|
3d recon without postprocess indpndt
|
$852.00 |
$852.00 |
$852.00 |
$508.13
|
|
5% dextrose and 0.45% saline
|
$80.00 |
$80.00 |
$80.00 |
$48.00
|
|
88334 ap bill cytologic exam each additional site
|
$88.80 |
$88.80 |
$88.80 |
$100.10
|
|
Abatacept (with maltose) 250 mg intravenous solution
|
$2,478.00 |
$2,478.00 |
$2,478.00 |
$3,138.72
|
|
Abdominal and Pelvic Blood Vessel Ultrasound (complete)
|
$1,596.00 |
$1,596.00 |
$1,596.00 |
$988.00
|
|
Abdominal and Pelvic Blood Vessel Ultrasound (limited)
|
$1,561.60 |
$1,561.60 |
$1,561.60 |
$662.40
|
|
Abdominal CT scan (with and without contrast)
|
$2,976.80 |
$2,976.80 |
$2,976.80 |
$1,976.94
|
|
Abdominal CT scan (with contrast)
|
$2,932.00 |
$2,932.00 |
$2,932.00 |
$1,667.60
|
|
Abdominal CT scan (without contrast)
|
$2,240.00 |
$2,240.00 |
$2,240.00 |
$1,353.32
|
|
Abdominal MRI (with and without contrast)
|
$4,335.20 |
$4,335.20 |
$4,335.20 |
$2,967.00
|
|
Abdominal MRI (with contrast)
|
$3,473.60 |
$3,473.60 |
$3,473.60 |
$2,240.00
|
|
Abdominal MRI (without contrast)
|
$3,044.00 |
$3,044.00 |
$3,044.00 |
$2,048.36
|
|
Abdominal Ultrasound (complete)
|
$1,108.00 |
$1,108.00 |
$1,108.00 |
$783.00
|
|
Abdominal Ultrasound (limited)
|
$771.20 |
$771.20 |
$771.20 |
$586.43
|
|
Abdominal X-ray (2 views)
|
$406.40 |
$406.40 |
$406.40 |
$318.20
|
|
Abdominal X-ray Series (acute, with chest view)
|
$636.80 |
$636.80 |
$636.80 |
$418.63
|
|
Abdominal X-ray (single view)
|
$400.80 |
$400.80 |
$400.80 |
$260.00
|
|
Acetaminophen level
|
$122.40 |
$122.40 |
$122.40 |
$116.80
|
|
Acetone qualitative
|
$52.80 |
$52.80 |
$52.80 |
$46.80
|
|
Acetylcysteine 200 mg/ml (20 %) intravenous solution
|
$77.07 |
$77.07 |
$77.07 |
$218.79
|
|
Acetylcysteine non-comp unit
|
$12.72 |
$12.72 |
$12.72 |
$31.21
|
|
Acute hepatitis panel
|
$345.60 |
$345.60 |
$345.60 |
$284.95
|
|
Acyclovir 400 mg tablet
|
$5.15 |
$5.15 |
$5.15 |
$54.77
|
|
Acyclovir 5 mg/ml in ns IV syringe (neo/ped) - cnr
|
$62.17 |
$62.17 |
$62.17 |
$64.45
|
|
#acylcarnitineprfl
|
$49.60 |
$49.60 |
$49.60 |
$121.55
|
|
Adenosine 3 mg/250 ml bag for osm
|
$61.58 |
$61.58 |
$61.58 |
$271.98
|
|
Adh-sendout
|
$344.00 |
$344.00 |
$344.00 |
$118.79
|
|
Admelog u-100 insulin lispro 100 unit/ml subcutaneous solution
|
$30.40 |
$30.40 |
$30.40 |
$193.40
|
|
Administration chemotherapy IV infusion each additional hour
|
$288.80 |
$288.80 |
$288.80 |
$230.35
|
|
Administration chemotherapy IV infusion each addl sequential infusion diff substance/drug >1 hr
|
$383.20 |
$383.20 |
$383.20 |
$298.98
|
|
Administration chemotherapy IV infusion up to 1 hour single/initial substance/drug
|
$859.20 |
$859.20 |
$859.20 |
$668.98
|
|
Administration chemotherapy IV push single/initial substance/drug
|
$571.20 |
$571.20 |
$571.20 |
$439.20
|
|
Administration chemotherapy subcutaneous/im anti neoplastic hormonal
|
$261.60 |
$261.60 |
$261.60 |
$212.80
|
|
Administration chemotherapy subcutaneous/im anti neoplastic non hormonal
|
$287.20 |
$287.20 |
$287.20 |
$256.49
|
|
Administration immunization each additional component
|
$24.00 |
$24.00 |
$24.00 |
$29.20
|
|
Administration immunization each additional vaccine
|
$56.00 |
$56.00 |
$56.00 |
$47.40
|
|
Administration immunization first component each vaccine
|
$32.00 |
$32.00 |
$32.00 |
$46.40
|
|
Administration immunization intranasal/oral route 1 vaccine
|
$32.00 |
$32.00 |
$32.00 |
$48.00
|
|
Administration immunization intranasal/oral route each additional vaccine
|
$32.00 |
$32.00 |
$32.00 |
$30.24
|
|
_afb id by dna probe rflx ast
|
$51.20 |
$51.20 |
$51.20 |
$104.50
|
|
Albumin body fluid quantitative each specimen
|
$48.00 |
$48.00 |
$48.00 |
$47.45
|
|
Albumin (human), 25%, 50ml
|
$96.91 |
$96.91 |
$96.91 |
$244.70
|
|
Albumin (human), 5%, 250 ml
|
$105.12 |
$105.12 |
$105.12 |
$252.77
|
|
Albumin (microalbumin) 24 hour urine quantitative
|
$169.60 |
$169.60 |
$169.60 |
$58.17
|
|
Albumin serum plasma or whole blood
|
$100.00 |
$100.00 |
$100.00 |
$43.00
|
|
Albuterol ipratrop non-comp
|
$5.19 |
$5.19 |
$5.19 |
$5.67
|
|
Albuterol non-comp unit
|
$6.12 |
$6.12 |
$6.12 |
$5.40
|
|
Alcohol (ethanol) any specimen except urine/breath
|
$153.60 |
$153.60 |
$153.60 |
$96.00
|
|
Alkaline phosphatase
|
$85.60 |
$85.60 |
$85.60 |
$46.80
|
|
Allergen alpha lactalbumin ige
|
$66.40 |
$66.40 |
$66.40 |
$48.57
|
|
Allergen egg white ige
|
$112.00 |
$112.00 |
$112.00 |
$38.00
|
|
Allergy injections; 2 or more 95117
|
$68.80 |
$68.80 |
$68.80 |
$45.00
|
|
Allergy injection; single 95115
|
$48.80 |
$48.80 |
$48.80 |
$46.80
|
|
Alpha-fetoprotein tumor marker
|
$192.00 |
$192.00 |
$192.00 |
$106.00
|
|
Alprostadil for injection
|
$84.80 |
$84.80 |
$84.80 |
$511.41
|
|
Alteplase 100 mg infusion from pyxis vial
|
$334.64 |
$334.64 |
$334.64 |
$15,857.45
|
|
Alt/sgpt
|
$85.60 |
$85.60 |
$85.60 |
$47.50
|
|
Aluminum - quest
|
$34.40 |
$34.40 |
$34.40 |
$83.05
|
|
Aminocaproic acid 5 g/250 ml 0.9% nacl IV - cnr
|
$63.49 |
$63.49 |
$63.49 |
$37.33
|
|
Aminophylline 25 mg/ml intravenous solution (wrapper)
|
$68.68 |
$68.68 |
$68.68 |
$47.06
|
|
Amiodarone 150 mg/100 ml (1.5 mg/ml) in dextrose, iso-osmotic IV
|
$139.20 |
$139.20 |
$139.20 |
$108.13
|
|
Amiodarone 50 mg/ml intravenous solution
|
$61.48 |
$61.48 |
$61.48 |
$55.86
|
|
Amitriptyline (elavil) -sendout
|
$81.60 |
$81.60 |
$81.60 |
$87.45
|
|
Ammonia
|
$175.20 |
$175.20 |
$175.20 |
$119.70
|
|
Amphetamine confirm urine -sendout
|
$67.20 |
$67.20 |
$67.20 |
$93.61
|
|
Amphetamines 5 or more
|
$88.00 |
$88.00 |
$88.00 |
$90.48
|
|
Amphotericin b liposomal in d5w IV syringe 1 mg/ml (neo/ped) - cnr
|
$240.21 |
$240.21 |
$240.21 |
$519.03
|
|
Ampicillin 1 gram solution for injection
|
$61.96 |
$61.96 |
$61.96 |
$56.70
|
|
Ampicillin-sulbactam 1.5 gram solution for injection
|
$62.74 |
$62.74 |
$62.74 |
$54.57
|
|
Amplification real-time pcr dna markers infectious disease bacterial vaginosis and vaginitis
|
$496.00 |
$496.00 |
$496.00 |
$262.99
|
|
Amylase
|
$104.80 |
$104.80 |
$104.80 |
$90.00
|
|
Ana ds-dna
|
$417.60 |
$417.60 |
$417.60 |
$55.24
|
|
Analysis gene f2 20210g>a variant
|
$192.00 |
$192.00 |
$192.00 |
$226.85
|
|
Analysis gene f5 leiden variant
|
$192.00 |
$192.00 |
$192.00 |
$249.60
|
|
Anca screen with reflex to titer -quest
|
$204.80 |
$204.80 |
$204.80 |
$101.50
|
|
Angiotensin ii 0.5 mg/ml soln 1 ml vial
|
$231.52 |
$231.52 |
$231.52 |
$2,979.43
|
|
Ankle X-ray
|
$420.00 |
$420.00 |
$420.00 |
$356.32
|
|
Ankle X-ray (2 views, both ankles)
|
$346.40 |
$346.40 |
$346.40 |
$282.96
|
|
Anora (draw only)
|
$52.00 |
$52.00 |
$52.00 |
$35.00
|
|
Antibody bacterium, not elsewhere specified
|
$35.20 |
$35.20 |
$35.20 |
$57.85
|
|
Antibody htlv/hiv confirm test
|
$293.60 |
$293.60 |
$293.60 |
$131.56
|
|
Antibody identification platelet antibodies heparin-pf4 igg
|
$105.60 |
$105.60 |
$105.60 |
$224.00
|
|
Antibody id rbc panel
|
$243.20 |
$243.20 |
$243.20 |
$291.75
|
|
Antibody screen rbc
|
$116.80 |
$116.80 |
$116.80 |
$108.55
|
|
Antineutrophil cytoplasmic antibody screen each antibody
|
$90.40 |
$90.40 |
$90.40 |
$38.50
|
|
Antineutrophil cytoplasmic antibody titer each antibody
|
$62.40 |
$62.40 |
$62.40 |
$42.00
|
|
Antinuclear antibodies
|
$176.80 |
$176.80 |
$176.80 |
$90.00
|
|
Antinuclear antibodies titer
|
$160.00 |
$160.00 |
$160.00 |
$80.04
|
|
Antistreptolysin o titer
|
$91.20 |
$91.20 |
$91.20 |
$54.00
|
|
Antithrombin iii activity
|
$245.60 |
$245.60 |
$245.60 |
$115.15
|
|
Aortic Aneurysm Screening Ultrasound
|
$612.00 |
$612.00 |
$612.00 |
$394.55
|
|
Apl(pml-rara) quant - sendout
|
$500.80 |
$500.80 |
$500.80 |
$513.00
|
|
Application finger splntstatic 29130
|
$216.80 |
$216.80 |
$216.80 |
$208.50
|
|
Application long leg splint 29505
|
$325.60 |
$325.60 |
$325.60 |
$338.25
|
|
Application lower leg splint 29515
|
$299.20 |
$299.20 |
$299.20 |
$340.20
|
|
Application of forearm cast 29075
|
$236.00 |
$236.00 |
$236.00 |
$358.20
|
|
Application of long arm cast 29065
|
$283.20 |
$283.20 |
$283.20 |
$396.77
|
|
Application of paste boot 29580
|
$280.00 |
$280.00 |
$280.00 |
$340.11
|
|
Application short leg cast 29405
|
$370.40 |
$370.40 |
$370.40 |
$393.98
|
|
Application skin substitute graft face/scalp/neck/genit/hnd/ft <100 sq cm 1st 25 sq cm
|
$3,061.60 |
$3,061.60 |
$3,061.60 |
$2,123.50
|
