|
3-d radiotherapy plan
|
$2,922.50 |
$2,922.50 |
$2,922.50 |
$5,002.69
|
|
3d recon without postprocess indpndt
|
$60.00 |
$60.00 |
$60.00 |
$485.00
|
|
88334 ap bill cytologic exam each additional site
|
$101.00 |
$101.00 |
$101.00 |
$97.65
|
|
Abatacept (with maltose) 250 mg intravenous solution
|
$1,834.69 |
$1,834.69 |
$1,834.69 |
$3,128.29
|
|
#a/b/c/c/h pnl-candida albicans ab
|
$56.50 |
$56.50 |
$56.50 |
$53.95
|
|
Abd aorta w/runoff s&i
|
$4,929.00 |
$4,929.00 |
$4,929.00 |
$3,569.56
|
|
Abd/low ext cath 1st
|
$1,500.00 |
$1,500.00 |
$1,500.00 |
$2,015.85
|
|
Abd/low ext cath 2nd
|
$932.00 |
$932.00 |
$932.00 |
$2,015.85
|
|
Abdominal CT scan (with and without contrast)
|
$1,065.50 |
$1,065.50 |
$1,065.50 |
$2,009.80
|
|
Abdominal CT scan (with contrast)
|
$1,043.00 |
$1,043.00 |
$1,043.00 |
$1,680.60
|
|
Abdominal CT scan (without contrast)
|
$658.50 |
$658.50 |
$658.50 |
$1,358.76
|
|
Abdominal MRI (with and without contrast)
|
$2,458.50 |
$2,458.50 |
$2,458.50 |
$3,015.94
|
|
Abdominal MRI (with contrast)
|
$2,638.50 |
$2,638.50 |
$2,638.50 |
$2,268.20
|
|
Abdominal MRI (without contrast)
|
$1,497.50 |
$1,497.50 |
$1,497.50 |
$2,050.14
|
|
Abdominal paracentesis w/image guidance
|
$1,797.00 |
$1,797.00 |
$1,797.00 |
$1,651.20
|
|
Abdominal Ultrasound (complete)
|
$513.00 |
$513.00 |
$513.00 |
$785.55
|
|
Abdominal Ultrasound (limited)
|
$495.50 |
$495.50 |
$495.50 |
$590.00
|
|
Ablation of upper extremity nerves rf
|
$412.50 |
$412.50 |
$412.50 |
$808.50
|
|
Abobotulinumtoxina
|
$1,245.55 |
$1,245.55 |
$1,245.55 |
$1,541.21
|
|
Abscess drain retroperitoneal surg code
|
$3,108.50 |
$3,108.50 |
$3,108.50 |
$2,957.17
|
|
Acetaminophen 10 mg/ml soln 100 ml glass cont
|
$10.60 |
$10.60 |
$10.60 |
$74.96
|
|
Acetaminophen level
|
$106.00 |
$106.00 |
$106.00 |
$107.62
|
|
Acetazolamide 500 mg solution for injection
|
$45.66 |
$45.66 |
$45.66 |
$122.55
|
|
Acetylcholine receptor modulating antibody
|
$93.00 |
$93.00 |
$93.00 |
$64.50
|
|
Acetylcysteine 200 mg/ml (20 %) intravenous solution
|
$59.03 |
$59.03 |
$59.03 |
$216.00
|
|
Acute hepatitis panel
|
$257.50 |
$257.50 |
$257.50 |
$292.00
|
|
Acyclovir 400 mg tablet
|
$1,331.74 |
$1,331.74 |
$1,331.74 |
$45.06
|
|
Acyclovir 5 mg/ml in ns IV syringe (neo/ped) - cnr
|
$9.60 |
$9.60 |
$9.60 |
$63.48
|
|
Adalimumab injection
|
$8,684.45 |
$8,684.45 |
$8,684.45 |
$6,853.40
|
|
Adapter b 8 channel 10cm
|
$1,999.20 |
$1,999.20 |
$1,999.20 |
$5,695.04
|
|
Adenosine 3 mg/250 ml bag for osm
|
$336.41 |
$336.41 |
$336.41 |
$255.41
|
|
Admelog u-100 insulin lispro 100 unit/ml subcutaneous solution
|
$430.34 |
$430.34 |
$430.34 |
$181.12
|
|
Administration chemotherapy IV infusion each additional hour
|
$81.00 |
$81.00 |
$81.00 |
$230.35
|
|
Administration chemotherapy IV infusion each addl sequential infusion diff substance/drug >1 hr
|
$81.00 |
$81.00 |
$81.00 |
$294.00
|
|
Administration chemotherapy IV infusion up to 1 hour single/initial substance/drug
|
$379.00 |
$379.00 |
$379.00 |
$657.12
|
|
Administration chemotherapy IV push single/initial substance/drug
|
$248.00 |
$248.00 |
$248.00 |
$439.20
|
|
Administration chemotherapy subcutaneous/im anti neoplastic hormonal
|
$81.00 |
$81.00 |
$81.00 |
$211.09
|
|
Administration chemotherapy subcutaneous/im anti neoplastic non hormonal
|
$81.00 |
$81.00 |
$81.00 |
$257.40
|
|
Administration immunization 1 vaccine
|
$110.50 |
$110.50 |
$110.50 |
$69.21
|
|
Administration immunization each additional vaccine
|
$110.50 |
$110.50 |
$110.50 |
$47.40
|
|
Administration vaccine hepatitis b
|
$67.00 |
$67.00 |
$67.00 |
$54.40
|
|
Administration vaccine influenza virus
|
$67.00 |
$67.00 |
$67.00 |
$50.43
|
|
Administration vaccine pneumococcal
|
$67.00 |
$67.00 |
$67.00 |
$50.43
|
|
Ado-trastuzumab emtansine 100 mg intravenous solution
|
$8,192.13 |
$8,192.13 |
$8,192.13 |
$11,350.31
|
|
Adrenalin epinephrine inject
|
$260.92 |
$260.92 |
$260.92 |
$229.69
|
|
_afb org id by sequencing rflx ast-sendout
|
$704.00 |
$704.00 |
$704.00 |
$315.00
|
|
Agalsidase beta 35 mg intravenous solution
|
$8,960.84 |
$8,960.84 |
$8,960.84 |
$14,475.20
|
|
Albumin body fluid quantitative each specimen
|
$43.50 |
$43.50 |
$43.50 |
$46.23
|
|
Albumin (human), 25%, 50ml
|
$164.73 |
$164.73 |
$164.73 |
$244.70
|
|
Albumin (human), 5%, 250 ml
|
$88.24 |
$88.24 |
$88.24 |
$243.59
|
|
Albumin (microalbumin) 24 hour urine quantitative
|
$34.00 |
$34.00 |
$34.00 |
$57.00
|
|
Albumin serum plasma or whole blood
|
$25.00 |
$25.00 |
$25.00 |
$40.80
|
|
Alcohol/subs interv >30 min
|
$185.00 |
$185.00 |
$185.00 |
$190.13
|
|
Aldesleukin injection
|
$1,458.52 |
$1,458.52 |
$1,458.52 |
$9,030.11
|
|
Alemtuzumab 12 mg/1.2 ml intravenous solution
|
$0.01 |
$0.01 |
$0.01 |
$47,974.31
|
|
Alkaline phosphatase
|
$34.00 |
$34.00 |
$34.00 |
$46.40
|
|
Allergen alpha lactalbumin ige
|
$85.50 |
$85.50 |
$85.50 |
$48.00
|
|
Allergen egg white ige
|
$133.00 |
$133.00 |
$133.00 |
$38.00
|
|
Allograft allowrap 4x4cm dry 16sqcm
|
$13,687.41 |
$13,687.41 |
$13,687.41 |
$5,401.92
|
|
Allograft amniotic activebarrier 200 2x2cm-q4100-cost per sheet
|
$15,677.20 |
$15,677.20 |
$15,677.20 |
$9,018.12
|
|
Allograft dermis 20x25x1mm decell w/matracell arthroflex
|
$11,215.90 |
$11,215.90 |
$11,215.90 |
$6,414.50
|
|
Allograft ecm allopatch hd dehydr thick 0.8-1.7mmx2x5cm-cost per sq cm
|
$35,023.09 |
$35,023.09 |
$35,023.09 |
$23,373.60
|
|
Allograft epieffect 2x3cm-q4186-cost per sq cm
|
$4,370.56 |
$4,370.56 |
$4,370.56 |
$874.65
|
|
Allograft graftjacket 2x12cm-q4107-cost per sq cm
|
$7,046.40 |
$7,046.40 |
$7,046.40 |
$4,677.40
|
|
Allograft membrn amnio 1x2cm hu ambriodry
|
$1,424.50 |
$1,424.50 |
$1,424.50 |
$4,725.00
|
|
Allograft umbil cord+amniotic membrane-q4148-cost per sq cm
|
$8,112.50 |
$8,112.50 |
$8,112.50 |
$4,561.83
|
|
Alpha-1-proteinase inhibitor (human) 1,000 mg (+/-) IV solution
|
$747.50 |
$747.50 |
$747.50 |
$12.50
|
|
Alpha-fetoprotein tumor marker
|
$68.00 |
$68.00 |
$68.00 |
$106.00
|
|
Alprostadil for injection
|
$211.30 |
$211.30 |
$211.30 |
$519.93
|
|
Alteplase 100 mg infusion from pyxis vial
|
$16,135.56 |
$16,135.56 |
$16,135.56 |
$15,857.45
|
|
Alt/sgpt
|
$34.00 |
$34.00 |
$34.00 |
$47.45
|
|
Aluminum - quest
|
$102.50 |
$102.50 |
$102.50 |
$83.05
|
|
Amifostine
|
$791.74 |
$791.74 |
$791.74 |
$2,121.39
|
|
Amikacin 4 mg/ml intravitreal injection - cnr
|
$8.37 |
$8.37 |
$8.37 |
$39.84
|
|
Aminophylline 25 mg/ml intravenous solution (wrapper)
|
$22.84 |
$22.84 |
$22.84 |
$45.02
|
|
Amiodarone 150 mg/100 ml (1.5 mg/ml) in dextrose, iso-osmotic IV
|
$83.85 |
$83.85 |
$83.85 |
$119.07
|
|
Amiodarone 50 mg/ml intravenous solution
|
$6.00 |
$6.00 |
$6.00 |
$55.86
|
|
Amivantamab-vmjw 50 mg/ml intravenous solution
|
$4,740.26 |
$4,740.26 |
$4,740.26 |
$7,994.03
|
|
Ammonia
|
$59.50 |
$59.50 |
$59.50 |
$119.70
|
|
Amphotericin b in d5w IV syringe 0.1 mg/ml (neo/ped) - cnr
|
$68.96 |
$68.96 |
$68.96 |
$117.75
|
|
Amphotericin b liposomal in d5w IV syringe 1 mg/ml (neo/ped) - cnr
|
$182.96 |
$182.96 |
$182.96 |
$543.85
|
|
Ampicillin 1 gram solution for injection
|
$39.38 |
$39.38 |
$39.38 |
$56.70
|
|
Ampicillin-sulbactam 1.5 gram solution for injection
|
$30.56 |
$30.56 |
$30.56 |
$53.86
|
|
Amylase
|
$34.00 |
$34.00 |
$34.00 |
$89.04
|
|
Analysis complx cranial nerve pulse gen prgrmg 95977
|
$404.50 |
$404.50 |
$404.50 |
$338.40
|
|
Analysis gene f2 20210g>a variant
|
$145.00 |
$145.00 |
$145.00 |
$219.60
|
|
Analysis gene f5 leiden variant
|
$165.00 |
$165.00 |
$165.00 |
$230.40
|
|
Analysis; simple cranial nerv pulse gen prgrmg 95976
|
$268.00 |
$268.00 |
$268.00 |
$122.20
|
|
An cholangiogram percutaneous compl
|
$6,180.50 |
$6,180.50 |
$6,180.50 |
$2,626.65
|
|
An fluoro guide for cvp
|
$214.50 |
$214.50 |
$214.50 |
$515.00
|
|
Angioplasty fem/pop unilat 37224
|
$8,139.00 |
$8,139.00 |
$8,139.00 |
$8,772.38
|
|
Angioplasty/iliac/init ves/unilat 37220
|
$12,522.50 |
$12,522.50 |
$12,522.50 |
$10,173.90
|
|
Angiotensin ii 0.5 mg/ml soln 1 ml vial
|
$1,775.28 |
$1,775.28 |
$1,775.28 |
$3,080.85
|
|
Angio tib/peroneal/init ves/unila 37228
|
$17,126.00 |
$17,126.00 |
$17,126.00 |
$10,522.96
|
|
Ankle X-ray
|
$210.50 |
$210.50 |
$210.50 |
$353.60
|
|
Antibody bacterium, not elsewhere specified
|
$56.00 |
$56.00 |
$56.00 |
$57.81
|
|
Antibody elution rbc reference
|
$111.50 |
$111.50 |
$111.50 |
$175.50
|
|
Antibody identification platelet antibodies heparin-pf4 igg
|
$504.00 |
$504.00 |
$504.00 |
$218.30
|
|
Antibody id rbc panel
|
$477.00 |
$477.00 |
$477.00 |
$274.56
|
|
Antibody screen rbc
|
$64.50 |
$64.50 |
$64.50 |
$100.00
|
