|
Albuterol ipratrop non-comp
|
$1.30 |
$2.88 |
$12.19 |
|
|
Albuterol non-comp con
|
$20.05 |
$21.60 |
$58.92 |
|
|
Albuterol non-comp unit
|
$3.40 |
$3.44 |
$66.26 |
|
|
Alcohol (ethanol) any specimen except urine/breath
|
$180.80 |
$180.80 |
$180.80 |
|
|
Alkaline phosphatase
|
$48.00 |
$48.00 |
$48.00 |
|
|
Allergen alpha lactalbumin ige
|
$66.40 |
$66.40 |
$66.40 |
|
|
Allergen egg white ige
|
$46.40 |
$46.40 |
$46.40 |
|
|
Allograft 160mg placental salera mini membrane
|
$35.73 |
$35.73 |
$46.77 |
|
|
Allograft amnioexcel plus 17mm disk
|
$457.60 |
$457.60 |
$866.60 |
|
|
Allograft dermis 20x25x1mm decell w/matracell arthroflex
|
$453.38 |
$453.38 |
$577.03 |
|
|
Allograft ecm allopatch hd dehydr thick 0.8-1.7mmx2x5cm-cost per sq cm
|
$456.77 |
$456.77 |
$581.34 |
|
|
Allograft epieffect 2x3cm-q4186-cost per sq cm
|
$518.00 |
$518.00 |
$671.04 |
|
|
Allograft graftjacket 2x12cm-q4107-cost per sq cm
|
$804.01 |
$804.01 |
$950.20 |
|
|
Allograft membrn amnio 1x2cm hu ambriodry
|
$5,104.00 |
$5,104.00 |
$6,032.00 |
|
|
Allograft umbilical epicord 15 sq cm-q4187-cost per sq cm
|
$396.59 |
$396.59 |
$504.75 |
|
|
Alpha-1-proteinase inhibitor (human) 1,000 mg (+/-) IV solution
|
$739.68 |
$739.68 |
$829.00 |
|
|
Alpha-fetoprotein tumor marker
|
$89.60 |
$89.60 |
$89.60 |
|
|
Alprostadil for injection
|
$70.61 |
$70.61 |
$322.36 |
|
|
Alteplase 100 mg infusion from pyxis vial
|
$227.50 |
$7,445.27 |
$13,143.43 |
|
|
Alt/sgpt
|
$36.80 |
$36.80 |
$36.80 |
|
|
Alveoloplasty each quadrant
|
$3,453.60 |
$3,453.60 |
$3,453.60 |
|
|
Alys cplx sp/pn npgt w/prgrm
|
$545.60 |
$545.60 |
$665.60 |
|
|
Amantadine (symmetrel)-sendout
|
$80.80 |
$80.80 |
$80.80 |
|
|
Amifostine
|
$2,945.56 |
$2,945.56 |
$2,945.56 |
|
|
Amikacin 4 mg/ml intravitreal injection - cnr
|
$33.47 |
$40.28 |
$57.43 |
|
|
Amino acids quant 2-5
|
$113.60 |
$113.60 |
$113.60 |
|
|
Aminocaproic acid 5 g/250 ml 0.9% nacl IV - cnr
|
$27.49 |
$30.72 |
$52.20 |
|
|
Aminophylline 25 mg/ml intravenous solution (wrapper)
|
$28.55 |
$32.68 |
$34.46 |
|
|
Amiodarone 150 mg/100 ml (1.5 mg/ml) in dextrose, iso-osmotic IV
|
$55.68 |
$105.92 |
$155.04 |
|
|
Amiodarone 50 mg/ml intravenous solution
|
$23.12 |
$27.71 |
$31.28 |
|
|
Amivantamab-vmjw 50 mg/ml intravenous solution
|
$3,466.44 |
$3,466.44 |
$3,466.44 |
|
|
Ammonia
|
$68.80 |
$68.80 |
$68.80 |
|
|
Amniocentesisdiagnostic 59000
|
$1,024.00 |
$1,024.00 |
$1,288.00 |
|
|
Amniocentesis therapeutic
|
$966.40 |
$966.40 |
$966.40 |
|
|
Amp f/th 1/2 jt/phalanx w/neurect local flap
|
$3,835.20 |
$3,835.20 |
$4,928.80 |
|
|
Amphetamine confirm urine -sendout
|
$75.20 |
$75.20 |
$75.20 |
|
|
Amphetamines 5 or more
|
$57.60 |
$57.60 |
$57.60 |
|
|
Amphotericin b in d5w IV syringe 0.1 mg/ml (neo/ped) - cnr
|
$40.48 |
$40.48 |
$68.40 |
|
|
Amphotericin b liposomal in d5w IV syringe 1 mg/ml (neo/ped) - cnr
|
$126.14 |
$126.14 |
$622.23 |
|
|
Ampicillin 1 gram solution for injection
|
$27.85 |
$28.20 |
$64.28 |
|
|
Ampicillin-sulbactam 1.5 gram solution for injection
|
$27.66 |
$29.55 |
$97.47 |
|
|
Amplification real-time pcr dna markers infectious disease bacterial vaginosis and vaginitis
|
$496.00 |
$496.00 |
$496.00 |
|
|
Amputation toe interphalangeal joint
|
$4,482.40 |
$4,482.40 |
$4,956.80 |
|
|
Amylase
|
$76.80 |
$76.80 |
$76.80 |
|
|
Analysis complx cranial nerve pulse gen prgrmg 95977
|
$309.60 |
$309.60 |
$309.60 |
|
|
Analysis gene f2 20210g>a variant
|
$192.00 |
$192.00 |
$192.00 |
|
|
Analysis gene f5 leiden variant
|
$192.00 |
$192.00 |
$192.00 |
|
|
Analysis nerve
|
$269.60 |
$269.60 |
$269.60 |
|
|
Analysis; simple cranial nerv pulse gen prgrmg 95976
|
$133.60 |
$133.60 |
$133.60 |
|
|
Analysis tumor
|
$222.40 |
$222.40 |
$222.40 |
|
|
Analyze neurostimulator simple w/reprogramming 95971
|
$320.00 |
$320.00 |
$586.40 |
|
|
Anastrozole 1 mg
|
$1.79 |
$2.92 |
$3.40 |
|
|
Anca screen with reflex to titer -quest
|
$105.60 |
$105.60 |
$105.60 |
|
|
An cholangiogram percutaneous compl
|
$2,255.20 |
$2,255.20 |
$4,163.20 |
|
|
An fluoro guide for cvp
|
$446.40 |
$446.40 |
$877.60 |
|
|
Angio balloon ctrl dialysis seg add-on
|
$9,584.80 |
$9,584.80 |
$11,648.80 |
|
|
Angiotensin ii 0.5 mg/ml soln 1 ml vial
|
$92.96 |
$428.36 |
$2,892.02 |
|
|
Angio trnslmnl balloon same artery ea addl
|
$7,871.20 |
$7,871.20 |
$8,226.40 |
|
|
Angio trnslmnl balloon same artery ini
|
$11,862.40 |
$11,862.40 |
$16,529.60 |
|
|
Angio trnslmnl balloon same vein ea addl
|
$7,950.40 |
$7,950.40 |
$8,226.40 |
|
|
Angio trnslmnl balloon same vein ini
|
$11,399.20 |
$11,399.20 |
$16,529.60 |
|
|
Anidulafungin injection
|
$126.25 |
$126.25 |
$126.25 |
|
|
Ankle X-ray
|
$193.60 |
$220.00 |
$408.00 |
|
|
Ankle X-ray (2 views, both ankles)
|
$160.80 |
$212.00 |
$404.00 |
|
|
Anl sp inf pmp w/mdreprg&fil
|
$589.60 |
$589.60 |
$1,108.00 |
|
|
Anodyne therapy charges pt
|
$61.60 |
$61.60 |
$61.60 |
|
|
Anogenital exam child w imag
|
$320.00 |
$320.00 |
$320.00 |
|
|
Anora (draw only)
|
$15.20 |
$15.20 |
$15.20 |
|
|
Anoscopy and biopsy
|
$4,436.80 |
$4,436.80 |
$4,436.80 |
|
|
Anoscopy and dilation 46604
|
$2,108.80 |
$2,108.80 |
$2,108.80 |
|
|
Anoscopy control bleeding 46614
|
$2,400.80 |
$2,400.80 |
$2,809.60 |
|
|
Anoscopy remove fb 46608
|
$1,466.40 |
$1,466.40 |
$1,652.80 |
|
|
Anoscopy remove lesions w/cautery/snare 46612
|
$5,017.60 |
$5,017.60 |
$5,017.60 |
|
|
Antibody bacterium, not elsewhere specified
|
$30.40 |
$30.40 |
$30.40 |
|
|
Antibody elution rbc reference
|
$157.60 |
$157.60 |
$157.60 |
|
|
Antibody identification platelet antibodies heparin-pf4 igg
|
$123.20 |
$123.20 |
$123.20 |
|
|
Antibody id rbc panel
|
$304.00 |
$304.00 |
$304.00 |
|
|
Antibody screen rbc
|
$97.60 |
$97.60 |
$97.60 |
|
|
Antihemophilic factor-vwf 250 unit-600 unit intravenous solution
|
$16.80 |
$16.80 |
$25.72 |
|
|
Antihemophilic viii/vwf comp
|
$16.80 |
$16.80 |
$2,960.00 |
|
|
Anti-inhibitor
|
$16.80 |
$16.80 |
$25.47 |
|
|
Antineutrophil cytoplasmic antibody screen each antibody
|
$52.80 |
$52.80 |
$52.80 |
|
|
Antineutrophil cytoplasmic antibody titer each antibody
|
$66.40 |
$66.40 |
$66.40 |
|
|
Antinuclear antibodies
|
$72.80 |
$72.80 |
$72.80 |
|
|
Antinuclear antibodies titer
|
$72.80 |
$72.80 |
$72.80 |
|
|
Antistreptolysin o titer
|
$64.80 |
$64.80 |
$64.80 |
|
|
Antithrombin iii activity
|
$120.00 |
$120.00 |
$120.00 |
|
|
Antithrombin iii injection
|
$16.80 |
$16.80 |
$2,650.00 |
|
|
Anti-thymocyte glob (equine)(1:1000) intradermal test dose
|
$3,025.91 |
$3,025.91 |
$4,275.68 |
|
|
Antithymocyte globuln rabbit
|
$1,800.11 |
$1,800.11 |
$1,866.16 |
|
|
Aortic Aneurysm Screening Ultrasound
|
$456.80 |
$458.40 |
$461.60 |
|
|
Apheresis immunoads slctv
|
$5,686.40 |
$5,686.40 |
$7,190.40 |
|
|
Apheresis plasma
|
$2,840.00 |
$2,840.00 |
$3,900.80 |
|
|
Apheresis rbc
|
$3,600.00 |
$3,600.00 |
$3,600.00 |
|
|
Apheresis wbc
|
$1,959.20 |
$1,959.20 |
$1,959.20 |
|
|
App high cost ss f/n/g/h/f >100sq cm 1st 100sq cm
|
$3,293.60 |
$3,293.60 |
$3,569.60 |
|
|
App high cost ss f/n/g/h/f >100sq cm addl 100sq cm
|
$852.00 |
$852.00 |
$1,710.40 |
|
|
App high cost ss f/n/g/h/f <100sq cm addl <25sq cm
|
$875.20 |
$875.20 |
$1,267.20 |
|
|
App high cost ss t/a/l >100sq cm 1st 100sq cm
|
$3,767.20 |
$3,767.20 |
$4,055.20 |
|
|
App high cost ss t/a/l >100sq cm addl 100sq cm
|
$868.00 |
$868.00 |
$1,762.40 |
|
