout
|
$118.40 |
$118.40 |
$118.40 |
$87.45
|
|
Ammonia
|
$79.20 |
$79.20 |
$79.20 |
$119.70
|
|
Ampicillin 1 gram solution for injection
|
$62.00 |
$62.00 |
$62.00 |
$56.70
|
|
Ampicillin-sulbactam 1.5 gram solution for injection
|
$83.52 |
$83.52 |
$83.52 |
$54.57
|
|
Amplification real-time pcr dna markers infectious disease bacterial vaginosis and vaginitis
|
$496.00 |
$496.00 |
$496.00 |
$262.99
|
|
Amylase
|
$87.20 |
$87.20 |
$87.20 |
$90.00
|
|
Analysis gene f2 20210g>a variant
|
$244.00 |
$244.00 |
$244.00 |
$226.85
|
|
Analysis gene f5 leiden variant
|
$248.00 |
$248.00 |
$248.00 |
$249.60
|
|
Anastrozole 1 mg
|
$4.96 |
$4.96 |
$4.96 |
$22.40
|
|
Anca screen with reflex to titer -quest
|
$126.40 |
$126.40 |
$126.40 |
$101.50
|
|
Angiotensin ii 0.5 mg/ml soln 1 ml vial
|
$265.61 |
$265.61 |
$265.61 |
$2,979.43
|
|
Ankle X-ray
|
$352.80 |
$352.80 |
$352.80 |
$356.32
|
|
Ankle X-ray (2 views, both ankles)
|
$208.80 |
$208.80 |
$208.80 |
$282.96
|
|
Anora (draw only)
|
$45.60 |
$45.60 |
$45.60 |
$35.00
|
|
Antibody bacterium, not elsewhere specified
|
$31.20 |
$31.20 |
$31.20 |
$57.85
|
|
Antibody screen rbc
|
$56.00 |
$56.00 |
$56.00 |
$108.55
|
|
Antineutrophil cytoplasmic antibody screen each antibody
|
$53.60 |
$53.60 |
$53.60 |
$38.50
|
|
Antinuclear antibodies
|
$69.60 |
$69.60 |
$69.60 |
$90.00
|
|
Antinuclear antibodies titer
|
$61.60 |
$61.60 |
$61.60 |
$80.04
|
|
Antistreptolysin o titer
|
$48.00 |
$48.00 |
$48.00 |
$54.00
|
|
Antithrombin iii activity
|
$125.60 |
$125.60 |
$125.60 |
$115.15
|
|
Aortic Aneurysm Screening Ultrasound
|
$520.80 |
$520.80 |
$520.80 |
$394.55
|
|
Application finger splntstatic 29130
|
$186.40 |
$186.40 |
$186.40 |
$208.50
|
|
Application long leg splint 29505
|
$279.20 |
$279.20 |
$279.20 |
$338.25
|
|
Application lower leg splint 29515
|
$257.60 |
$257.60 |
$257.60 |
$340.20
|
|
Application multi layer compression below knee (both sides)
|
$384.80 |
$384.80 |
$384.80 |
$375.06
|
|
Application of paste boot 29580
|
$344.00 |
$344.00 |
$344.00 |
$340.11
|
|
Applicator tag rfid localizer 12gx7cm
|
$99.20 |
$99.20 |
$99.20 |
$981.75
|
|
Appl modality 1/> areas paraffin bath 97018
|
$32.00 |
$32.00 |
$32.00 |
$69.00
|
|
Appl modality 1/> areas vasopneumatic devices 97016
|
$63.20 |
$63.20 |
$63.20 |
$75.98
|
|
Appl modality 1+lllt po pain
|
$65.60 |
$65.60 |
$65.60 |
$54.61
|
|
Appl multlay comprs arm/hand
|
$271.20 |
$271.20 |
$271.20 |
$289.60
|
|
Aprepitant 130 mg/18 ml (7.2 mg/ml) intravenous emulsion
|
$434.40 |
$434.40 |
$434.40 |
$955.43
|
|
Aqua therapy w/exercise/ea 15 min 97113
|
$124.80 |
$124.80 |
$124.80 |
$100.75
|
|
Aquatic exercise - group charge
|
$81.60 |
$81.60 |
$81.60 |
$87.45
|
|
Aripiprazole 441 mg/1.6 ml inj
|
$3,367.88 |
$3,367.88 |
$3,367.88 |
$6,387.85
|
|
Arm CT Scan (with contrast, both arms)
|
$2,773.60 |
$2,773.60 |
$2,773.60 |
$1,687.88
|
|
Arm CT Scan (without contrast, both arms)
|
$2,227.20 |
$2,227.20 |
$2,227.20 |
$1,380.00
|
|
Arm or Leg Ultrasound (limited, left side)
|
$464.00 |
$464.00 |
$464.00 |
$426.00
|
