|
11-desoxycortisol - sendout
|
$105.30 |
$105.30 |
$105.30 |
$92.04
|
|
17-hydroxypregnenolone
|
$82.55 |
$82.55 |
$82.55 |
$98.40
|
|
1st hosp/birthing center care per day nml nb 99460
|
$143.00 |
$143.00 |
$143.00 |
$172.80
|
|
5' nucleotidase - sendout
|
$66.95 |
$66.95 |
$66.95 |
$64.80
|
|
88334 ap bill cytologic exam each additional site
|
$84.50 |
$84.50 |
$84.50 |
$98.15
|
|
Abatacept (with maltose) 250 mg intravenous solution
|
$3,138.72 |
$3,138.72 |
$3,138.72 |
$3,649.67
|
|
#a/b/c/c/h pnl-candida albicans ab
|
$60.45 |
$60.45 |
$60.45 |
$53.95
|
|
Abdominal CT scan (with and without contrast)
|
$2,377.05 |
$2,377.05 |
$2,377.05 |
$1,997.40
|
|
Abdominal CT scan (with contrast)
|
$1,954.55 |
$1,954.55 |
$1,954.55 |
$1,678.00
|
|
Abdominal CT scan (without contrast)
|
$1,504.10 |
$1,504.10 |
$1,504.10 |
$1,290.90
|
|
Abdominal MRI (with and without contrast)
|
$2,897.05 |
$2,897.05 |
$2,897.05 |
$2,713.80
|
|
Abdominal MRI (without contrast)
|
$2,085.85 |
$2,085.85 |
$2,085.85 |
$1,883.70
|
|
Abdominal paracentesis w/image guidance
|
$523.25 |
$523.25 |
$523.25 |
$1,666.30
|
|
Abdominal Ultrasound (complete)
|
$806.65 |
$806.65 |
$806.65 |
$733.85
|
|
Abdominal Ultrasound (limited)
|
$493.35 |
$493.35 |
$493.35 |
$603.33
|
|
Abd paracentesis/w/o image guide 49082
|
$447.20 |
$447.20 |
$447.20 |
$1,145.00
|
|
Ablation of upper extremity nerves rf
|
$265.85 |
$265.85 |
$265.85 |
$1,408.20
|
|
Acetaminophen 10 mg/ml soln 100 ml glass cont
|
$32.64 |
$32.64 |
$32.64 |
$47.25
|
|
Acetaminophen level
|
$139.10 |
$139.10 |
$139.10 |
$117.01
|
|
Acetazolamide 500 mg solution for injection
|
$120.00 |
$120.00 |
$120.00 |
$97.26
|
|
Acetone qualitative
|
$48.75 |
$48.75 |
$48.75 |
$48.75
|
|
Acetylcholine receptor modulating antibody
|
$184.60 |
$184.60 |
$184.60 |
$93.60
|
|
Acetylcholinesterase assay
|
$195.00 |
$195.00 |
$195.00 |
$107.63
|
|
Acetylcysteine 200 mg/ml (20 %) intravenous solution
|
$160.95 |
$160.95 |
$160.95 |
$406.77
|
|
Actinotherapy uv light
|
$105.30 |
$105.30 |
$105.30 |
$111.15
|
|
Acute hepatitis panel
|
$355.55 |
$355.55 |
$355.55 |
$310.20
|
|
Acyclovir 5 mg/ml in ns IV syringe (neo/ped) - cnr
|
$63.47 |
$63.47 |
$63.47 |
$63.47
|
|
#acylcarnitineprfl
|
$148.85 |
$148.85 |
$148.85 |
$110.25
|
|
Adenosine 3 mg/250 ml bag for osm
|
$16.55 |
$16.55 |
$16.55 |
$97.58
|
|
Adh-sendout
|
$151.45 |
$151.45 |
$151.45 |
$152.10
|
|
Admelog u-100 insulin lispro 100 unit/ml subcutaneous solution
|
$183.76 |
$183.76 |
$183.76 |
$163.25
|
|
Administration chemotherapy IV infusion each additional hour
|
$307.45 |
$307.45 |
$307.45 |
$230.35
|
|
Administration chemotherapy IV infusion each addl sequential infusion diff substance/drug >1 hr
|
$307.45 |
$307.45 |
$307.45 |
$319.15
|
|
Administration chemotherapy IV infusion up to 1 hour single/initial substance/drug
|
$307.45 |
$307.45 |
$307.45 |
$735.00
|
|
Administration chemotherapy IV push single/initial substance/drug
|
$211.25 |
$211.25 |
$211.25 |
$464.40
|
|
Administration chemotherapy subcutaneous/im anti neoplastic hormonal
|
$182.00 |
$182.00 |
$182.00 |
$224.00
|
|
Administration chemotherapy subcutaneous/im anti neoplastic non hormonal
|
$182.00 |
$182.00 |
$182.00 |
$267.43
|
|
Administration immunization 1 vaccine
|
$54.60 |
$54.60 |
$54.60 |
$66.51
|
|
Administration immunization each additional component
|
$0.65 |
$0.65 |
$0.65 |
$27.20
|
|
Administration immunization each additional vaccine
|
$48.75 |
$48.75 |
$48.75 |
$46.23
|
|
Administration immunization first component each vaccine
|
$30.55 |
$30.55 |
$30.55 |
$46.00
|
|
Administration vaccine hepatitis b
|
$46.80 |
$46.80 |
$46.80 |
$38.25
|
|
Administration vaccine influenza virus
|
$46.80 |
$46.80 |
$46.80 |
$37.05
|
|
Administration vaccine pneumococcal
|
$46.80 |
$46.80 |
$46.80 |
$38.25
|
|
Albumin body fluid quantitative each specimen
|
$51.35 |
$51.35 |
$51.35 |
$42.90
|
|
Albumin (human), 25%, 50ml
|
$141.45 |
$141.45 |
$141.45 |
$295.80
|
|
Albumin (human), 5%, 250 ml
|
$141.30 |
$141.30 |
$141.30 |
$295.80
|
|
Albumin, human 5 % intravenous solution
|
$497.96 |
$497.96 |
$497.96 |
$470.97
|
|
Albumin (microalbumin) 24 hour urine quantitative
|
$67.60 |
$67.60 |
$67.60 |
$60.45
|
|
Albumin serum plasma or whole blood
|
$51.35 |
$51.35 |
$51.35 |
$41.90
|
|
Alcohol (ethanol) any specimen except urine/breath
|
$106.60 |
$106.60 |
$106.60 |
$78.00
|
|
Alkaline phosphatase
|
$65.65 |
$65.65 |
$65.65 |
$47.40
|
|
Allergen alpha lactalbumin ige
|
$40.30 |
$40.30 |
$40.30 |
$56.35
|
|
Allergen egg white ige
|
$59.80 |
$59.80 |
$59.80 |
$41.38
|
|
Allergy injection; single 95115
|
$35.10 |
$35.10 |
$35.10 |
$46.80
|
|
Allograft epieffect 2x3cm-q4186-cost per sq cm
|
$317.85 |
$317.85 |
$317.85 |
$3,035.85
|
|
Allograft umbilical epicord 15 sq cm-q4187-cost per sq cm
|
$598.00 |
$598.00 |
$598.00 |
$4,038.75
|
|
Alpha-fetoprotein amniotic
|
$102.70 |
$102.70 |
$102.70 |
$102.49
|
|
Alpha-fetoprotein tumor marker
|
$140.40 |
$140.40 |
$140.40 |
$124.20
|
|
Alteplase 100 mg infusion from pyxis vial
|
$17,217.91 |
$17,217.91 |
$17,217.91 |
$285.00
|
|
Alt/sgpt
|
$59.80 |
$59.80 |
$59.80 |
$44.68
|
|
Aluminum - quest
|
$91.00 |
$91.00 |
$91.00 |
$121.25
|
|
Amantadine (symmetrel)-sendout
|
$161.85 |
$161.85 |
$161.85 |
$169.80
|
|
Amino acids quant 2-5
|
$137.80 |
$137.80 |
$137.80 |
$148.20
|
|
Aminophylline 25 mg/ml intravenous solution (wrapper)
|
$66.47 |
$66.47 |
$66.47 |
$43.72
|
|
Amiodarone 50 mg/ml intravenous solution
|
$7.15 |
$7.15 |
$7.15 |
$42.92
|
|
Amitriptyline (elavil) -sendout
|
$99.45 |
$99.45 |
$99.45 |
$96.35
|
|
Ammonia
|
$107.25 |
$107.25 |
$107.25 |
$96.53
|
|
Amphetamine confirm urine -sendout
|
$89.70 |
$89.70 |
$89.70 |
$93.61
|
|
Amphetamines 5 or more
|
$93.60 |
$93.60 |
$93.60 |
$85.15
|
|
Ampicillin 1 gram solution for injection
|
$21.48 |
$21.48 |
$21.48 |
$77.40
|
|
Ampicillin-sulbactam 1.5 gram solution for injection
|
$21.16 |
$21.16 |
$21.16 |
$45.34
|
|
Amplification real-time pcr dna markers infectious disease bacterial vaginosis and vaginitis
|
$482.30 |
$482.30 |
$482.30 |
$362.93
|
|
Amylase
|
$94.25 |
$94.25 |
$94.25 |
$83.20
|
|
Ana ds-dna
|
$89.05 |
$89.05 |
$89.05 |
$69.03
|
|
Analysis gene f2 20210g>a variant
|
$270.40 |
$270.40 |
$270.40 |
$249.03
|
|
Analysis gene f5 leiden variant
|
$350.35 |
$350.35 |
$350.35 |
$263.90
|
|
Anaplsma phgcytophlm amp prb
|
$154.70 |
$154.70 |
$154.70 |
$105.00
|
|
Anca screen with reflex to titer -quest
|
$135.20 |
$135.20 |
$135.20 |
$112.45
|
|
Ankle X-ray
|
$461.50 |
$461.50 |
$461.50 |
$327.20
|
|
Anodyne therapy charges pt
|
$43.55 |
$43.55 |
$43.55 |
$41.02
|
|
Antibody bacterium, not elsewhere specified
|
$52.65 |
$52.65 |
$52.65 |
$61.45
|
|
Antibody elution rbc reference
|
$133.25 |
$133.25 |
$133.25 |
$168.00
|
|
Antibody htlv/hiv confirm test
|
$101.40 |
$101.40 |
$101.40 |
$154.85
|
|
Antibody identification platelet antibodies heparin-pf4 igg
|
$301.60 |
$301.60 |
$301.60 |
$227.00
|
|
Antibody id rbc panel
|
$203.45 |
$203.45 |
$203.45 |
$265.05
|
|
Antibody influenza virus
|
$59.80 |
$59.80 |
$59.80 |
$65.79
|
|
Antibody screen rbc
|
$75.40 |
$75.40 |
$75.40 |
$101.09
|
|
Anti mog serum - sendout
|
$395.85 |
$395.85 |
$395.85 |
$154.84
|
|
Antineutrophil cytoplasmic antibody screen each antibody
|
$113.75 |
$113.75 |
$113.75 |
$59.15
|
|
Antineutrophil cytoplasmic antibody titer each antibody
|
$90.35 |
$90.35 |
$90.35 |
$48.57
|
|
Antinuclear antibodies
|
$110.50 |
$110.50 |
$110.50 |
$98.25
|
|
Antinuclear antibodies titer
|
$79.95 |
$79.95 |
$79.95 |
$79.95
|
|
Antistreptolysin o screen
|
$57.20 |
$57.20 |
$57.20 |
$57.20
|
|
Antistreptolysin o titer
|
$104.00 |
$104.00 |
$104.00 |
$60.00
|
|
Antithrombin iii activity
|
$176.15 |
$176.15 |
$176.15 |
$135.20
|
|
Apl(pml-rara) quant - sendout
|
$482.95 |
$482.95 |
$482.95 |
$484.25
|
|
Appendix Removal (Laparoscopic)
|
$8,727.00 |
$8,727.00 |
$8,727.00 |
$6,604.91
|
|
App high cost ss f/n/g/h/f >100sq cm 1st 100sq cm
|
$1,061.45 |
$1,061.45 |
$1,061.45 |
$2,108.87
|
|
App high cost ss f/n/g/h/f >100sq cm addl 100sq cm
|
$248.30 |
$248.30 |
$248.30 |
$1,057.11
|
