|
11-desoxycortisol - sendout
|
$154.80 |
$154.80 |
$154.80 |
$84.56
|
|
17-hydroxypregnenolone
|
$144.00 |
$144.00 |
$144.00 |
$85.15
|
|
17-ketosteroids
|
$75.60 |
$75.60 |
$75.60 |
$46.20
|
|
2d tte w or without fol w/con,co
|
$1,286.40 |
$1,286.40 |
$1,286.40 |
$1,142.70
|
|
3-d radiotherapy plan
|
$5,494.80 |
$5,494.80 |
$5,494.80 |
$4,886.50
|
|
3d recon without postprocess indpndt
|
$629.40 |
$629.40 |
$629.40 |
$480.00
|
|
5' nucleotidase - sendout
|
$71.40 |
$71.40 |
$71.40 |
$45.90
|
|
88334 ap bill cytologic exam each additional site
|
$147.00 |
$147.00 |
$147.00 |
$97.65
|
|
99381 initial comp preventive med less than 1 year new
|
$105.00 |
$105.00 |
$105.00 |
$135.00
|
|
99382 initial comp preventive med 1 to 4 years new
|
$109.80 |
$109.80 |
$109.80 |
$135.00
|
|
99383 initial comp preventive med 5 to 11 years new
|
$113.40 |
$113.40 |
$113.40 |
$116.00
|
|
99391 periodic comp preventive med less than 1 year est
|
$105.00 |
$105.00 |
$105.00 |
$113.52
|
|
99392 periodic comp preventive med 1 to 4 years est
|
$109.80 |
$109.80 |
$109.80 |
$133.92
|
|
99393 periodic comp preventive med 5 to 11 years est
|
$113.40 |
$113.40 |
$113.40 |
$120.25
|
|
99394 periodic comp preventive med 12 to 17 years est
|
$116.40 |
$116.40 |
$116.40 |
$137.15
|
|
99397 periodic comp preventive med 65+ years est
|
$129.00 |
$129.00 |
$129.00 |
$164.73
|
|
Abatacept (with maltose) 250 mg intravenous solution
|
$3,692.10 |
$3,692.10 |
$3,692.10 |
$3,128.29
|
|
#a/b/c/c/h pnl-candida albicans ab
|
$105.00 |
$105.00 |
$105.00 |
$53.60
|
|
Abd/low ext cath 2nd
|
$1,320.60 |
$1,320.60 |
$1,320.60 |
$2,158.00
|
|
Abdominal CT scan (with and without contrast)
|
$1,690.20 |
$1,690.20 |
$1,690.20 |
$1,976.00
|
|
Abdominal CT scan (with contrast)
|
$1,269.00 |
$1,269.00 |
$1,269.00 |
$1,664.40
|
|
Abdominal CT scan (without contrast)
|
$1,171.80 |
$1,171.80 |
$1,171.80 |
$1,358.76
|
|
Abdominal MRI (with and without contrast)
|
$2,478.60 |
$2,478.60 |
$2,478.60 |
$3,039.92
|
|
Abdominal MRI (with contrast)
|
$2,523.00 |
$2,523.00 |
$2,523.00 |
$2,210.00
|
|
Abdominal MRI (without contrast)
|
$1,964.40 |
$1,964.40 |
$1,964.40 |
$2,010.62
|
|
Abdominal pad
|
$214.46 |
$214.46 |
$214.46 |
$151.32
|
|
Abdominal paracentesis w/image guidance
|
$1,912.80 |
$1,912.80 |
$1,912.80 |
$1,637.98
|
|
Abdominal Ultrasound (complete)
|
$696.60 |
$696.60 |
$696.60 |
$785.55
|
|
Abdominal Ultrasound (limited)
|
$468.60 |
$468.60 |
$468.60 |
$600.00
|
|
Abd paracentesis/w/o image guide 49082
|
$1,401.60 |
$1,401.60 |
$1,401.60 |
$1,145.00
|
|
Abduct control hip semi-flex
|
$546.63 |
$546.63 |
$546.63 |
$499.86
|
|
Abduction bar jointed adjust
|
$651.40 |
$651.40 |
$651.40 |
$595.67
|
|
Abduction rotation bar shoe
|
$230.35 |
$230.35 |
$230.35 |
$150.99
|
|
Abduct rotation bar without shoe
|
$210.64 |
$210.64 |
$210.64 |
$192.62
|
|
Abl1 gene
|
$911.40 |
$911.40 |
$911.40 |
$668.85
|
|
Ablation of upper extremity nerves rf
|
$3,534.60 |
$3,534.60 |
$3,534.60 |
$832.50
|
|
Abscess drain retroperitoneal surg code
|
$2,670.00 |
$2,670.00 |
$2,670.00 |
$2,903.45
|
|
Acetaminophen level
|
$109.80 |
$109.80 |
$109.80 |
$116.80
|
|
Acetazolamide 500 mg solution for injection
|
$124.74 |
$124.74 |
$124.74 |
$113.40
|
|
Acetone qualitative
|
$17.40 |
$17.40 |
$17.40 |
$43.80
|
|
Acetylcholine receptor modulating antibody
|
$61.80 |
$61.80 |
$61.80 |
$61.80
|
|
Acetylcholinesterase assay
|
$166.20 |
$166.20 |
$166.20 |
$108.35
|
|
Acetylcysteine 200 mg/ml (20 %) intravenous solution
|
$13.44 |
$13.44 |
$13.44 |
$244.95
|
|
Acetylcysteine non-comp unit
|
$110.28 |
$110.28 |
$110.28 |
$31.21
|
|
Acne surgery 10040
|
$396.00 |
$396.00 |
$396.00 |
$265.20
|
|
Acute hepatitis panel
|
$309.00 |
$309.00 |
$309.00 |
$281.05
|
|
Acyclovir 5 mg/ml in ns IV syringe (neo/ped) - cnr
|
$17.04 |
$17.04 |
$17.04 |
$64.45
|
|
#acylcarnitineprfl
|
$174.00 |
$174.00 |
$174.00 |
$121.55
|
|
Adapter b 8 channel 10cm
|
$10,973.17 |
$10,973.17 |
$10,973.17 |
$6,142.50
|
|
Add le poly knee custom kafo
|
$493.94 |
$493.94 |
$493.94 |
$451.68
|
|
Adenosine 3 mg/250 ml bag for osm
|
$21.72 |
$21.72 |
$21.72 |
$271.98
|
|
Adenovirus antibody,serum - quest
|
$89.40 |
$89.40 |
$89.40 |
$60.00
|
|
Adh-sendout
|
$210.00 |
$210.00 |
$210.00 |
$109.28
|
|
Admelog u-100 insulin lispro 100 unit/ml subcutaneous solution
|
$52.50 |
$52.50 |
$52.50 |
$171.07
|
|
Administration chemotherapy IV infusion each additional hour
|
$130.20 |
$130.20 |
$130.20 |
$230.35
|
|
Administration chemotherapy IV infusion each addl sequential infusion diff substance/drug >1 hr
|
$135.60 |
$135.60 |
$135.60 |
$298.98
|
|
Administration chemotherapy IV infusion up to 1 hour single/initial substance/drug
|
$691.80 |
$691.80 |
$691.80 |
$644.28
|
|
Administration chemotherapy IV push single/initial substance/drug
|
$421.20 |
$421.20 |
$421.20 |
$439.45
|
|
Administration chemotherapy subcutaneous/im anti neoplastic hormonal
|
$237.60 |
$237.60 |
$237.60 |
$220.00
|
|
Administration chemotherapy subcutaneous/im anti neoplastic non hormonal
|
$263.40 |
$263.40 |
$263.40 |
$264.00
|
|
Ado-trastuzumab emtansine 100 mg intravenous solution
|
$11,897.10 |
$11,897.10 |
$11,897.10 |
$11,350.31
|
|
Aep neurodiagnostic i&r
|
$241.80 |
$241.80 |
$241.80 |
$570.16
|
|
Aep thrshld est mlt freq i&r
|
$241.80 |
$241.80 |
$241.80 |
$573.65
|
|
_afb id by dna probe rflx ast
|
$86.40 |
$86.40 |
$86.40 |
$93.52
|
|
#afb mycobacteria suscep. #1
|
$33.60 |
$33.60 |
$33.60 |
$38.58
|
|
_afb org id by sequencing rflx ast-sendout
|
$150.60 |
$150.60 |
$150.60 |
$289.60
|
|
Afo molded ankle gauntlet
|
$1,167.90 |
$1,167.90 |
$1,167.90 |
$765.51
|
|
Afo molded plas rig ant tib
|
$2,666.02 |
$2,666.02 |
$2,666.02 |
$2,011.42
|
|
Afo molded to patient plasti
|
$1,115.12 |
$1,115.12 |
$1,115.12 |
$697.20
|
|
Afo rig ant tib tcf/= custom
|
$2,308.88 |
$2,308.88 |
$2,308.88 |
$1,535.95
|
|
Afo sing bar clasp attach sh
|
$725.64 |
$725.64 |
$725.64 |
$663.56
|
|
Afo sing solid stirrup calf
|
$1,044.73 |
$1,044.73 |
$1,044.73 |
$955.35
|
|
Afo sing upright with adjust s
|
$1,062.95 |
$1,062.95 |
$1,062.95 |
$696.71
|
|
Afo spiral molded to pt plas
|
$1,989.91 |
$1,989.91 |
$1,989.91 |
$1,450.86
|
|
Afo sprng wir drsflx calf bd
|
$738.21 |
$738.21 |
$738.21 |
$483.88
|
|
Afo supramalleolar custom
|
$1,455.99 |
$1,455.99 |
$1,455.99 |
$1,162.69
|
|
Afo tib fx cast plaster mold
|
$2,039.47 |
$2,039.47 |
$2,039.47 |
$1,864.98
|
|
Afo tibial fracture rigid
|
$1,994.30 |
$1,994.30 |
$1,994.30 |
$1,464.20
|
|
Afo tibial fracture soft
|
$1,305.39 |
$1,305.39 |
$1,305.39 |
$1,060.02
|
|
Afo, walk boot type, cus fab
|
$4,105.91 |
$4,105.91 |
$4,105.91 |
$2,903.60
|
|
Afo w/ankle joint, prefab
|
$1,652.97 |
$1,652.97 |
$1,652.97 |
$567.00
|
|
Ak/knee disartic pelvic band
|
$202.92 |
$202.92 |
$202.92 |
$185.56
|
|
Ak/knee disartic silesian ba
|
$252.37 |
$252.37 |
$252.37 |
$156.80
|
|
Ak sleeve susp neoprene/equa
|
$457.18 |
$457.18 |
$457.18 |
$275.52
|
|
Albumin body fluid quantitative each specimen
|
$34.20 |
$34.20 |
$34.20 |
$47.50
|
|
Albumin (human), 25%, 50ml
|
$356.40 |
$356.40 |
$356.40 |
$219.30
|
|
Albumin (microalbumin) 24 hour urine quantitative
|
$45.60 |
$45.60 |
$45.60 |
$55.90
|
|
Albumin serum plasma or whole blood
|
$33.60 |
$33.60 |
$33.60 |
$40.00
|
|
Albuterol ipratrop non-comp
|
$3.00 |
$3.00 |
$3.00 |
$5.19
|
|
Albuterol non-comp con
|
$3.00 |
$3.00 |
$3.00 |
$5.61
|
|
Albuterol non-comp unit
|
$3.00 |
$3.00 |
$3.00 |
$5.11
|
|
Alcohol (ethanol) any specimen except urine/breath
|
$146.40 |
$146.40 |
$146.40 |
$94.90
|
|
Alkaline phosphatase
|
$36.00 |
$36.00 |
$36.00 |
$46.50
|
|
Allergen alpha lactalbumin ige
|
$37.80 |
$37.80 |
$37.80 |
$46.80
|
|
Allergen egg white ige
|
$22.20 |
$22.20 |
$22.20 |
$33.50
|
|
Allergen specific ige qual multi scrn ea
|
$28.20 |
$28.20 |
$28.20 |
$24.00
|
|
Allograft 160mg placental salera mini membrane
|
$7,229.74 |
$7,229.74 |
$7,229.74 |
$6,611.20
|
|
Allograft allowrap 4x4cm dry 16sqcm
|
$14,256.87 |
$14,256.87 |
$14,256.87 |
$5,401.92
|
|
Allograft amnioexcel plus 17mm disk
|
$17,889.76 |
$17,889.76 |
$17,889.76 |
$2,677.80
|
|
Allograft amniotic activebarrier 200 2x2cm-q4100-cost per sheet
|
$13,715.06 |
$13,715.06 |
$13,715.06 |
$11,121.17
|
