|
Administration vaccine influenza virus
|
$38.25 |
$38.25 |
$38.25 |
$51.11
|
|
Administration vaccine pneumococcal
|
$38.25 |
$38.25 |
$38.25 |
$50.43
|
|
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 |
$229.69
|
|
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 |
$642.53
|
|
_afb id by dna probe rflx ast
|
$150.00 |
$150.00 |
$150.00 |
$104.50
|
|
After cataract laser surgery
|
$1,499.25 |
$1,499.25 |
$1,499.25 |
$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 |
$46.20
|
|
Albumin (human), 25%, 50ml
|
$295.80 |
$295.80 |
$295.80 |
$244.70
|
|
Albumin (human), 5%, 250 ml
|
$295.80 |
$295.80 |
$295.80 |
$252.35
|
|
Albumin (microalbumin) 24 hour urine quantitative
|
$85.50 |
$85.50 |
$85.50 |
$57.60
|
|
Albumin serum plasma or whole blood
|
$43.50 |
$43.50 |
$43.50 |
$42.40
|
|
Albuterol ipratrop non-comp
|
$2.43 |
$2.43 |
$2.43 |
$5.61
|
|
Albuterol non-comp con
|
$44.56 |
$44.56 |
$44.56 |
$6.00
|
|
Albuterol non-comp unit
|
$2.43 |
$2.43 |
$2.43 |
$5.28
|
|
Alcohol (ethanol) any specimen except urine/breath
|
$60.75 |
$60.75 |
$60.75 |
$96.00
|
|
Aldosterone suppression eval
|
$672.00 |
$672.00 |
$672.00 |
$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
|
$51.75 |
$51.75 |
$51.75 |
$46.80
|
|
Allergen alpha lactalbumin ige
|
$110.25 |
$110.25 |
$110.25 |
$48.60
|
|
Allergen egg white ige
|
$81.00 |
$81.00 |
$81.00 |
$38.00
|
|
Allergen specific ige qual multi scrn ea
|
$39.00 |
$39.00 |
$39.00 |
$24.00
|
|
Allergy injections; 2 or more 95117
|
$66.75 |
$66.75 |
$66.75 |
$47.20
|
|
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 |
$388.86
|
|
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 |
$10,179.63
|
|
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 |
$726.60
|
|
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 |
$1,131.50
|
|
All tstg perq&iq drugs/biol
|
$70.50 |
$70.50 |
$70.50 |
$64.80
|
|
Alpha-fetoprotein amniotic
|
$61.50 |
$61.50 |
$61.50 |
$89.04
|
|
Alpha-fetoprotein tumor marker
|
$168.75 |
$168.75 |
$168.75 |
$105.00
|
|
Alprostadil for injection
|
$800.48 |
$800.48 |
$800.48 |
$505.39
|
|
Alteplase 100 mg infusion from pyxis vial
|
$31,563.16 |
$31,563.16 |
$31,563.16 |
$15,857.45
|
|
Alt/sgpt
|
$63.75 |
$63.75 |
$63.75 |
$47.31
|
|
Aluminum - quest
|
$168.00 |
$168.00 |
$168.00 |
$83.21
|
|
Alys cplx sp/pn npgt w/prgrm
|
$1,410.00 |
$1,410.00 |
$1,410.00 |
$411.45
|
|
Amantadine (symmetrel)-sendout
|
$240.00 |
$240.00 |
$240.00 |
$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 |
$111.06
|
|
Aminocaproic acid 5 g/250 ml 0.9% nacl IV - cnr
|
$35.21 |
$35.21 |
$35.21 |
$37.33
|
|
Aminolevulinic acid delta
|
$570.00 |
$570.00 |
$570.00 |
$87.12
|
|
Aminophylline 25 mg/ml intravenous solution (wrapper)
|
$65.64 |
$65.64 |
$65.64 |
$46.93
|
|
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
|
$260.25 |
$260.25 |
$260.25 |
$87.60
|
|
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 |
$118.80
|
|
Amniocentesisdiagnostic 59000
|
$1,104.00 |
$1,104.00 |
$1,104.00 |
$943.50
|
|
Amniocentesis therapeutic
|
$850.50 |
$850.50 |
$850.50 |
$791.05
|
|
Amphetamine confirm urine -sendout
|
$94.50 |
$94.50 |
$94.50 |
$93.61
|
|
Amphetamines 5 or more
|
$462.75 |
$462.75 |
$462.75 |
$87.75
|
|
Amphotericin b in d5w IV syringe 0.1 mg/ml (neo/ped) - cnr
|
$130.08 |
$130.08 |
$130.08 |
$122.91
|
|
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 |
$56.28
|
|
Ampicillin-sulbactam 1.5 gram solution for injection
|
$18.87 |
$18.87 |
$18.87 |
$54.57
|
|
Amylase
|
$168.00 |
$168.00 |
$168.00 |
$87.41
|
|
Analgesics non-opioid definitive assay 1 or 2 acetaminophen
|
$79.50 |
$79.50 |
$79.50 |
$117.01
|
|
Anal/urinary muscle study
|
$730.50 |
$730.50 |
$730.50 |
$407.00
|
|
Anal/urinary muscle study
|
$940.50 |
$940.50 |
$940.50 |
$587.40
|
|
Analysis complx cranial nerve pulse gen prgrmg 95977
|
$1,058.25 |
$1,058.25 |
$1,058.25 |
$320.40
|
|
Analysis gene f2 20210g>a variant
|
$436.50 |
$436.50 |
$436.50 |
$226.85
|
|
Analysis gene f5 leiden variant
|
$577.50 |
$577.50 |
$577.50 |
$249.60
|
|
Analysis; simple cranial nerv pulse gen prgrmg 95976
|
$1,038.00 |
$1,038.00 |
$1,038.00 |
$122.20
|
|
Analyze neurostimulator simple w/reprogramming 95971
|
$1,311.00 |
$1,311.00 |
$1,311.00 |
$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 |
$100.89
|
|
An cholangiogram percutaneous compl
|
$2,959.50 |
$2,959.50 |
$2,959.50 |
$2,494.35
|
|
An fluoro guide for cvp
|
$888.75 |
$888.75 |
$888.75 |
$528.00
|
|
Angio balloon ctrl dialysis seg add-on
|
$2,028.00 |
$2,028.00 |
$2,028.00 |
$5,799.20
|
|
Angiotensin ii 0.5 mg/ml soln 1 ml vial
|
$59,352.27 |
$59,352.27 |
$59,352.27 |
$2,925.60
|
|
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
|
$7,883.25 |
$7,883.25 |
$7,883.25 |
$9,120.80
|
|
Angio trnslmnl balloon same vein ea addl
|
$4,999.50 |
$4,999.50 |
$4,999.50 |
$4,390.75
|
|
Angio trnslmnl balloon same vein ini
|
$7,457.25 |
$7,457.25 |
$7,457.25 |
$8,359.11
|
|
Anidulafungin injection
|
$116.22 |
$116.22 |
$116.22 |
$312.30
|
|
Ankle X-ray
|
$396.75 |
$396.75 |
$396.75 |
$353.60
|
|
Ankle X-ray (2 views, both ankles)
|
$361.50 |
$361.50 |
$361.50 |
$283.00
|
|
Anl sp inf pmp w/mdreprg&fil
|
$693.75 |
$693.75 |
$693.75 |
$630.96
|
|
Annual Physical, Established Patient (age 18-39)
|
$167.25 |
$167.25 |
$167.25 |
$153.51
|
|
Annual Physical, Established Patient (age 40-64)
|
$167.25 |
$167.25 |
$167.25 |
$160.73
|
|
Annual Physical, New Patient (age 18-39)
|
$167.25 |
$167.25 |
$167.25 |
$154.00
|
|
Annual Physical, New Patient (age 40-64)
|
$167.25 |
$167.25 |
$167.25 |
$167.25
|
|
Anodyne therapy charges pt
|
$92.25 |
$92.25 |
$92.25 |
$42.00
|
