|
17-hydroxypregnenolone
|
$95.20 |
$95.20 |
$95.20 |
$90.90
|
|
2nd order venous cath
|
$1,457.60 |
$1,457.60 |
$1,457.60 |
$1,497.85
|
|
3-d radiotherapy plan
|
$8,770.40 |
$8,770.40 |
$8,770.40 |
$4,965.20
|
|
3d recon without postprocess indpndt
|
$628.80 |
$628.80 |
$628.80 |
$505.05
|
|
5% dextrose and 0.45% saline
|
$20.00 |
$20.00 |
$20.00 |
$48.00
|
|
5' nucleotidase - sendout
|
$46.40 |
$46.40 |
$46.40 |
$50.05
|
|
88334 ap bill cytologic exam each additional site
|
$140.00 |
$140.00 |
$140.00 |
$97.65
|
|
Abatacept (with maltose) 250 mg intravenous solution
|
$3,627.00 |
$3,627.00 |
$3,627.00 |
$3,128.29
|
|
#a/b/c/c/h pnl-candida albicans ab
|
$49.60 |
$49.60 |
$49.60 |
$53.90
|
|
Abd/low ext cath 1st
|
$1,803.20 |
$1,803.20 |
$1,803.20 |
$2,015.85
|
|
Abd/low ext cath 2nd
|
$1,803.20 |
$1,803.20 |
$1,803.20 |
$2,015.85
|
|
Abd/low ext cath 3rd
|
$2,102.40 |
$2,102.40 |
$2,102.40 |
$2,417.40
|
|
Abd/low ext cath addl
|
$1,803.20 |
$1,803.20 |
$1,803.20 |
$963.76
|
|
Abdominal CT scan (with and without contrast)
|
$560.00 |
$560.00 |
$560.00 |
$1,976.94
|
|
Abdominal CT scan (with contrast)
|
$468.50 |
$468.50 |
$468.50 |
$1,667.60
|
|
Abdominal CT scan (without contrast)
|
$273.50 |
$273.50 |
$273.50 |
$1,358.76
|
|
Abdominal MRI (with and without contrast)
|
$706.00 |
$706.00 |
$706.00 |
$2,967.00
|
|
Abdominal MRI (with contrast)
|
$639.50 |
$639.50 |
$639.50 |
$2,226.96
|
|
Abdominal MRI (without contrast)
|
$457.00 |
$457.00 |
$457.00 |
$2,048.36
|
|
Abdominal paracentesis w/image guidance
|
$2,604.80 |
$2,604.80 |
$2,604.80 |
$1,636.80
|
|
Abdominal Ultrasound (complete)
|
$1,272.00 |
$1,272.00 |
$1,272.00 |
$785.25
|
|
Abdominal Ultrasound (limited)
|
$946.40 |
$946.40 |
$946.40 |
$581.10
|
|
Abd paracentesis/w/o image guide 49082
|
$940.80 |
$940.80 |
$940.80 |
$1,145.00
|
|
Ablate bone tumor(s) perq
|
$27,863.20 |
$27,863.20 |
$27,863.20 |
$9,437.59
|
|
Ablate heart dysrhythm focus
|
$17,766.40 |
$17,766.40 |
$17,766.40 |
$9,476.33
|
|
Ablation cardiac vagal inputs atrium
|
$4,380.80 |
$4,380.80 |
$4,380.80 |
$2,260.30
|
|
Ablation cryo abd perit om
|
$2,803.20 |
$2,803.20 |
$2,803.20 |
$2,312.80
|
|
Abscess drain retroperitoneal surg code
|
$4,962.40 |
$4,962.40 |
$4,962.40 |
$2,999.34
|
|
Acetaminophen 10 mg/ml soln 100 ml glass cont
|
$22.00 |
$22.00 |
$22.00 |
$73.44
|
|
Acetaminophen 120 mg rectal suppository
|
$1,676.00 |
$1,676.00 |
$1,676.00 |
$75.09
|
|
Acetylcholine receptor modulating antibody
|
$49.60 |
$49.60 |
$49.60 |
$66.28
|
|
Acetylcysteine 200 mg/ml (20 %) intravenous solution
|
$531.60 |
$531.60 |
$531.60 |
$224.98
|
|
Actinotherapy uv light
|
$184.00 |
$184.00 |
$184.00 |
$105.60
|
|
Acute hepatitis panel
|
$237.60 |
$237.60 |
$237.60 |
$284.70
|
|
Acyclovir 5 mg/ml in ns IV syringe (neo/ped) - cnr
|
$9.60 |
$9.60 |
$9.60 |
$64.15
|
|
#acylcarnitineprfl
|
$84.00 |
$84.00 |
$84.00 |
$118.85
|
|
Adapter b 8 channel 10cm
|
$36.96 |
$36.96 |
$36.96 |
$6,142.50
|
|
Adenosine 3 mg/250 ml bag for osm
|
$382.60 |
$382.60 |
$382.60 |
$272.57
|
|
Admelog u-100 insulin lispro 100 unit/ml subcutaneous solution
|
$754.60 |
$754.60 |
$754.60 |
$197.05
|
|
Administration chemotherapy IV infusion each additional hour
|
$283.20 |
$283.20 |
$283.20 |
$230.35
|
|
Administration chemotherapy IV infusion each addl sequential infusion diff substance/drug >1 hr
|
$218.40 |
$218.40 |
$218.40 |
$298.35
|
|
Administration chemotherapy IV infusion up to 1 hour single/initial substance/drug
|
$795.20 |
$795.20 |
$795.20 |
$647.50
|
|
Administration chemotherapy IV push single/initial substance/drug
|
$246.40 |
$246.40 |
$246.40 |
$437.19
|
|
Administration chemotherapy subcutaneous/im anti neoplastic non hormonal
|
$187.20 |
$187.20 |
$187.20 |
$254.40
|
|
Administration immunization 1 vaccine
|
$205.60 |
$205.60 |
$205.60 |
$67.60
|
|
Administration immunization each additional vaccine
|
$80.00 |
$80.00 |
$80.00 |
$46.89
|
|
Administration vaccine hepatitis b
|
$23.20 |
$23.20 |
$23.20 |
$51.80
|
|
Administration vaccine influenza virus
|
$205.60 |
$205.60 |
$205.60 |
$48.73
|
|
Administration vaccine pneumococcal
|
$205.60 |
$205.60 |
$205.60 |
$48.73
|
|
Administration vaccine rsv monoclonal ab seasonal dose im
|
$283.20 |
$283.20 |
$283.20 |
$41.45
|
|
_afb org id by sequencing rflx ast-sendout
|
$480.00 |
$480.00 |
$480.00 |
$293.02
|
|
Albumin body fluid quantitative each specimen
|
$39.20 |
$39.20 |
$39.20 |
$47.45
|
|
Albumin (human), 25%, 50ml
|
$145.20 |
$145.20 |
$145.20 |
$235.92
|
|
Albumin (human), 5%, 250 ml
|
$157.40 |
$157.40 |
$157.40 |
$246.00
|
|
Albumin (microalbumin) 24 hour urine quantitative
|
$36.00 |
$36.00 |
$36.00 |
$57.60
|
|
Albumin serum plasma or whole blood
|
$20.80 |
$20.80 |
$20.80 |
$42.40
|
|
Alkaline phosphatase
|
$25.60 |
$25.60 |
$25.60 |
$46.80
|
|
Allergen alpha lactalbumin ige
|
$89.60 |
$89.60 |
$89.60 |
$48.57
|
|
Allergen egg white ige
|
$32.00 |
$32.00 |
$32.00 |
$37.20
|
|
Allograft dermis 20x25x1mm decell w/matracell arthroflex
|
$4,259.62 |
$4,259.62 |
$4,259.62 |
$6,414.50
|
|
Allograft ecm allopatch hd dehydr thick 0.8-1.7mmx2x5cm-cost per sq cm
|
$17,961.08 |
$17,961.08 |
$17,961.08 |
$21,790.11
|
|
Alpha-1-proteinase inhibitor (human) 1,000 mg (+/-) IV solution
|
$2,080.00 |
$2,080.00 |
$2,080.00 |
$12.50
|
|
Alpha-fetoprotein tumor marker
|
$69.60 |
$69.60 |
$69.60 |
$103.80
|
|
Alteplase 100 mg infusion from pyxis vial
|
$10,011.40 |
$10,011.40 |
$10,011.40 |
$15,857.45
|
|
Alt/sgpt
|
$26.40 |
$26.40 |
$26.40 |
$47.40
|
|
Aluminum - quest
|
$127.20 |
$127.20 |
$127.20 |
$81.49
|
|
Amikacin 4 mg/ml intravitreal injection - cnr
|
$15.60 |
$15.60 |
$15.60 |
$40.40
|
|
Amino acid screen, urine
|
$68.80 |
$68.80 |
$68.80 |
$77.00
|
|
Aminolevulinic acid delta
|
$68.00 |
$68.00 |
$68.00 |
$85.15
|
|
Aminophylline 25 mg/ml intravenous solution (wrapper)
|
$36.20 |
$36.20 |
$36.20 |
$46.24
|
|
Amiodarone 150 mg/100 ml (1.5 mg/ml) in dextrose, iso-osmotic IV
|
$85.20 |
$85.20 |
$85.20 |
$114.96
|
|
Amiodarone 50 mg/ml intravenous solution
|
$27.80 |
$27.80 |
$27.80 |
$55.86
|
|
Ammonia
|
$60.80 |
$60.80 |
$60.80 |
$119.70
|
|
Amphotericin b liposomal in d5w IV syringe 1 mg/ml (neo/ped) - cnr
|
$838.80 |
$838.80 |
$838.80 |
$519.03
|
|
Ampicillin 1 gram solution for injection
|
$11.60 |
$11.60 |
$11.60 |
$58.35
|
|
Ampicillin-sulbactam 1.5 gram solution for injection
|
$11.00 |
$11.00 |
$11.00 |
$54.57
|
|
Amylase
|
$26.40 |
$26.40 |
$26.40 |
$89.04
|
|
Analysis gene f2 20210g>a variant
|
$272.80 |
$272.80 |
$272.80 |
$222.05
|
|
Analysis gene f5 leiden variant
|
$305.60 |
$305.60 |
$305.60 |
$237.60
|
|
Analysis; simple cranial nerv pulse gen prgrmg 95976
|
$75.20 |
$75.20 |
$75.20 |
$123.84
|
|
Anaplsma phgcytophlm amp prb
|
$162.40 |
$162.40 |
$162.40 |
$82.65
|
|
Anca screen with reflex to titer -quest
|
$75.20 |
$75.20 |
$75.20 |
$99.00
|
|
An cholangiogram percutaneous compl
|
$2,242.40 |
$2,242.40 |
$2,242.40 |
$2,494.35
|
|
An fluoro guide for cvp
|
$824.80 |
$824.80 |
$824.80 |
$515.00
|
|
Angio balloon ctrl dialysis seg add-on
|
$15,871.20 |
$15,871.20 |
$15,871.20 |
$5,500.00
|
|
Angioplasty fem/pop unilat 37224
|
$14,673.60 |
$14,673.60 |
$14,673.60 |
$8,835.00
|
|
Angioplasty/iliac/init ves/unilat 37220
|
$14,186.40 |
$14,186.40 |
$14,186.40 |
$10,173.90
|
|
Angioplasty tib/pero/unilat/ea add 37232
|
$6,600.80 |
$6,600.80 |
$6,600.80 |
$5,950.50
|
|
Angiotensin ii 0.5 mg/ml soln 1 ml vial
|
$398.20 |
$398.20 |
$398.20 |
$2,792.09
|
|
Angio tib/peroneal/init ves/unila 37228
|
$15,250.40 |
$15,250.40 |
$15,250.40 |
$10,513.36
|
|
Angio trnslmnl balloon same artery ini
|
$10,860.00 |
$10,860.00 |
$10,860.00 |
$9,074.63
|
|
Angio trnslmnl balloon same vein ini
|
$12,846.40 |
$12,846.40 |
$12,846.40 |
$8,466.00
|
|
Ankle X-ray
|
$483.20 |
$483.20 |
$483.20 |
$352.80
|
|
Anodyne therapy charges pt
|
$164.80 |
$164.80 |
$164.80 |
$42.00
|
|
Anoscopy remove fb 46608
|
$1,249.60 |
$1,249.60 |
$1,249.60 |
$1,374.60
|
|
Antibody bacterium, not elsewhere specified
|
$53.60 |
$53.60 |
$53.60 |
$57.81
|
|
Antibody elution rbc reference
|
$670.40 |
$670.40 |
$670.40 |
$175.50
|
|
Antibody identification platelet antibodies heparin-pf4 igg
|
$116.00 |
$116.00 |
$116.00 |
$219.30
|
|
Antibody id rbc panel
|
$1,403.20 |
$1,403.20 |
$1,403.20 |
$290.21
|
|
Antibody screen rbc
|
$208.80 |
$208.80 |
$208.80 |
$106.88
|
