|
Administration immunization each additional vaccine
|
$45.00 |
$45.00 |
$45.00 |
$47.40
|
|
Administration immunization first component each vaccine
|
$67.50 |
$67.50 |
$67.50 |
$46.40
|
|
Administration immunization intranasal/oral route 1 vaccine
|
$56.25 |
$56.25 |
$56.25 |
$48.00
|
|
Administration immunization intranasal/oral route each additional vaccine
|
$44.25 |
$44.25 |
$44.25 |
$30.24
|
|
Administration rsv monoclonal ab seasonal dose im w/counseling
|
$36.75 |
$36.75 |
$36.75 |
$44.80
|
|
Administration vaccine hepatitis b
|
$38.25 |
$38.25 |
$38.25 |
$53.00
|
|
Administration vaccine influenza virus
|
$38.25 |
$38.25 |
$38.25 |
$51.07
|
|
Administration vaccine pneumococcal
|
$38.25 |
$38.25 |
$38.25 |
$49.68
|
|
Administration vaccine rsv monoclonal ab seasonal dose im
|
$36.75 |
$36.75 |
$36.75 |
$41.45
|
|
Ado-trastuzumab emtansine 100 mg intravenous solution
|
$23,602.63 |
$23,602.63 |
$23,602.63 |
$11,350.31
|
|
Adrenalin epinephrine inject
|
$28.46 |
$28.46 |
$28.46 |
$231.47
|
|
Aep hearing status deter i&r
|
$568.50 |
$568.50 |
$568.50 |
$303.00
|
|
Aep neurodiagnostic i&r
|
$1,471.50 |
$1,471.50 |
$1,471.50 |
$583.80
|
|
Aep thrshld est mlt freq i&r
|
$1,308.00 |
$1,308.00 |
$1,308.00 |
$635.00
|
|
_afb id by dna probe rflx ast
|
$163.50 |
$163.50 |
$163.50 |
$104.50
|
|
After cataract laser surgery
|
$1,459.50 |
$1,459.50 |
$1,459.50 |
$1,373.11
|
|
Agalsidase beta 35 mg intravenous solution
|
$28,942.08 |
$28,942.08 |
$28,942.08 |
$14,475.20
|
|
Air conduction bilat
|
$106.50 |
$106.50 |
$106.50 |
$134.00
|
|
Airway resistance by impulse oscillometry 94728
|
$425.25 |
$425.25 |
$425.25 |
$297.00
|
|
Albumin body fluid quantitative each specimen
|
$43.50 |
$43.50 |
$43.50 |
$47.45
|
|
Albumin (human), 25%, 50ml
|
$295.80 |
$295.80 |
$295.80 |
$244.70
|
|
Albumin (human), 5%, 250 ml
|
$295.80 |
$295.80 |
$295.80 |
$252.77
|
|
Albumin (microalbumin) 24 hour urine quantitative
|
$60.00 |
$60.00 |
$60.00 |
$58.17
|
|
Albumin serum plasma or whole blood
|
$38.25 |
$38.25 |
$38.25 |
$43.00
|
|
Albuterol ipratrop non-comp
|
$2.43 |
$2.43 |
$2.43 |
$5.67
|
|
Albuterol non-comp con
|
$44.56 |
$44.56 |
$44.56 |
$6.07
|
|
Albuterol non-comp unit
|
$2.43 |
$2.43 |
$2.43 |
$5.40
|
|
Alcohol (ethanol) any specimen except urine/breath
|
$60.75 |
$60.75 |
$60.75 |
$96.00
|
|
Alcohol/subs interv 15-30mn
|
$54.00 |
$54.00 |
$54.00 |
$56.70
|
|
Alcohol/subs interv >30 min
|
$100.50 |
$100.50 |
$100.50 |
$190.13
|
|
Aldosterone suppression eval
|
$904.50 |
$904.50 |
$904.50 |
$315.20
|
|
Alemtuzumab 12 mg/1.2 ml intravenous solution
|
$112,036.08 |
$112,036.08 |
$112,036.08 |
$47,974.31
|
|
Alginate drsg >16 <=48 sq in
|
$59.44 |
$59.44 |
$59.44 |
$43.72
|
|
Alginate drsg wound filler
|
$23.50 |
$23.50 |
$23.50 |
$15.79
|
|
Alkaline phosphatase
|
$46.50 |
$46.50 |
$46.50 |
$46.80
|
|
Allergen alpha lactalbumin ige
|
$110.25 |
$110.25 |
$110.25 |
$48.57
|
|
Allergen egg white ige
|
$81.00 |
$81.00 |
$81.00 |
$38.00
|
|
Allergen specific ige qual multi scrn ea
|
$78.00 |
$78.00 |
$78.00 |
$24.00
|
|
Allergy injections; 2 or more 95117
|
$44.25 |
$44.25 |
$44.25 |
$45.00
|
|
Allergy injection; single 95115
|
$42.75 |
$42.75 |
$42.75 |
$46.80
|
|
Allergy Skin Testing
|
$97.50 |
$97.50 |
$97.50 |
$47.44
|
|
Allg patch or app # of tests 95044
|
$780.00 |
$780.00 |
$780.00 |
$423.37
|
|
Allograft allowrap 4x4cm dry 16sqcm
|
$13,768.09 |
$13,768.09 |
$13,768.09 |
$5,399.16
|
|
Allograft amnioexcel plus 17mm disk
|
$13,478.20 |
$13,478.20 |
$13,478.20 |
$497.95
|
|
Allograft amniotic activebarrier 200 2x2cm-q4100-cost per sheet
|
$911.25 |
$911.25 |
$911.25 |
$9,900.02
|
|
Allograft dermis 20x25x1mm decell w/matracell arthroflex
|
$9,702.00 |
$9,702.00 |
$9,702.00 |
$6,285.56
|
|
Allograft ecm allopatch hd dehydr thick 0.8-1.7mmx2x5cm-cost per sq cm
|
$30,615.48 |
$30,615.48 |
$30,615.48 |
$20,311.34
|
|
Allograft epieffect 2x3cm-q4186-cost per sq cm
|
$10,046.28 |
$10,046.28 |
$10,046.28 |
$858.66
|
|
Allograft graftjacket 2x12cm-q4107-cost per sq cm
|
$6,367.50 |
$6,367.50 |
$6,367.50 |
$4,677.40
|
|
Allograft membrn amnio 1x2cm hu ambriodry
|
$1,887.75 |
$1,887.75 |
$1,887.75 |
$5,096.00
|
|
Allograft umbil cord+amniotic membrane-q4148-cost per sq cm
|
$6,075.00 |
$6,075.00 |
$6,075.00 |
$5,278.73
|
|
Allograft umbilical epicord 15 sq cm-q4187-cost per sq cm
|
$4,038.75 |
$4,038.75 |
$4,038.75 |
$1,225.35
|
|
All tstg perq&iq drugs/biol
|
$70.50 |
$70.50 |
$70.50 |
$64.80
|
|
All tstg perq&iq w/venoms
|
$101.25 |
$101.25 |
$101.25 |
$41.34
|
|
Alpha-fetoprotein amniotic
|
$65.25 |
$65.25 |
$65.25 |
$89.04
|
|
Alpha-fetoprotein tumor marker
|
$168.75 |
$168.75 |
$168.75 |
$106.00
|
|
Alprostadil for injection
|
$800.48 |
$800.48 |
$800.48 |
$511.41
|
|
Alteplase 100 mg infusion from pyxis vial
|
$31,563.16 |
$31,563.16 |
$31,563.16 |
$15,857.45
|
|
Alt/sgpt
|
$60.75 |
$60.75 |
$60.75 |
$47.50
|
|
Aluminum - quest
|
$240.75 |
$240.75 |
$240.75 |
$83.05
|
|
Alys cplx sp/pn npgt w/prgrm
|
$1,450.50 |
$1,450.50 |
$1,450.50 |
$411.45
|
|
Amantadine (symmetrel)-sendout
|
$588.75 |
$588.75 |
$588.75 |
$179.70
|
|
Ambl bp mntr w/sw a/r
|
$368.25 |
$368.25 |
$368.25 |
$320.45
|
|
Amikacin 4 mg/ml intravitreal injection - cnr
|
$79.87 |
$79.87 |
$79.87 |
$39.84
|
|
Amino acids quant 2-5
|
$239.25 |
$239.25 |
$239.25 |
$112.00
|
|
Aminocaproic acid 5 g/250 ml 0.9% nacl IV - cnr
|
$35.21 |
$35.21 |
$35.21 |
$37.33
|
|
Aminolevulinic acid delta
|
$712.50 |
$712.50 |
$712.50 |
$87.12
|
|
Aminophylline 25 mg/ml intravenous solution (wrapper)
|
$65.64 |
$65.64 |
$65.64 |
$47.06
|
|
Amiodarone 150 mg/100 ml (1.5 mg/ml) in dextrose, iso-osmotic IV
|
$119.07 |
$119.07 |
$119.07 |
$108.13
|
|
Amiodarone 50 mg/ml intravenous solution
|
$50.85 |
$50.85 |
$50.85 |
$55.86
|
|
Amitriptyline (elavil) -sendout
|
$374.25 |
$374.25 |
$374.25 |
$87.45
|
|
Amivantamab-vmjw 50 mg/ml intravenous solution
|
$14,075.19 |
$14,075.19 |
$14,075.19 |
$9,084.45
|
|
Ammonia
|
$151.50 |
$151.50 |
$151.50 |
$119.70
|
|
Amniocentesisdiagnostic 59000
|
$1,271.25 |
$1,271.25 |
$1,271.25 |
$942.60
|
|
Amniocentesis therapeutic
|
$930.00 |
$930.00 |
$930.00 |
$791.05
|
|
Amphetamine confirm urine -sendout
|
$135.75 |
$135.75 |
$135.75 |
$93.61
|
|
Amphetamines 5 or more
|
$696.75 |
$696.75 |
$696.75 |
$90.48
|
|
Amphotericin b in d5w IV syringe 0.1 mg/ml (neo/ped) - cnr
|
$130.08 |
$130.08 |
$130.08 |
$123.53
|
|
Amphotericin b lipid complex
|
$360.00 |
$360.00 |
$360.00 |
$226.80
|
|
Amphotericin b liposomal in d5w IV syringe 1 mg/ml (neo/ped) - cnr
|
$434.39 |
$434.39 |
$434.39 |
$519.03
|
|
Ampicillin 1 gram solution for injection
|
$114.78 |
$114.78 |
$114.78 |
$56.70
|
|
Ampicillin-sulbactam 1.5 gram solution for injection
|
$18.87 |
$18.87 |
$18.87 |
$54.57
|
|
Amylase
|
$168.00 |
$168.00 |
$168.00 |
$90.00
|
|
Analgesics non-opioid definitive assay 1 or 2 acetaminophen
|
$255.75 |
$255.75 |
$255.75 |
$117.01
|
|
Anal/urinary muscle study
|
$427.50 |
$427.50 |
$427.50 |
$407.00
|
|
Anal/urinary muscle study
|
$749.25 |
$749.25 |
$749.25 |
$602.80
|
|
Analysis complx cranial nerve pulse gen prgrmg 95977
|
$1,124.25 |
$1,124.25 |
$1,124.25 |
$320.40
|
|
Analysis gene f2 20210g>a variant
|
$464.25 |
$464.25 |
$464.25 |
$226.85
|
|
Analysis gene f5 leiden variant
|
$613.50 |
$613.50 |
$613.50 |
$249.60
|
|
Analysis; simple cranial nerv pulse gen prgrmg 95976
|
$1,058.25 |
$1,058.25 |
$1,058.25 |
$122.20
|
|
Analyze neurostimulator simple w/reprogramming 95971
|
$1,341.00 |
$1,341.00 |
$1,341.00 |
$375.00
|
|
Anaplsma phgcytophlm amp prb
|
$105.00 |
$105.00 |
$105.00 |
$85.80
|
|
Anca screen with reflex to titer -quest
|
$280.50 |
$280.50 |
$280.50 |
$101.50
|
|
An cholangiogram percutaneous compl
|
$2,959.50 |
$2,959.50 |
$2,959.50 |
$2,480.94
|
|
An fluoro guide for cvp
|
$888.75 |
$888.75 |
$888.75 |
$525.85
|
|
Angio balloon ctrl dialysis seg add-on
|
$2,028.00 |
$2,028.00 |
$2,028.00 |
$5,728.50
|
|
Angiotensin ii 0.5 mg/ml soln 1 ml vial
|
$59,352.27 |
$59,352.27 |
$59,352.27 |
$2,979.43
|
|
Angio trnslmnl balloon same artery ea addl
|
$2,886.75 |
$2,886.75 |
$2,886.75 |
$4,560.40
|
|
Angio trnslmnl balloon same artery ini
|
$8,920.50 |
$8,920.50 |
$8,920.50 |
$9,074.63
|
|
Angio trnslmnl balloon same vein ea addl
|
$7,500.00 |
$7,500.00 |
$7,500.00 |
$4,350.00
|
