|
5% dextrose and 0.45% saline
|
$40.00 |
$40.00 |
$40.00 |
$48.00
|
|
Abatacept (with maltose) 250 mg intravenous solution
|
$2,302.84 |
$2,302.84 |
$2,302.84 |
$3,138.72
|
|
Abdominal and Pelvic Blood Vessel Ultrasound (complete)
|
$1,189.60 |
$1,189.60 |
$1,189.60 |
$988.00
|
|
Abdominal and Pelvic Blood Vessel Ultrasound (limited)
|
$824.80 |
$824.80 |
$824.80 |
$662.40
|
|
Abdominal CT scan (with and without contrast)
|
$2,805.60 |
$2,805.60 |
$2,805.60 |
$1,976.94
|
|
Abdominal CT scan (with contrast)
|
$2,612.00 |
$2,612.00 |
$2,612.00 |
$1,667.60
|
|
Abdominal CT scan (without contrast)
|
$1,972.00 |
$1,972.00 |
$1,972.00 |
$1,353.32
|
|
Abdominal MRI (with and without contrast)
|
$3,704.80 |
$3,704.80 |
$3,704.80 |
$2,967.00
|
|
Abdominal MRI (with contrast)
|
$3,248.00 |
$3,248.00 |
$3,248.00 |
$2,240.00
|
|
Abdominal MRI (without contrast)
|
$2,712.80 |
$2,712.80 |
$2,712.80 |
$2,048.36
|
|
Abdominal paracentesis w/image guidance
|
$1,933.60 |
$1,933.60 |
$1,933.60 |
$1,632.96
|
|
Abdominal Ultrasound (complete)
|
$897.60 |
$897.60 |
$897.60 |
$783.00
|
|
Abdominal Ultrasound (limited)
|
$704.00 |
$704.00 |
$704.00 |
$586.43
|
|
Abdominal X-ray (2 views)
|
$372.80 |
$372.80 |
$372.80 |
$318.20
|
|
Abdominal X-ray Series (acute, with chest view)
|
$568.80 |
$568.80 |
$568.80 |
$418.63
|
|
Abdominal X-ray (single view)
|
$299.20 |
$299.20 |
$299.20 |
$260.00
|
|
Acetaminophen level
|
$55.20 |
$55.20 |
$55.20 |
$116.80
|
|
Acetazolamide 500 mg solution for injection
|
$59.55 |
$59.55 |
$59.55 |
$122.55
|
|
Acetone qualitative
|
$29.60 |
$29.60 |
$29.60 |
$46.80
|
|
Acetylcysteine 200 mg/ml (20 %) intravenous solution
|
$70.96 |
$70.96 |
$70.96 |
$218.79
|
|
Acetylcysteine non-comp unit
|
$39.92 |
$39.92 |
$39.92 |
$31.21
|
|
Acute hepatitis panel
|
$212.00 |
$212.00 |
$212.00 |
$284.95
|
|
Acyclovir 400 mg tablet
|
$3.03 |
$3.03 |
$3.03 |
$54.77
|
|
Acyclovir 5 mg/ml in ns IV syringe (neo/ped) - cnr
|
$26.80 |
$26.80 |
$26.80 |
$64.45
|
|
#acylcarnitineprfl
|
$57.60 |
$57.60 |
$57.60 |
$121.55
|
|
Adenosine 3 mg/250 ml bag for osm
|
$27.57 |
$27.57 |
$27.57 |
$271.98
|
|
Admelog u-100 insulin lispro 100 unit/ml subcutaneous solution
|
$28.28 |
$28.28 |
$28.28 |
$193.40
|
|
Administration chemotherapy IV infusion each additional hour
|
$154.40 |
$154.40 |
$154.40 |
$230.35
|
|
Administration chemotherapy IV infusion up to 1 hour single/initial substance/drug
|
$803.20 |
$803.20 |
$803.20 |
$668.98
|
|
Administration chemotherapy subcutaneous/im anti neoplastic hormonal
|
$232.00 |
$232.00 |
$232.00 |
$212.80
|
|
Administration chemotherapy subcutaneous/im anti neoplastic non hormonal
|
$283.20 |
$283.20 |
$283.20 |
$256.49
|
|
Administration immunization each additional vaccine
|
$62.40 |
$62.40 |
$62.40 |
$47.40
|
|
Administration immunization intranasal/oral route 1 vaccine
|
$56.80 |
$56.80 |
$56.80 |
$48.00
|
|
Administration immunization intranasal/oral route each additional vaccine
|
$56.00 |
$56.00 |
$56.00 |
$30.24
|
|
_afb id by dna probe rflx ast
|
$64.00 |
$64.00 |
$64.00 |
$104.50
|
|
Albumin body fluid quantitative each specimen
|
$70.40 |
$70.40 |
$70.40 |
$47.45
|
|
Albumin (human), 25%, 50ml
|
$91.80 |
$91.80 |
$91.80 |
$244.70
|
|
Albumin (microalbumin) 24 hour urine quantitative
|
$57.60 |
$57.60 |
$57.60 |
$58.17
|
|
Albumin serum plasma or whole blood
|
$44.80 |
$44.80 |
$44.80 |
$43.00
|
|
Albuterol ipratrop non-comp
|
$8.19 |
$8.19 |
$8.19 |
$5.67
|
|
Albuterol non-comp con
|
$67.76 |
$67.76 |
$67.76 |
$6.07
|
|
Albuterol non-comp unit
|
$3.43 |
$3.43 |
$3.43 |
$5.40
|
|
Alcohol (ethanol) any specimen except urine/breath
|
$188.00 |
$188.00 |
$188.00 |
$96.00
|
|
Alkaline phosphatase
|
$51.20 |
$51.20 |
$51.20 |
$46.80
|
|
Allergen egg white ige
|
$41.60 |
$41.60 |
$41.60 |
$38.00
|
|
Alpha-fetoprotein tumor marker
|
$110.40 |
$110.40 |
$110.40 |
$106.00
|
|
Als1-emergency
|
$1,532.80 |
$1,532.80 |
$1,532.80 |
$1,103.37
|
|
Als 2
|
$1,784.00 |
$1,784.00 |
$1,784.00 |
$1,288.56
|
|
Alteplase 100 mg infusion from pyxis vial
|
$8,973.77 |
$8,973.77 |
$8,973.77 |
$15,857.45
|
|
Alt/sgpt
|
$50.40 |
$50.40 |
$50.40 |
$47.50
|
|
Aminocaproic acid 5 g/250 ml 0.9% nacl IV - cnr
|
$29.92 |
$29.92 |
$29.92 |
$37.33
|
|
Aminolevulinic acid delta
|
$121.60 |
$121.60 |
$121.60 |
$87.12
|
|
Aminophylline 25 mg/ml intravenous solution (wrapper)
|
$33.12 |
$33.12 |
$33.12 |
$47.06
|
|
Amiodarone 150 mg/100 ml (1.5 mg/ml) in dextrose, iso-osmotic IV
|
$96.00 |
$96.00 |
$96.00 |
$108.13
|
|
Amiodarone 50 mg/ml intravenous solution
|
$25.79 |
$25.79 |
$25.79 |
$55.86
|
|
Amitriptyline (elavil) -sendout
|
$82.40 |
$82.40 |
$82.40 |
$87.45
|
|
Ammonia
|
$97.60 |
$97.60 |
$97.60 |
$119.70
|
|
Ampicillin 1 gram solution for injection
|
$26.28 |
$26.28 |
$26.28 |
$56.70
|
|
Ampicillin-sulbactam 1.5 gram solution for injection
|
$27.96 |
$27.96 |
$27.96 |
$54.57
|
|
Amplification real-time pcr dna markers infectious disease bacterial vaginosis and vaginitis
|
$496.00 |
$496.00 |
$496.00 |
$262.99
|
|
Amylase
|
$68.00 |
$68.00 |
$68.00 |
$90.00
|
|
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
|
|
Anastrozole 1 mg
|
$5.46 |
$5.46 |
$5.46 |
$22.40
|
|
Anca screen with reflex to titer -quest
|
$119.20 |
$119.20 |
$119.20 |
$101.50
|
|
Angiotensin ii 0.5 mg/ml soln 1 ml vial
|
$70.72 |
$70.72 |
$70.72 |
$2,979.43
|
|
Ankle X-ray
|
$327.20 |
$327.20 |
$327.20 |
$356.32
|
|
Ankle X-ray (2 views, both ankles)
|
$269.60 |
$269.60 |
$269.60 |
$282.96
|
|
Antibody bacterium, not elsewhere specified
|
$54.40 |
$54.40 |
$54.40 |
$57.85
|
|
Antibody elution rbc reference
|
$173.60 |
$173.60 |
$173.60 |
$177.29
|
|
Antibody htlv/hiv confirm test
|
$219.20 |
$219.20 |
$219.20 |
$131.56
|
|
Antibody htlv-i
|
$66.40 |
$66.40 |
$66.40 |
$49.53
|
|
Antibody htlv-ii
|
$66.40 |
$66.40 |
$66.40 |
$46.15
|
|
Antibody identification platelet antibodies heparin-pf4 igg
|
$66.40 |
$66.40 |
$66.40 |
$224.00
|
|
Antibody id rbc panel
|
$173.60 |
$173.60 |
$173.60 |
$291.75
|
|
Antibody screen rbc
|
$94.40 |
$94.40 |
$94.40 |
$108.55
|
|
Antineutrophil cytoplasmic antibody screen each antibody
|
$53.60 |
$53.60 |
$53.60 |
$38.50
|
|
Antineutrophil cytoplasmic antibody titer each antibody
|
$48.00 |
$48.00 |
$48.00 |
$42.00
|
|
Antinuclear antibodies
|
$69.60 |
$69.60 |
$69.60 |
$90.00
|
|
Antinuclear antibodies titer
|
$86.40 |
$86.40 |
$86.40 |
$80.04
|
|
Antipsychotics nos 1-3
|
$148.80 |
$148.80 |
$148.80 |
$136.61
|
|
Antistreptolysin o titer
|
$60.00 |
$60.00 |
$60.00 |
$54.00
|
|
Antithrombin iii activity
|
$47.20 |
$47.20 |
$47.20 |
$115.15
|
|
Aortic Aneurysm Screening Ultrasound
|
$476.80 |
$476.80 |
$476.80 |
$394.55
|
|
Application finger splntstatic 29130
|
$276.80 |
$276.80 |
$276.80 |
$208.50
|
|
Application long leg splint 29505
|
$415.20 |
$415.20 |
$415.20 |
$338.25
|
|
Application lower leg splint 29515
|
$382.40 |
$382.40 |
$382.40 |
$340.20
|
|
Application of forearm cast 29075
|
$301.60 |
$301.60 |
$301.60 |
$358.20
|
|
Application short leg cast 29405
|
$356.00 |
$356.00 |
$356.00 |
$393.98
|
|
Appl modality 1/> areas paraffin bath 97018
|
$81.60 |
$81.60 |
$81.60 |
$69.00
|
|
Apply hand/wrist cast 29085
|
$236.00 |
$236.00 |
$236.00 |
$271.80
|
|
#aptt mix-1:1 incubated
|
$352.80 |
$352.80 |
$352.80 |
$157.30
|
|
Aqaprn-4 antb flo cytmtry ea
|
$190.40 |
$190.40 |
$190.40 |
$231.66
|
|
Aquatic exercise - group charge
|
$112.80 |
$112.80 |
$112.80 |
$87.45
|
|
Aripiprazole 441 mg/1.6 ml inj
|
$3,504.21 |
$3,504.21 |
$3,504.21 |
$6,387.85
|
|
Arm CT Scan (without contrast, both arms)
|
$1,801.60 |
$1,801.60 |
$1,801.60 |
$1,380.00
|
|
Arm or Leg Ultrasound (limited, left side)
|
$503.20 |
$503.20 |
$503.20 |
$426.00
|
|
Arthrocentesis/aspiration/injection intermediate joint/bursa without ultrasound guidance right
|
$508.80 |
$508.80 |
$508.80 |
$609.00
|
|
Arthrocentesis/aspiration/injection small joint/bursa without ultrasound guidance
|
$488.00 |
$488.00 |
$488.00 |
$494.40
|
|
Assay myeloperoxidase
|
$133.60 |
$133.60 |
$133.60 |
$97.41
|
