|
Allergy injections; 2 or more 95117
|
$22.75 |
$22.75 |
$22.75 |
$51.07
|
|
Allergy injection; single 95115
|
$25.35 |
$25.35 |
$25.35 |
$46.80
|
|
Allograft amnioexcel plus 17mm disk
|
$560.95 |
$560.95 |
$560.95 |
$6,637.80
|
|
Allograft epieffect 2x3cm-q4186-cost per sq cm
|
$414.05 |
$414.05 |
$414.05 |
$3,035.85
|
|
Allograft umbilical epicord 15 sq cm-q4187-cost per sq cm
|
$373.10 |
$373.10 |
$373.10 |
$4,038.75
|
|
Alpha-1-proteinase inhibitor (human) 1,000 mg (+/-) IV solution
|
$1,291.29 |
$1,291.29 |
$1,291.29 |
$13.14
|
|
Alpha-fetoprotein amniotic
|
$92.95 |
$92.95 |
$92.95 |
$100.20
|
|
Alpha-fetoprotein tumor marker
|
$110.50 |
$110.50 |
$110.50 |
$115.70
|
|
Alprostadil for injection
|
$511.84 |
$511.84 |
$511.84 |
$550.20
|
|
Alteplase 100 mg infusion from pyxis vial
|
$17,217.91 |
$17,217.91 |
$17,217.91 |
$285.00
|
|
Alt/sgpt
|
$70.20 |
$70.20 |
$70.20 |
$44.68
|
|
Aluminum - quest
|
$102.05 |
$102.05 |
$102.05 |
$114.40
|
|
Alveoloplasty each quadrant
|
$11,259.15 |
$11,259.15 |
$11,259.15 |
$3,190.65
|
|
Alys cplx sp/pn npgt w/prgrm
|
$2,423.20 |
$2,423.20 |
$2,423.20 |
$417.47
|
|
Amantadine (symmetrel)-sendout
|
$142.35 |
$142.35 |
$142.35 |
$174.75
|
|
Ambl bp mntr w/sw a/r
|
$328.90 |
$328.90 |
$328.90 |
$320.45
|
|
Amikacin 4 mg/ml intravitreal injection - cnr
|
$24.18 |
$24.18 |
$24.18 |
$36.30
|
|
Amino acid screen, urine
|
$172.90 |
$172.90 |
$172.90 |
$64.28
|
|
Amino acids quant 2-5
|
$365.95 |
$365.95 |
$365.95 |
$148.20
|
|
Aminocaproic acid 5 g/250 ml 0.9% nacl IV - cnr
|
$32.77 |
$32.77 |
$32.77 |
$32.77
|
|
Aminolevulinic acid delta
|
$62.40 |
$62.40 |
$62.40 |
$95.80
|
|
Aminophylline 25 mg/ml intravenous solution (wrapper)
|
$13.30 |
$13.30 |
$13.30 |
$41.59
|
|
Amiodarone 150 mg/100 ml (1.5 mg/ml) in dextrose, iso-osmotic IV
|
$139.64 |
$139.64 |
$139.64 |
$202.10
|
|
Amiodarone 50 mg/ml intravenous solution
|
$7.15 |
$7.15 |
$7.15 |
$42.92
|
|
Amitriptyline (elavil) -sendout
|
$89.05 |
$89.05 |
$89.05 |
$96.35
|
|
Ammonia
|
$154.70 |
$154.70 |
$154.70 |
$96.53
|
|
Amniocentesisdiagnostic 59000
|
$2,455.70 |
$2,455.70 |
$2,455.70 |
$876.60
|
|
Amniocentesis therapeutic
|
$1,044.55 |
$1,044.55 |
$1,044.55 |
$747.75
|
|
Amphetamine confirm urine -sendout
|
$132.60 |
$132.60 |
$132.60 |
$93.61
|
|
Amphetamines 5 or more
|
$92.95 |
$92.95 |
$92.95 |
$81.25
|
|
Amphotericin b in d5w IV syringe 0.1 mg/ml (neo/ped) - cnr
|
$145.08 |
$145.08 |
$145.08 |
$130.08
|
|
Amphotericin b liposomal in d5w IV syringe 1 mg/ml (neo/ped) - cnr
|
$990.96 |
$990.96 |
$990.96 |
$178.45
|
|
Ampicillin 1 gram solution for injection
|
$21.48 |
$21.48 |
$21.48 |
$44.25
|
|
Ampicillin-sulbactam 1.5 gram solution for injection
|
$45.34 |
$45.34 |
$45.34 |
$43.20
|
|
Amplification real-time pcr dna markers infectious disease bacterial vaginosis and vaginitis
|
$638.95 |
$638.95 |
$638.95 |
$362.93
|
|
Amputation toe interphalangeal joint
|
$6,927.05 |
$6,927.05 |
$6,927.05 |
$3,594.44
|
|
Amylase
|
$189.80 |
$189.80 |
$189.80 |
$84.50
|
|
Ana ds-dna
|
$154.70 |
$154.70 |
$154.70 |
$69.03
|
|
Anal/urinary muscle study
|
$2,347.71 |
$2,347.71 |
$2,347.71 |
$407.61
|
|
Anal/urinary muscle study
|
$3,373.73 |
$3,373.73 |
$3,373.73 |
$575.00
|
|
Analysis gene f2 20210g>a variant
|
$528.45 |
$528.45 |
$528.45 |
$244.00
|
|
Analysis gene f5 leiden variant
|
$494.65 |
$494.65 |
$494.65 |
$253.11
|
|
Analyze neurostimulator simple w/reprogramming 95971
|
$1,188.85 |
$1,188.85 |
$1,188.85 |
$411.45
|
|
Anaplsma phgcytophlm amp prb
|
$230.75 |
$230.75 |
$230.75 |
$105.00
|
|
Anca screen with reflex to titer -quest
|
$223.60 |
$223.60 |
$223.60 |
$112.45
|
|
An cholangiogram percutaneous compl
|
$2,060.20 |
$2,060.20 |
$2,060.20 |
$2,417.63
|
|
An fluoro guide for cvp
|
$858.00 |
$858.00 |
$858.00 |
$484.45
|
|
Angio balloon ctrl dialysis seg add-on
|
$9,787.94 |
$9,787.94 |
$9,787.94 |
$5,536.00
|
|
Angioplasty fem/pop unilat 37224
|
$18,726.25 |
$18,726.25 |
$18,726.25 |
$11,392.58
|
|
Angiotensin ii 0.5 mg/ml soln 1 ml vial
|
$4.87 |
$4.87 |
$4.87 |
$44,765.71
|
|
Angio tib/peroneal/init ves/unila 37228
|
$22,170.29 |
$22,170.29 |
$22,170.29 |
$14,806.05
|
|
Angio trnslmnl balloon same artery ea addl
|
$3,675.75 |
$3,675.75 |
$3,675.75 |
$5,855.20
|
|
Angio trnslmnl balloon same artery ini
|
$14,288.77 |
$14,288.77 |
$14,288.77 |
$9,966.40
|
|
Angio trnslmnl balloon same vein ea addl
|
$3,622.45 |
$3,622.45 |
$3,622.45 |
$4,390.75
|
|
Angio trnslmnl balloon same vein ini
|
$14,910.15 |
$14,910.15 |
$14,910.15 |
$8,766.15
|
|
Anidulafungin injection
|
$288.50 |
$288.50 |
$288.50 |
$116.22
|
|
Ankle arthroscopy/surgery
|
$16,551.26 |
$16,551.26 |
$16,551.26 |
$3,591.33
|
|
Ankle X-ray
|
$611.00 |
$611.00 |
$611.00 |
$325.59
|
|
Anl sp inf pmp w/mdreprg&fil
|
$390.65 |
$390.65 |
$390.65 |
$693.75
|
|
Anodyne therapy charges pt
|
$50.05 |
$50.05 |
$50.05 |
$41.02
|
|
Anora (draw only)
|
$12.35 |
$12.35 |
$12.35 |
$36.36
|
|
Ant colporrhaphy/rpr cyctocele 57240
|
$13,730.04 |
$13,730.04 |
$13,730.04 |
$4,760.24
|
|
Antibody bacterium, not elsewhere specified
|
$93.60 |
$93.60 |
$93.60 |
$57.85
|
|
Antibody elution rbc reference
|
$156.00 |
$156.00 |
$156.00 |
$163.80
|
|
Antibody htlv/hiv confirm test
|
$135.85 |
$135.85 |
$135.85 |
$154.85
|
|
Antibody htlv-i
|
$59.80 |
$59.80 |
$59.80 |
$49.53
|
|
Antibody identification platelet antibodies heparin-pf4 igg
|
$416.00 |
$416.00 |
$416.00 |
$218.30
|
|
Antibody id rbc panel
|
$328.90 |
$328.90 |
$328.90 |
$258.40
|
|
Antibody influenza virus
|
$101.40 |
$101.40 |
$101.40 |
$63.33
|
|
Antibody lymphocytic choriomeningitis
|
$65.00 |
$65.00 |
$65.00 |
$57.85
|
|
Antibody screen rbc
|
$157.95 |
$157.95 |
$157.95 |
$102.05
|
|
Antibody tetanus
|
$96.20 |
$96.20 |
$96.20 |
$76.05
|
|
Antihemophilic viii/vwf comp
|
$5,556.46 |
$5,556.46 |
$5,556.46 |
$1.23
|
|
Anti-inhibitor
|
$6,479.93 |
$6,479.93 |
$6,479.93 |
$3.67
|
|
Anti mog serum - sendout
|
$443.95 |
$443.95 |
$443.95 |
$154.84
|
|
Antineutrophil cytoplasmic antibody screen each antibody
|
$104.65 |
$104.65 |
$104.65 |
$58.80
|
|
Antineutrophil cytoplasmic antibody titer each antibody
|
$174.20 |
$174.20 |
$174.20 |
$48.57
|
|
Antinuclear antibodies
|
$108.55 |
$108.55 |
$108.55 |
$97.60
|
|
Antinuclear antibodies titer
|
$89.05 |
$89.05 |
$89.05 |
$78.65
|
|
Antistreptolysin o titer
|
$95.55 |
$95.55 |
$95.55 |
$58.50
|
|
Antithrombin iii activity
|
$248.30 |
$248.30 |
$248.30 |
$135.20
|
|
Antithrombin iii injection
|
$4,490.17 |
$4,490.17 |
$4,490.17 |
$6.36
|
|
Anti-thymocyte glob (equine)(1:1000) intradermal test dose
|
$10,397.58 |
$10,397.58 |
$10,397.58 |
$6,946.62
|
|
Antithymocyte globuln rabbit
|
$2,245.01 |
$2,245.01 |
$2,245.01 |
$996.39
|
|
Ant/post colporrhap/enterocele rpr 57265
|
$17,674.92 |
$17,674.92 |
$17,674.92 |
$5,463.96
|
|
Ant sgm img i&r speclr mic
|
$124.80 |
$124.80 |
$124.80 |
$147.72
|
|
Apheresis plasma
|
$6,579.27 |
$6,579.27 |
$6,579.27 |
$3,498.41
|
|
Apl(pml-rara) quant - sendout
|
$618.80 |
$618.80 |
$618.80 |
$465.60
|
|
Appendix Removal (Laparoscopic)
|
$18,364.70 |
$18,364.70 |
$18,364.70 |
$6,604.91
|
|
App high cost ss f/n/g/h/f >100sq cm 1st 100sq cm
|
$3,283.15 |
$3,283.15 |
$3,283.15 |
$2,078.20
|
|
App high cost ss f/n/g/h/f >100sq cm addl 100sq cm
|
$3,213.60 |
$3,213.60 |
$3,213.60 |
$1,057.11
|
|
App high cost ss f/n/g/h/f <100sq cm addl <25sq cm
|
$512.20 |
$512.20 |
$512.20 |
$552.00
|
|
App high cost ss t/a/l >100sq cm 1st 100sq cm
|
$1,373.45 |
$1,373.45 |
$1,373.45 |
$2,978.25
|
|
App high cost ss t/a/l >100sq cm addl 100sq cm
|
$709.15 |
$709.15 |
$709.15 |
$1,051.25
|
|
App high cost ss t/a/l <100sq cm addl <25sq cm
|
$512.20 |
$512.20 |
$512.20 |
$549.08
|
|
Application finger splntstatic 29130
|
$188.50 |
$188.50 |
$188.50 |
$208.50
|
|
Application long leg splint 29505
|
$265.20 |
$265.20 |
$265.20 |
$338.25
|
|
Application lower leg splint 29515
|
$586.95 |
$586.95 |
$586.95 |
$345.60
|
|
Application multi layer compression below knee (both sides)
|
$286.65 |
$286.65 |
$286.65 |
$384.80
|
|
Application of forearm cast 29075
|
$292.50 |
$292.50 |
$292.50 |
$375.00
|
