|
11-desoxycortisol - sendout
|
$193.20 |
$193.20 |
$193.20 |
$82.50
|
|
17-hydroxypregnenolone
|
$183.60 |
$183.60 |
$183.60 |
$78.00
|
|
17-ketosteroids
|
$117.00 |
$117.00 |
$117.00 |
$42.90
|
|
2nd order venous cath
|
$384.60 |
$384.60 |
$384.60 |
$1,548.00
|
|
3-d radiotherapy plan
|
$8,104.80 |
$8,104.80 |
$8,104.80 |
$4,953.00
|
|
3d recon without postprocess indpndt
|
$364.20 |
$364.20 |
$364.20 |
$454.23
|
|
5' nucleotidase - sendout
|
$88.80 |
$88.80 |
$88.80 |
$50.05
|
|
88334 ap bill cytologic exam each additional site
|
$101.40 |
$101.40 |
$101.40 |
$92.82
|
|
Abatacept (with maltose) 250 mg intravenous solution
|
$5,998.50 |
$5,998.50 |
$5,998.50 |
$3,627.00
|
|
#a/b/c/c/h pnl-candida albicans ab
|
$102.60 |
$102.60 |
$102.60 |
$52.20
|
|
Abd aorta w/runoff s&i
|
$6,830.40 |
$6,830.40 |
$6,830.40 |
$3,667.71
|
|
Abd/low ext cath 1st
|
$3,381.00 |
$3,381.00 |
$3,381.00 |
$2,146.30
|
|
Abd/low ext cath 2nd
|
$2,199.60 |
$2,199.60 |
$2,199.60 |
$2,167.80
|
|
Abd/low ext cath 3rd
|
$4,798.20 |
$4,798.20 |
$4,798.20 |
$2,545.00
|
|
Abd/low ext cath addl
|
$851.40 |
$851.40 |
$851.40 |
$905.00
|
|
Abdominal CT scan (with and without contrast)
|
$2,158.20 |
$2,158.20 |
$2,158.20 |
$1,951.30
|
|
Abdominal CT scan (with contrast)
|
$1,897.80 |
$1,897.80 |
$1,897.80 |
$1,632.95
|
|
Abdominal CT scan (without contrast)
|
$1,636.80 |
$1,636.80 |
$1,636.80 |
$1,318.20
|
|
Abdominal pad
|
$722.01 |
$722.01 |
$722.01 |
$196.11
|
|
Abdominal paracentesis w/image guidance
|
$2,116.80 |
$2,116.80 |
$2,116.80 |
$1,666.30
|
|
Abdominoplasty 15830
|
$35,681.22 |
$35,681.22 |
$35,681.22 |
$5,774.26
|
|
Abd paracentesis/w/o image guide 49082
|
$1,293.60 |
$1,293.60 |
$1,293.60 |
$1,176.00
|
|
Abduct control hip semi-flex
|
$1,840.34 |
$1,840.34 |
$1,840.34 |
$499.86
|
|
Abduction bar jointed adjust
|
$2,193.09 |
$2,193.09 |
$2,193.09 |
$595.67
|
|
Abduction rotation bar shoe
|
$775.54 |
$775.54 |
$775.54 |
$210.65
|
|
Abduct rotation bar without shoe
|
$709.16 |
$709.16 |
$709.16 |
$192.62
|
|
Abl1 gene
|
$970.20 |
$970.20 |
$970.20 |
$632.80
|
|
Ablate bone tumor(s) perq
|
$15,314.40 |
$15,314.40 |
$15,314.40 |
$9,773.01
|
|
Ablate inf turbinate submuc 30802
|
$47,125.19 |
$47,125.19 |
$47,125.19 |
$1,747.81
|
|
Ablate inf turbinate superf 30801
|
$36,252.65 |
$36,252.65 |
$36,252.65 |
$2,133.48
|
|
Ablate pulm tumor perq rf
|
$8,028.00 |
$8,028.00 |
$8,028.00 |
$6,904.15
|
|
Ablation of upper extremity nerves rf
|
$106,185.43 |
$106,185.43 |
$106,185.43 |
$1,055.60
|
|
Abscess drain retroperitoneal surg code
|
$3,403.20 |
$3,403.20 |
$3,403.20 |
$3,053.18
|
|
Access & clsr pq fem art endogft dlvry w/img uni
|
$985.80 |
$985.80 |
$985.80 |
$2,786.16
|
|
Acetaminophen level
|
$137.40 |
$137.40 |
$137.40 |
$117.01
|
|
Acetazolamide 500 mg solution for injection
|
$368.58 |
$368.58 |
$368.58 |
$114.46
|
|
Acetone qualitative
|
$36.60 |
$36.60 |
$36.60 |
$43.80
|
|
Acetylcholine receptor modulating antibody
|
$61.80 |
$61.80 |
$61.80 |
$61.80
|
|
Acetylcholinesterase assay
|
$91.80 |
$91.80 |
$91.80 |
$106.70
|
|
Acetylcysteine 200 mg/ml (20 %) intravenous solution
|
$39.72 |
$39.72 |
$39.72 |
$300.00
|
|
Acetylcysteine non-comp unit
|
$31.68 |
$31.68 |
$31.68 |
$29.01
|
|
Acute hepatitis panel
|
$732.00 |
$732.00 |
$732.00 |
$284.70
|
|
Acyclovir 5 mg/ml in ns IV syringe (neo/ped) - cnr
|
$245.70 |
$245.70 |
$245.70 |
$62.16
|
|
#acylcarnitineprfl
|
$402.00 |
$402.00 |
$402.00 |
$95.94
|
|
Adapter b 8 channel 10cm
|
$13,517.26 |
$13,517.26 |
$13,517.26 |
$5,782.66
|
|
Add le poly knee custom kafo
|
$1,662.96 |
$1,662.96 |
$1,662.96 |
$451.68
|
|
Adenosine 3 mg/250 ml bag for osm
|
$64.08 |
$64.08 |
$64.08 |
$234.26
|
|
Adenovirus ag ia
|
$34.20 |
$34.20 |
$34.20 |
$30.40
|
|
Adenovirus antibody,serum - quest
|
$89.40 |
$89.40 |
$89.40 |
$64.35
|
|
Adh-sendout
|
$140.40 |
$140.40 |
$140.40 |
$109.28
|
|
Adj gastric band via subq port
|
$17,925.06 |
$17,925.06 |
$17,925.06 |
$1,845.00
|
|
Adj tis trans/see area/10.1-30sqcm 14041
|
$17,496.72 |
$17,496.72 |
$17,496.72 |
$2,837.09
|
|
Admelog u-100 insulin lispro 100 unit/ml subcutaneous solution
|
$861.30 |
$861.30 |
$861.30 |
$181.12
|
|
Administration chemotherapy IV infusion each additional hour
|
$428.40 |
$428.40 |
$428.40 |
$230.35
|
|
Administration chemotherapy IV infusion each addl sequential infusion diff substance/drug >1 hr
|
$363.00 |
$363.00 |
$363.00 |
$298.98
|
|
Administration chemotherapy IV infusion up to 1 hour single/initial substance/drug
|
$419.40 |
$419.40 |
$419.40 |
$644.28
|
|
Administration chemotherapy IV push single/initial substance/drug
|
$649.80 |
$649.80 |
$649.80 |
$439.45
|
|
Administration chemotherapy subcutaneous/im anti neoplastic hormonal
|
$241.80 |
$241.80 |
$241.80 |
$207.94
|
|
Administration chemotherapy subcutaneous/im anti neoplastic non hormonal
|
$241.80 |
$241.80 |
$241.80 |
$260.00
|
|
Ado-trastuzumab emtansine 100 mg intravenous solution
|
$25,469.82 |
$25,469.82 |
$25,469.82 |
$12,791.80
|
|
_afb id by dna probe rflx ast
|
$162.00 |
$162.00 |
$162.00 |
$89.70
|
|
#afb mycobacteria suscep. #1
|
$86.40 |
$86.40 |
$86.40 |
$38.58
|
|
_afb org id by sequencing rflx ast-sendout
|
$180.60 |
$180.60 |
$180.60 |
$289.60
|
|
Afo molded ankle gauntlet
|
$3,931.99 |
$3,931.99 |
$3,931.99 |
$1,067.98
|
|
Afo molded plas rig ant tib
|
$7,320.91 |
$7,320.91 |
$7,320.91 |
$2,412.47
|
|
Afo molded to patient plasti
|
$3,754.31 |
$3,754.31 |
$3,754.31 |
$825.89
|
|
Afo rig ant tib tcf/= custom
|
$6,340.21 |
$6,340.21 |
$6,340.21 |
$1,535.95
|
|
Afo sing bar clasp attach sh
|
$2,443.04 |
$2,443.04 |
$2,443.04 |
$663.56
|
|
Afo sing solid stirrup calf
|
$3,517.31 |
$3,517.31 |
$3,517.31 |
$955.35
|
|
Afo sing upright with adjust s
|
$3,578.66 |
$3,578.66 |
$3,578.66 |
$696.71
|
|
Afo spiral molded to pt plas
|
$5,464.31 |
$5,464.31 |
$5,464.31 |
$1,819.66
|
|
Afo sprng wir drsflx calf bd
|
$2,485.36 |
$2,485.36 |
$2,485.36 |
$675.05
|
|
Afo supramalleolar custom
|
$3,998.17 |
$3,998.17 |
$3,998.17 |
$1,331.42
|
|
Afo tib fx cast plaster mold
|
$5,600.40 |
$5,600.40 |
$5,600.40 |
$1,864.98
|
|
Afo tibial fracture rigid
|
$5,476.36 |
$5,476.36 |
$5,476.36 |
$1,514.10
|
|
Afo tibial fracture soft
|
$4,394.88 |
$4,394.88 |
$4,394.88 |
$855.63
|
|
Afo, walk boot type, cus fab
|
$6,419.11 |
$6,419.11 |
$6,419.11 |
$2,903.60
|
|
Afo w/ankle joint, prefab
|
$4,539.08 |
$4,539.08 |
$4,539.08 |
$969.02
|
|
Air injection into abdomen 49400
|
$579.60 |
$579.60 |
$579.60 |
$531.49
|
|
Ak/knee disartic pelvic band
|
$683.17 |
$683.17 |
$683.17 |
$185.56
|
|
Ak/knee disartic silesian ba
|
$849.64 |
$849.64 |
$849.64 |
$230.77
|
|
Ak sleeve susp neoprene/equa
|
$1,539.19 |
$1,539.19 |
$1,539.19 |
$418.06
|
|
Albumin body fluid quantitative each specimen
|
$55.20 |
$55.20 |
$55.20 |
$47.50
|
|
Albumin (human), 25%, 50ml
|
$1,053.00 |
$1,053.00 |
$1,053.00 |
$244.70
|
|
Albumin (human), 5%, 250 ml
|
$1,053.00 |
$1,053.00 |
$1,053.00 |
$251.66
|
|
Albumin, human 5 % intravenous solution
|
$544.08 |
$544.08 |
$544.08 |
$169.14
|
|
Albumin (microalbumin) 24 hour urine quantitative
|
$67.80 |
$67.80 |
$67.80 |
$57.20
|
|
Albumin serum plasma or whole blood
|
$27.60 |
$27.60 |
$27.60 |
$40.00
|
|
Albuterol ipratrop non-comp
|
$4.80 |
$4.80 |
$4.80 |
$6.62
|
|
Albuterol non-comp con
|
$4.80 |
$4.80 |
$4.80 |
$5.61
|
|
Albuterol non-comp unit
|
$4.80 |
$4.80 |
$4.80 |
$5.11
|
|
Alcohol (ethanol) any specimen except urine/breath
|
$146.40 |
$146.40 |
$146.40 |
$95.94
|
|
Alkaline phosphatase
|
$27.60 |
$27.60 |
$27.60 |
$45.75
|
|
Allergen alpha lactalbumin ige
|
$34.20 |
$34.20 |
$34.20 |
$50.00
|
|
Allergen egg white ige
|
$37.20 |
$37.20 |
$37.20 |
$36.82
|
|
Allergen specific ige qual multi scrn ea
|
$11.40 |
$11.40 |
$11.40 |
$24.00
|
|
Allograft 160mg placental salera mini membrane
|
$11,302.84 |
$11,302.84 |
$11,302.84 |
$5,481.00
|
|
Allograft allowrap 4x4cm dry 16sqcm
|
$17,562.28 |
$17,562.28 |
$17,562.28 |
$5,000.92
|
|
Allograft amnioexcel plus 17mm disk
|
$22,037.44 |
$22,037.44 |
$22,037.44 |
$2,747.07
|
|
Allograft amniotic activebarrier 200 2x2cm-q4100-cost per sheet
|
$16,894.85 |
$16,894.85 |
$16,894.85 |
$10,223.11
|
