|
Alcohol/subs interv 15-30mn
|
$393.00 |
$393.00 |
$393.00 |
$56.70
|
|
Alcohol/subs interv >30 min
|
$550.80 |
$550.80 |
$550.80 |
$190.13
|
|
Alginate dressing <=16 sq in
|
$75.00 |
$75.00 |
$75.00 |
$16.56
|
|
Alginate drsg >16 <=48 sq in
|
$161.40 |
$161.40 |
$161.40 |
$43.72
|
|
Alkaline phosphatase
|
$85.20 |
$85.20 |
$85.20 |
$46.80
|
|
Allergen alpha lactalbumin ige
|
$39.00 |
$39.00 |
$39.00 |
$48.57
|
|
Allergen egg white ige
|
$39.00 |
$39.00 |
$39.00 |
$38.00
|
|
Allergy injections; 2 or more 95117
|
$24.60 |
$24.60 |
$24.60 |
$45.00
|
|
Allergy injection; single 95115
|
$24.60 |
$24.60 |
$24.60 |
$46.80
|
|
Allograft dermis 20x25x1mm decell w/matracell arthroflex
|
$10,239.60 |
$10,239.60 |
$10,239.60 |
$6,285.56
|
|
Allograft ecm allopatch hd dehydr thick 0.8-1.7mmx2x5cm-cost per sq cm
|
$24,912.00 |
$24,912.00 |
$24,912.00 |
$20,311.34
|
|
Alpha-1-proteinase inhibitor (human) 1,000 mg (+/-) IV solution
|
$36.00 |
$36.00 |
$36.00 |
$13.14
|
|
Alpha-fetoprotein afp-l3 frac & total
|
$1,284.00 |
$1,284.00 |
$1,284.00 |
$198.60
|
|
Alpha-fetoprotein amniotic
|
$160.20 |
$160.20 |
$160.20 |
$89.04
|
|
Alpha-fetoprotein tumor marker
|
$154.80 |
$154.80 |
$154.80 |
$106.00
|
|
Alprostadil for injection
|
$1,677.60 |
$1,677.60 |
$1,677.60 |
$511.41
|
|
Alteplase 100 mg infusion from pyxis vial
|
$316.80 |
$316.80 |
$316.80 |
$15,857.45
|
|
Alt/sgpt
|
$73.80 |
$73.80 |
$73.80 |
$47.50
|
|
Aluminum - quest
|
$319.20 |
$319.20 |
$319.20 |
$83.05
|
|
Amikacin 4 mg/ml intravitreal injection - cnr
|
$5.80 |
$5.80 |
$5.80 |
$39.84
|
|
Amino acids quant 2-5
|
$220.80 |
$220.80 |
$220.80 |
$112.00
|
|
Aminocaproic acid 5 g/250 ml 0.9% nacl IV - cnr
|
$12.80 |
$12.80 |
$12.80 |
$37.33
|
|
Aminolevulinic acid delta
|
$178.80 |
$178.80 |
$178.80 |
$87.12
|
|
Aminophylline 25 mg/ml intravenous solution (wrapper)
|
$10.60 |
$10.60 |
$10.60 |
$47.06
|
|
Amiodarone 50 mg/ml intravenous solution
|
$115.20 |
$115.20 |
$115.20 |
$55.86
|
|
Amivantamab-vmjw 50 mg/ml intravenous solution
|
$31.80 |
$31.80 |
$31.80 |
$9,084.45
|
|
Ammonia
|
$151.20 |
$151.20 |
$151.20 |
$119.70
|
|
Amphotericin b liposomal in d5w IV syringe 1 mg/ml (neo/ped) - cnr
|
$223.80 |
$223.80 |
$223.80 |
$519.03
|
|
Ampicillin 1 gram solution for injection
|
$34.20 |
$34.20 |
$34.20 |
$56.70
|
|
Ampicillin-sulbactam 1.5 gram solution for injection
|
$27.60 |
$27.60 |
$27.60 |
$54.57
|
|
Amplification real-time pcr dna markers infectious disease bacterial vaginosis and vaginitis
|
$280.20 |
$280.20 |
$280.20 |
$262.99
|
|
Amputation toe interphalangeal joint
|
$2,733.00 |
$2,733.00 |
$2,733.00 |
$4,196.50
|
|
Amylase
|
$93.00 |
$93.00 |
$93.00 |
$90.00
|
|
Anal/urinary muscle study
|
$1,198.20 |
$1,198.20 |
$1,198.20 |
$602.80
|
|
Analysis gene f2 20210g>a variant
|
$2,479.80 |
$2,479.80 |
$2,479.80 |
$226.85
|
|
Analysis gene f5 leiden variant
|
$1,126.20 |
$1,126.20 |
$1,126.20 |
$249.60
|
|
Anaplsma phgcytophlm amp prb
|
$457.20 |
$457.20 |
$457.20 |
$85.80
|
|
Anastrozole 1 mg
|
$1.00 |
$1.00 |
$1.00 |
$22.40
|
|
Anca screen with reflex to titer -quest
|
$255.00 |
$255.00 |
$255.00 |
$101.50
|
|
An cholangiogram percutaneous compl
|
$3,156.60 |
$3,156.60 |
$3,156.60 |
$2,480.94
|
|
Androstanediol
|
$403.80 |
$403.80 |
$403.80 |
$131.04
|
|
An fluoro guide for cvp
|
$318.60 |
$318.60 |
$318.60 |
$525.85
|
|
Angio balloon ctrl dialysis seg add-on
|
$11,247.60 |
$11,247.60 |
$11,247.60 |
$5,728.50
|
|
Angioplasty fem/pop unilat 37224
|
$15,494.40 |
$15,494.40 |
$15,494.40 |
$8,600.40
|
|
Angioplasty/iliac/init ves/unilat 37220
|
$13,437.00 |
$13,437.00 |
$13,437.00 |
$9,765.79
|
|
Angioplasty tib/pero/unilat/ea add 37232
|
$14,238.00 |
$14,238.00 |
$14,238.00 |
$5,950.50
|
|
Angiotensin ii
|
$215.40 |
$215.40 |
$215.40 |
$55.44
|
|
Angiotensin ii 0.5 mg/ml soln 1 ml vial
|
$21,829.80 |
$21,829.80 |
$21,829.80 |
$2,979.43
|
|
Angio tib/peroneal/init ves/unila 37228
|
$21,133.20 |
$21,133.20 |
$21,133.20 |
$10,413.45
|
|
Angio trnslmnl balloon same artery ea addl
|
$20,023.80 |
$20,023.80 |
$20,023.80 |
$4,560.40
|
|
Angio trnslmnl balloon same artery ini
|
$9,243.60 |
$9,243.60 |
$9,243.60 |
$9,074.63
|
|
Angio trnslmnl balloon same vein ea addl
|
$11,247.60 |
$11,247.60 |
$11,247.60 |
$4,350.00
|
|
Angio trnslmnl balloon same vein ini
|
$11,247.60 |
$11,247.60 |
$11,247.60 |
$8,359.11
|
|
Ankle X-ray
|
$180.60 |
$180.60 |
$180.60 |
$356.32
|
|
Ankle X-ray (2 views, both ankles)
|
$172.80 |
$172.80 |
$172.80 |
$282.96
|
|
Annual Physical, Established Patient (age 18-39)
|
$162.00 |
$162.00 |
$162.00 |
$153.51
|
|
Annual Physical, Established Patient (age 40-64)
|
$154.80 |
$154.80 |
$154.80 |
$160.73
|
|
Annual Physical, New Patient (age 18-39)
|
$279.60 |
$279.60 |
$279.60 |
$154.00
|
|
Annual Physical, New Patient (age 40-64)
|
$304.20 |
$304.20 |
$304.20 |
$167.25
|
|
Anora (draw only)
|
$20.40 |
$20.40 |
$20.40 |
$35.00
|
|
Antibody bacterium, not elsewhere specified
|
$105.60 |
$105.60 |
$105.60 |
$57.85
|
|
Antibody elution rbc reference
|
$189.60 |
$189.60 |
$189.60 |
$177.29
|
|
Antibody htlv-i
|
$79.20 |
$79.20 |
$79.20 |
$49.53
|
|
Antibody identification platelet antibodies heparin-pf4 igg
|
$384.60 |
$384.60 |
$384.60 |
$224.00
|
|
Antibody id rbc panel
|
$229.80 |
$229.80 |
$229.80 |
$291.75
|
|
Antibody influenza virus
|
$98.40 |
$98.40 |
$98.40 |
$54.00
|
|
Antibody lymphocytic choriomeningitis
|
$130.20 |
$130.20 |
$130.20 |
$46.58
|
|
Antibody screen rbc
|
$70.80 |
$70.80 |
$70.80 |
$108.55
|
|
Antibody tetanus
|
$93.00 |
$93.00 |
$93.00 |
$54.15
|
|
Antihemophilic factor-vwf 250 unit-600 unit intravenous solution
|
$4.60 |
$4.60 |
$4.60 |
$6.10
|
|
Anti mog serum - sendout
|
$115.80 |
$115.80 |
$115.80 |
$132.60
|
|
Antineutrophil cytoplasmic antibody screen each antibody
|
$255.00 |
$255.00 |
$255.00 |
$38.50
|
|
Antineutrophil cytoplasmic antibody titer each antibody
|
$255.00 |
$255.00 |
$255.00 |
$42.00
|
|
Antinuclear antibodies
|
$120.00 |
$120.00 |
$120.00 |
$90.00
|
|
Antinuclear antibodies titer
|
$87.60 |
$87.60 |
$87.60 |
$80.04
|
|
Antiphosphatidylserine antibody
|
$394.20 |
$394.20 |
$394.20 |
$67.43
|
|
Antistreptolysin o screen
|
$106.20 |
$106.20 |
$106.20 |
$58.56
|
|
Antistreptolysin o titer
|
$100.20 |
$100.20 |
$100.20 |
$54.00
|
|
Antithrombin iii activity
|
$275.40 |
$275.40 |
$275.40 |
$115.15
|
|
Antithrombin iii injection
|
$13.20 |
$13.20 |
$13.20 |
$11.85
|
|
Aortic Aneurysm Screening Ultrasound
|
$248.40 |
$248.40 |
$248.40 |
$394.55
|
|
Aortic dysfunction/dilation
|
$8,846.40 |
$8,846.40 |
$8,846.40 |
$1,153.60
|
|
Aortic dysfunction/dilation
|
$8,846.40 |
$8,846.40 |
$8,846.40 |
$1,700.16
|
|
Apc gene dup/delet variants
|
$2,234.40 |
$2,234.40 |
$2,234.40 |
$462.00
|
|
Apheresis plasma
|
$2,918.40 |
$2,918.40 |
$2,918.40 |
$3,226.34
|
|
Apl(pml-rara) quant - sendout
|
$415.80 |
$415.80 |
$415.80 |
$513.00
|
|
App high cost ss t/a/l <100sq cm addl <25sq cm
|
$1,472.40 |
$1,472.40 |
$1,472.40 |
$512.20
|
|
Application finger splntstatic 29130
|
$103.20 |
$103.20 |
$103.20 |
$208.50
|
|
Application long leg splint 29505
|
$1,440.60 |
$1,440.60 |
$1,440.60 |
$338.25
|
|
Application lower leg splint 29515
|
$262.80 |
$262.80 |
$262.80 |
$340.20
|
|
Application multi layer compression below knee (both sides)
|
$347.40 |
$347.40 |
$347.40 |
$375.06
|
|
Application of forearm cast 29075
|
$379.20 |
$379.20 |
$379.20 |
$358.20
|
|
Application of paste boot 29580
|
$316.20 |
$316.20 |
$316.20 |
$340.11
|
|
Application short leg cast 29405
|
$457.20 |
$457.20 |
$457.20 |
$393.98
|
|
Application skin substitute graft face/scalp/neck/genit/hnd/ft <100 sq cm 1st 25 sq cm
|
$1,279.80 |
$1,279.80 |
$1,279.80 |
$2,123.50
|
|
Application skin substitute graft trunk/arms/legs <100 sq cm 1st 25 sq cm
|
$1,352.40 |
$1,352.40 |
$1,352.40 |
$2,164.64
|
|
Appl modality 1/> areas paraffin bath 97018
|
$103.20 |
$103.20 |
$103.20 |
$69.00
|
|
Appl multlay comprs arm/hand
|
$519.60 |
$519.60 |
$519.60 |
$289.60
|
|
Apply forearm splintdynamic 29126
|
$228.00 |
$228.00 |
$228.00 |
$255.20
|
|
Apply intrcav radiat compl
|
$4,170.60 |
$4,170.60 |
$4,170.60 |
$1,813.50
|
