|
Acup 1/> w/estim 1st 15 min
|
$49.40 |
$49.40 |
$49.40 |
$56.16
|
|
Acup 1/> w/estim ea addl 15
|
$49.40 |
$49.40 |
$49.40 |
$57.98
|
|
Acup 1/> without estim ea add 15
|
$49.40 |
$49.40 |
$49.40 |
$43.00
|
|
Acup 1/> wo estim 1st 15 min
|
$49.40 |
$49.40 |
$49.40 |
$53.50
|
|
Acute hepatitis panel
|
$213.85 |
$213.85 |
$213.85 |
$284.95
|
|
Acyclovir 5 mg/ml in ns IV syringe (neo/ped) - cnr
|
$3.59 |
$3.59 |
$3.59 |
$64.45
|
|
#acylcarnitineprfl
|
$75.40 |
$75.40 |
$75.40 |
$121.55
|
|
Adapt behavior tx phys/qhp
|
$159.90 |
$159.90 |
$159.90 |
$244.07
|
|
Adapter b 8 channel 10cm
|
$6,142.50 |
$6,142.50 |
$6,142.50 |
$5,109.58
|
|
Adaptive behavior tx by tech
|
$159.90 |
$159.90 |
$159.90 |
$139.68
|
|
Adenosine 3 mg/250 ml bag for osm
|
$18.72 |
$18.72 |
$18.72 |
$271.98
|
|
Adenovirus ag ia
|
$53.95 |
$53.95 |
$53.95 |
$53.95
|
|
Adhesiolysis tube ovary 58740
|
$3,874.00 |
$3,874.00 |
$3,874.00 |
$1,620.60
|
|
Adh-sendout
|
$152.10 |
$152.10 |
$152.10 |
$118.79
|
|
Adj gastric band via subq port
|
$8,658.00 |
$8,658.00 |
$8,658.00 |
$1,666.86
|
|
Adjmt/revj ext fixj sys anes
|
$1,575.60 |
$1,575.60 |
$1,575.60 |
$8,261.40
|
|
Adj tis trans/see area/10.1-30sqcm 14041
|
$2,834.65 |
$2,834.65 |
$2,834.65 |
$3,397.11
|
|
Admelog u-100 insulin lispro 100 unit/ml subcutaneous solution
|
$223.94 |
$223.94 |
$223.94 |
$193.40
|
|
Administration chemotherapy IV infusion each additional hour
|
$319.15 |
$319.15 |
$319.15 |
$230.35
|
|
Administration chemotherapy IV infusion each addl sequential infusion diff substance/drug >1 hr
|
$319.15 |
$319.15 |
$319.15 |
$298.98
|
|
Administration chemotherapy IV infusion up to 1 hour single/initial substance/drug
|
$1,487.85 |
$1,487.85 |
$1,487.85 |
$668.98
|
|
Administration chemotherapy IV push single/initial substance/drug
|
$1,487.85 |
$1,487.85 |
$1,487.85 |
$439.20
|
|
Administration chemotherapy subcutaneous/im anti neoplastic hormonal
|
$319.15 |
$319.15 |
$319.15 |
$212.80
|
|
Administration chemotherapy subcutaneous/im anti neoplastic non hormonal
|
$319.15 |
$319.15 |
$319.15 |
$256.49
|
|
Administration immunization each additional component
|
$46.80 |
$46.80 |
$46.80 |
$29.20
|
|
Administration immunization each additional vaccine
|
$41.60 |
$41.60 |
$41.60 |
$47.40
|
|
Administration immunization first component each vaccine
|
$62.40 |
$62.40 |
$62.40 |
$46.40
|
|
Administration immunization intranasal/oral route 1 vaccine
|
$139.10 |
$139.10 |
$139.10 |
$48.00
|
|
Administration immunization intranasal/oral route each additional vaccine
|
$123.50 |
$123.50 |
$123.50 |
$30.24
|
|
Administration rsv monoclonal ab seasonal dose im w/counseling
|
$102.70 |
$102.70 |
$102.70 |
$44.80
|
|
Administration vaccine hepatitis b
|
$120.25 |
$120.25 |
$120.25 |
$53.00
|
|
Administration vaccine influenza virus
|
$120.25 |
$120.25 |
$120.25 |
$51.07
|
|
Administration vaccine pneumococcal
|
$27.95 |
$27.95 |
$27.95 |
$49.68
|
|
Administration vaccine rsv monoclonal ab seasonal dose im
|
$102.70 |
$102.70 |
$102.70 |
$41.45
|
|
Ado-trastuzumab emtansine 100 mg intravenous solution
|
$19,916.21 |
$19,916.21 |
$19,916.21 |
$11,350.31
|
|
Adrenalectomy expl w/exc retro tumor 60545
|
$5,441.80 |
$5,441.80 |
$5,441.80 |
$5,441.80
|
|
Adrenalin epinephrine inject
|
$712.08 |
$712.08 |
$712.08 |
$231.47
|
|
Advance care planning each additional 30 min 99498
|
$364.00 |
$364.00 |
$364.00 |
$110.56
|
|
Adv prim care mgmt lvl 1
|
$71.50 |
$71.50 |
$71.50 |
$51.52
|
|
Adv prim care mgmt lvl 2
|
$220.35 |
$220.35 |
$220.35 |
$51.52
|
|
Adv prim care mgmt lvl 3
|
$477.75 |
$477.75 |
$477.75 |
$139.68
|
|
Aep hearing status deter i&r
|
$260.00 |
$260.00 |
$260.00 |
$303.00
|
|
Aep neurodiagnostic i&r
|
$273.00 |
$273.00 |
$273.00 |
$583.80
|
|
Aep thrshld est mlt freq i&r
|
$390.00 |
$390.00 |
$390.00 |
$635.00
|
|
Afamelanotide implant, 1 mg
|
$78,638.30 |
$78,638.30 |
$78,638.30 |
$78,638.30
|
|
Afamitresgene autoleucel
|
$2,268,240.00 |
$2,268,240.00 |
$2,268,240.00 |
$2,125,068.14
|
|
_afb id by dna probe rflx ast
|
$89.70 |
$89.70 |
$89.70 |
$104.50
|
|
_afb org id by sequencing rflx ast-sendout
|
$517.40 |
$517.40 |
$517.40 |
$300.00
|
|
Aflibercept injection
|
$90,901.04 |
$90,901.04 |
$90,901.04 |
$2,738.00
|
|
Afo tibial fracture rigid
|
$821.60 |
$821.60 |
$821.60 |
$1,489.57
|
|
Afo, walk boot type, cus fab
|
$2,288.00 |
$2,288.00 |
$2,288.00 |
$2,859.19
|
|
After cataract laser surgery
|
$1,640.60 |
$1,640.60 |
$1,640.60 |
$1,373.11
|
|
Agalsidase beta 35 mg intravenous solution
|
$25,154.35 |
$25,154.35 |
$25,154.35 |
$14,475.20
|
|
Air conduction bilat
|
$335.40 |
$335.40 |
$335.40 |
$134.00
|
|
Air injection into abdomen 49400
|
$211.25 |
$211.25 |
$211.25 |
$525.60
|
|
Airway resistance by impulse oscillometry 94728
|
$468.00 |
$468.00 |
$468.00 |
$297.00
|
|
Albumin body fluid quantitative each specimen
|
$35.10 |
$35.10 |
$35.10 |
$47.45
|
|
Albumin (human), 25%, 50ml
|
$2.71 |
$2.71 |
$2.71 |
$244.70
|
|
Albumin, human 25 % intravenous solution
|
$3.26 |
$3.26 |
$3.26 |
$234.94
|
|
Albumin (human), 5%, 250 ml
|
$0.84 |
$0.84 |
$0.84 |
$252.77
|
|
Albumin, human 5 % intravenous solution
|
$1.54 |
$1.54 |
$1.54 |
$275.16
|
|
Albumin (microalbumin) 24 hour urine quantitative
|
$26.00 |
$26.00 |
$26.00 |
$58.17
|
|
Albumin serum plasma or whole blood
|
$22.10 |
$22.10 |
$22.10 |
$43.00
|
|
Albuterol ipratrop non-comp
|
$3.25 |
$3.25 |
$3.25 |
$5.67
|
|
Albuterol non-comp unit
|
$7.15 |
$7.15 |
$7.15 |
$5.40
|
|
Alcohol (ethanol) any specimen except urine/breath
|
$77.35 |
$77.35 |
$77.35 |
$96.00
|
|
Alcohol/subs interv 15-30mn
|
$185.90 |
$185.90 |
$185.90 |
$56.70
|
|
Alcohol/subs interv >30 min
|
$371.80 |
$371.80 |
$371.80 |
$190.13
|
|
Alemtuzumab 12 mg/1.2 ml intravenous solution
|
$77,335.02 |
$77,335.02 |
$77,335.02 |
$47,974.31
|
|
Alkaline phosphatase
|
$23.40 |
$23.40 |
$23.40 |
$46.80
|
|
Allergen alpha lactalbumin ige
|
$80.60 |
$80.60 |
$80.60 |
$48.57
|
|
Allergen egg white ige
|
$23.40 |
$23.40 |
$23.40 |
$38.00
|
|
Allergen specific ige qual multi scrn ea
|
$35.75 |
$35.75 |
$35.75 |
$24.00
|
|
Allergy injections; 2 or more 95117
|
$128.70 |
$128.70 |
$128.70 |
$45.00
|
|
Allergy injection; single 95115
|
$89.70 |
$89.70 |
$89.70 |
$46.80
|
|
Allergy Skin Testing
|
$109.85 |
$109.85 |
$109.85 |
$47.44
|
|
Allg patch or app # of tests 95044
|
$265.20 |
$265.20 |
$265.20 |
$423.37
|
|
Allograft epieffect 2x3cm-q4186-cost per sq cm
|
$1,115.40 |
$1,115.40 |
$1,115.40 |
$858.66
|
|
Allograft membrn amnio 1x2cm hu ambriodry
|
$1,178.45 |
$1,178.45 |
$1,178.45 |
$5,096.00
|
|
Alloskin
|
$582.40 |
$582.40 |
$582.40 |
$582.40
|
|
All tstg perq&iq drugs/biol
|
$107.25 |
$107.25 |
$107.25 |
$64.80
|
|
All tstg perq&iq w/venoms
|
$47.45 |
$47.45 |
$47.45 |
$41.34
|
|
Alpha-1-proteinase inhibitor (human) 1,000 mg (+/-) IV solution
|
$1.52 |
$1.52 |
$1.52 |
$13.14
|
|
Alpha-fetoprotein afp-l3 frac & total
|
$288.60 |
$288.60 |
$288.60 |
$198.60
|
|
Alpha-fetoprotein tumor marker
|
$75.40 |
$75.40 |
$75.40 |
$106.00
|
|
Alprostadil for injection
|
$1,639.15 |
$1,639.15 |
$1,639.15 |
$511.41
|
|
Als 1
|
$533.00 |
$533.00 |
$533.00 |
$853.44
|
|
Als1-emergency
|
$526.50 |
$526.50 |
$526.50 |
$1,103.37
|
|
Als 2
|
$561.60 |
$561.60 |
$561.60 |
$1,288.56
|
|
Alteplase 100 mg infusion from pyxis vial
|
$20,592.84 |
$20,592.84 |
$20,592.84 |
$15,857.45
|
|
Alt/sgpt
|
$24.05 |
$24.05 |
$24.05 |
$47.50
|
|
Altuviiio per factor viii iu
|
$13.32 |
$13.32 |
$13.32 |
$13.32
|
|
Aluminum - quest
|
$114.40 |
$114.40 |
$114.40 |
$83.05
|
|
Alveoloplasty each quadrant
|
$912.60 |
$912.60 |
$912.60 |
$3,892.00
|
|
Alys cplx sp/pn npgt w/prgrm
|
$411.45 |
$411.45 |
$411.45 |
$411.45
|
|
Ambl bp mntr w/software
|
$108.55 |
$108.55 |
$108.55 |
$178.20
|
|
Amifostine
|
$2,507.10 |
$2,507.10 |
$2,507.10 |
$2,121.39
|
|
Amikacin 4 mg/ml intravitreal injection - cnr
|
$9.36 |
$9.36 |
$9.36 |
$39.84
|
|
Amino acid screen, urine
|
$62.40 |
$62.40 |
$62.40 |
$77.00
|
|
Aminocaproic acid 5 g/250 ml 0.9% nacl IV - cnr
|
$1.27 |
$1.27 |
$1.27 |
$37.33
|
