|
Administration chemotherapy IV push single/initial substance/drug
|
$132.22 |
$285.12 |
$685.60 |
|
|
Administration chemotherapy subcutaneous/im anti neoplastic hormonal
|
$84.73 |
$155.20 |
$508.00 |
|
|
Administration chemotherapy subcutaneous/im anti neoplastic non hormonal
|
$84.73 |
$148.80 |
$508.00 |
|
|
Administration immunization each additional component
|
$24.00 |
$24.00 |
$24.00 |
|
|
Administration immunization each additional vaccine
|
$15.40 |
$40.00 |
$64.80 |
|
|
Administration immunization first component each vaccine
|
$32.00 |
$32.00 |
$32.00 |
|
|
Administration immunization intranasal/oral route 1 vaccine
|
$28.28 |
$32.00 |
$67.20 |
|
|
Administration immunization intranasal/oral route each additional vaccine
|
$10.08 |
$17.52 |
$61.60 |
|
|
Administration rsv monoclonal ab seasonal dose im w/counseling
|
$11.95 |
$11.95 |
$11.95 |
|
|
Administration vaccine hepatitis b
|
$8.59 |
$11.87 |
$11.87 |
|
|
Administration vaccine influenza virus
|
$12.29 |
$14.78 |
$40.80 |
|
|
Administration vaccine pneumococcal
|
$9.74 |
$14.50 |
$70.40 |
|
|
Ado-trastuzumab emtansine 100 mg intravenous solution
|
$7,010.12 |
$10,172.16 |
$10,332.71 |
|
|
Adrenal cortex & medulla img
|
$1,190.40 |
$1,190.40 |
$1,190.40 |
|
|
Aep hearing status deter i&r
|
$151.31 |
$197.23 |
$360.80 |
|
|
Aep neurodiagnostic i&r
|
$613.60 |
$760.65 |
$992.26 |
|
|
Aep thrshld est mlt freq i&r
|
$613.60 |
$760.65 |
$992.26 |
|
|
_afb id by dna probe rflx ast
|
$51.20 |
$67.20 |
$80.00 |
|
|
_afb org id by sequencing rflx ast-sendout
|
$174.22 |
$174.22 |
$214.98 |
|
|
Aflibercept injection
|
$1,930.00 |
$1,930.00 |
$1,930.00 |
|
|
Afo molded ankle gauntlet
|
$714.28 |
$948.75 |
$948.75 |
|
|
Afo molded plas rig ant tib
|
$1,776.21 |
$2,359.39 |
$2,359.39 |
|
|
Afo molded to patient plasti
|
$770.62 |
$1,023.62 |
$1,023.62 |
|
|
Afo rig ant tib tcf/= custom
|
$1,412.10 |
$1,875.66 |
$1,875.66 |
|
|
Afo sing bar clasp attach sh
|
$443.74 |
$589.51 |
$589.51 |
|
|
Afo sing solid stirrup calf
|
$638.96 |
$848.68 |
$848.68 |
|
|
Afo sing upright with adjust s
|
$650.10 |
$863.52 |
$863.52 |
|
|
Afo spiral molded to pt plas
|
$1,217.05 |
$1,616.50 |
$1,616.50 |
|
|
Afo sprng wir drsflx calf bd
|
$451.47 |
$599.70 |
$599.70 |
|
|
Afo supramalleolar custom
|
$890.46 |
$1,182.83 |
$1,182.83 |
|
|
Afo tib fx cast molded to pt
|
$1,819.22 |
$2,416.51 |
$2,416.51 |
|
|
Afo tib fx cast plaster mold
|
$1,247.34 |
$1,656.82 |
$1,656.82 |
|
|
Afo tib fx semi-rigid l2114
|
$999.94 |
$1,328.26 |
$1,328.26 |
|
|
Afo tibial fracture rigid
|
$466.10 |
$1,388.64 |
$1,620.08 |
|
|
Afo tibial fracture soft
|
$798.34 |
$1,060.47 |
$1,060.47 |
|
|
Afo w/ankle joint, prefab
|
$741.72 |
$985.32 |
$985.32 |
|
|
After cataract laser surgery
|
$891.86 |
$2,170.78 |
$3,375.84 |
|
|
Agalsidase beta 35 mg intravenous solution
|
$1,908.61 |
$12,809.81 |
$12,809.81 |
|
|
Air conduction bilat
|
$107.80 |
$107.80 |
$140.45 |
|
|
Air injection into abdomen 49400
|
$704.83 |
$704.83 |
$704.83 |
|
|
Airway resistance by impulse oscillometry 94728
|
$227.42 |
$332.86 |
$332.86 |
|
|
Ak 4 bar ling w/hydraul swig
|
$3,863.16 |
$5,131.50 |
$5,131.50 |
|
|
Ak 4 bar link w/fric swing
|
$2,539.82 |
$3,373.61 |
$3,373.61 |
|
|
Ak/bk self-aligning unit ea
|
$887.15 |
$1,178.35 |
$1,178.35 |
|
|
Ak flex inner socket ext fra
|
$2,254.73 |
$2,994.94 |
$2,994.94 |
|
|
Ak/knee disartic acrylic soc
|
$692.61 |
$920.02 |
$920.02 |
|
|
Ak/knee disartic pelvic band
|
$147.50 |
$201.49 |
$201.49 |
|
|
Ak/knee disartic pelvic join
|
$310.58 |
$424.31 |
$424.31 |
|
|
Ak/knee disartic silesian ba
|
$189.22 |
$258.50 |
$258.50 |
|
|
Ak open end sach
|
$5,475.57 |
$7,094.14 |
$7,094.14 |
|
|
Ak pelvic control belt light
|
$209.44 |
$286.16 |
$286.16 |
|
|
Ak pelvic control belt pad/l
|
$285.99 |
$390.71 |
$390.71 |
|
|
Ak sleeve susp neoprene/equa
|
$257.10 |
$351.23 |
$351.23 |
|
|
Ak univ multiplex sys frict
|
$2,329.38 |
$3,094.17 |
$3,094.17 |
|
|
Albumin body fluid quantitative each specimen
|
$28.80 |
$151.20 |
$185.81 |
|
|
Albumin (human), 25%, 50ml
|
$52.25 |
$130.36 |
$256.74 |
|
|
Albumin (human), 5%, 250 ml
|
$74.25 |
$293.33 |
$342.22 |
|
|
Albumin, human 5 % intravenous solution
|
$73.56 |
$75.95 |
$75.95 |
|
|
Albumin (microalbumin) 24 hour urine quantitative
|
$34.22 |
$38.54 |
$169.60 |
|
|
Albumin serum plasma or whole blood
|
$28.80 |
$98.54 |
$121.07 |
|
|
Albuterol ipratrop non-comp
|
$3.60 |
$5.19 |
$11.81 |
|
|
Albuterol non-comp con
|
$3.97 |
$21.20 |
$71.50 |
|
|
Albuterol non-comp unit
|
$3.43 |
$4.70 |
$12.83 |
|
|
Alcohol (ethanol) any specimen except urine/breath
|
$25.03 |
$27.50 |
$188.00 |
|
|
Aldesleukin injection
|
$7,578.74 |
$7,578.74 |
$7,578.74 |
|
|
Alemtuzumab 12 mg/1.2 ml intravenous solution
|
$33,625.63 |
$33,625.63 |
$33,625.63 |
|
|
Alginate dressing <=16 sq in
|
$13.10 |
$15.29 |
$15.29 |
|
|
Alginate drsg >16 <=48 sq in
|
$28.56 |
$70.56 |
$70.56 |
|
|
Alginate drsg wound filler
|
$4.37 |
$5.10 |
$5.10 |
|
|
Alkaline phosphatase
|
$28.80 |
$51.20 |
$85.60 |
|
|
Allergen alpha lactalbumin ige
|
$57.60 |
$66.40 |
$117.21 |
|
|
Allergen egg white ige
|
$27.20 |
$54.40 |
$112.00 |
|
|
Allergy injections; 2 or more 95117
|
$47.20 |
$68.80 |
$68.80 |
|
|
Allergy injection; single 95115
|
$42.40 |
$48.80 |
$48.80 |
|
|
Allograft amnioexcel plus 17mm disk
|
$421.60 |
$436.80 |
$497.95 |
|
|
Allograft dermis 20x25x1mm decell w/matracell arthroflex
|
$233.60 |
$233.60 |
$546.12 |
|
|
Allograft ecm allopatch hd dehydr thick 0.8-1.7mmx2x5cm-cost per sq cm
|
$60.48 |
$70.56 |
$550.20 |
|
|
Allograft epieffect 2x3cm-q4186-cost per sq cm
|
$352.00 |
$562.99 |
$656.82 |
|
|
Allograft graftjacket 2x12cm-q4107-cost per sq cm
|
$840.56 |
$5,449.70 |
$5,717.99 |
|
|
Allograft membrn amnio 1x2cm hu ambriodry
|
$6,624.00 |
$6,624.00 |
$6,624.00 |
|
|
Allograft umbilical epicord 15 sq cm-q4187-cost per sq cm
|
$477.71 |
$477.71 |
$477.71 |
|
|
Alloskin
|
$150.00 |
$150.00 |
$150.00 |
|
|
Alpha-1-proteinase inhibitor (human) 1,000 mg (+/-) IV solution
|
$900.96 |
$900.96 |
$2,625.77 |
|
|
Alpha-fetoprotein amniotic
|
$72.46 |
$72.46 |
$93.91 |
|
|
Alpha-fetoprotein tumor marker
|
$41.89 |
$90.44 |
$192.00 |
|
|
Alprostadil for injection
|
$76.64 |
$233.51 |
$262.38 |
|
|
Als 1
|
$1,321.60 |
$1,388.00 |
$1,514.40 |
|
|
Als1-emergency
|
$1,500.80 |
$1,532.80 |
$1,857.60 |
|
|
Als 2
|
$1,691.20 |
$1,784.00 |
$2,438.40 |
|
|
Alteplase 100 mg infusion from pyxis vial
|
$232.00 |
$11,935.98 |
$13,925.31 |
|
|
Alt/sgpt
|
$23.46 |
$25.68 |
$85.60 |
|
|
Aluminum - quest
|
$34.40 |
$176.00 |
$196.80 |
|
|
Alveoloplasty each quadrant
|
$3,572.00 |
$3,572.00 |
$3,572.00 |
|
|
Alys cplx sp/pn npgt w/prgrm
|
$245.00 |
$245.00 |
$245.00 |
|
|
Amantadine (symmetrel)-sendout
|
$120.00 |
$120.00 |
$120.00 |
|
|
Ambl bp mntr w/software
|
$201.60 |
$201.60 |
$201.60 |
|
|
Ambl bp mntr w/sw a/r
|
$306.40 |
$481.66 |
$544.08 |
|
|
Amifostine
|
$2,285.28 |
$2,285.28 |
$2,285.28 |
|
|
Amikacin 4 mg/ml intravitreal injection - cnr
|
$26.18 |
$29.99 |
$61.82 |
|
|
Amino acids quant 2-5
|
$266.40 |
$266.40 |
$266.40 |
|
