|
17-ketosteroids
|
$88.20 |
$88.20 |
$88.20 |
$55.00
|
|
24 hr ambulatory b/p monitor
|
$63.00 |
$63.00 |
$63.00 |
$313.04
|
|
3d recon without postprocess indpndt
|
$417.60 |
$417.60 |
$417.60 |
$508.13
|
|
88334 ap bill cytologic exam each additional site
|
$61.80 |
$61.80 |
$61.80 |
$100.10
|
|
99397 periodic comp preventive med 65+ years est
|
$156.60 |
$156.60 |
$156.60 |
$164.73
|
|
Abatacept (with maltose) 250 mg intravenous solution
|
$2,926.80 |
$2,926.80 |
$2,926.80 |
$3,138.72
|
|
#a/b/c/c/h pnl-candida albicans ab
|
$119.40 |
$119.40 |
$119.40 |
$53.95
|
|
Abdominal and Pelvic Blood Vessel Ultrasound (complete)
|
$658.20 |
$658.20 |
$658.20 |
$988.00
|
|
Abdominal and Pelvic Blood Vessel Ultrasound (limited)
|
$436.20 |
$436.20 |
$436.20 |
$662.40
|
|
Abdominal CT scan (with and without contrast)
|
$969.00 |
$969.00 |
$969.00 |
$1,976.94
|
|
Abdominal CT scan (with contrast)
|
$754.20 |
$754.20 |
$754.20 |
$1,667.60
|
|
Abdominal CT scan (without contrast)
|
$590.40 |
$590.40 |
$590.40 |
$1,353.32
|
|
Abdominal MRI (with and without contrast)
|
$1,915.20 |
$1,915.20 |
$1,915.20 |
$2,967.00
|
|
Abdominal MRI (with contrast)
|
$1,393.80 |
$1,393.80 |
$1,393.80 |
$2,240.00
|
|
Abdominal MRI (without contrast)
|
$1,335.60 |
$1,335.60 |
$1,335.60 |
$2,048.36
|
|
Abdominal paracentesis w/image guidance
|
$1,693.20 |
$1,693.20 |
$1,693.20 |
$1,632.96
|
|
Abdominal Ultrasound (complete)
|
$439.20 |
$439.20 |
$439.20 |
$783.00
|
|
Abdominal Ultrasound (limited)
|
$280.80 |
$280.80 |
$280.80 |
$586.43
|
|
Abdominal X-ray (2 views)
|
$110.40 |
$110.40 |
$110.40 |
$318.20
|
|
Abdominal X-ray Series (acute, with chest view)
|
$125.40 |
$125.40 |
$125.40 |
$418.63
|
|
Abdominal X-ray (single view)
|
$97.20 |
$97.20 |
$97.20 |
$260.00
|
|
Abdominoplasty 15830
|
$2,107.80 |
$2,107.80 |
$2,107.80 |
$6,442.80
|
|
Abd paracentesis/w/o image guide 49082
|
$153.00 |
$153.00 |
$153.00 |
$1,148.40
|
|
Ablate inf turbinate submuc 30802
|
$326.40 |
$326.40 |
$326.40 |
$2,060.00
|
|
Abobotulinumtoxina
|
$19.80 |
$19.80 |
$19.80 |
$1,541.21
|
|
Abscess imaging whole body
|
$1,153.80 |
$1,153.80 |
$1,153.80 |
$1,457.72
|
|
Acetaminophen 10 mg/ml soln 100 ml glass cont
|
$59.40 |
$59.40 |
$59.40 |
$72.74
|
|
Acetazolamide 500 mg solution for injection
|
$45.60 |
$45.60 |
$45.60 |
$122.55
|
|
Acetone qualitative
|
$46.80 |
$46.80 |
$46.80 |
$46.80
|
|
Acetylcysteine 200 mg/ml (20 %) intravenous solution
|
$260.40 |
$260.40 |
$260.40 |
$218.79
|
|
Acetylcysteine non-comp unit
|
$15.00 |
$15.00 |
$15.00 |
$31.21
|
|
Aco cont gluc mnt phys/qhp eqp 95250aco
|
$467.40 |
$467.40 |
$467.40 |
$341.00
|
|
Aco med nutria tx/group, ea 30 min 97804aco
|
$52.80 |
$52.80 |
$52.80 |
$38.50
|
|
Acromp/acromionectomy prtl
|
$1,094.40 |
$1,094.40 |
$1,094.40 |
$3,839.54
|
|
Acute hepatitis panel
|
$447.00 |
$447.00 |
$447.00 |
$284.95
|
|
Acyclovir 5 mg/ml in ns IV syringe (neo/ped) - cnr
|
$4.20 |
$4.20 |
$4.20 |
$64.45
|
|
Adalimumab injection
|
$1,089.60 |
$1,089.60 |
$1,089.60 |
$6,853.40
|
|
Adapter b 8 channel 10cm
|
$1,470.00 |
$1,470.00 |
$1,470.00 |
$5,109.58
|
|
Adenosine 3 mg/250 ml bag for osm
|
$51.00 |
$51.00 |
$51.00 |
$271.98
|
|
Adenovirus ag ia
|
$111.60 |
$111.60 |
$111.60 |
$53.95
|
|
Adenovirus antibody,serum - quest
|
$90.00 |
$90.00 |
$90.00 |
$58.00
|
|
Adj tis trans/see area/10.1-30sqcm 14041
|
$1,343.40 |
$1,343.40 |
$1,343.40 |
$3,397.11
|
|
Admelog u-100 insulin lispro 100 unit/ml subcutaneous solution
|
$237.60 |
$237.60 |
$237.60 |
$193.40
|
|
Admin ecg contrast agent
|
$104.40 |
$104.40 |
$104.40 |
$120.78
|
|
Administration chemotherapy IV infusion each additional hour
|
$193.20 |
$193.20 |
$193.20 |
$230.35
|
|
Administration chemotherapy IV infusion each addl sequential infusion diff substance/drug >1 hr
|
$271.80 |
$271.80 |
$271.80 |
$298.98
|
|
Administration chemotherapy IV infusion up to 1 hour single/initial substance/drug
|
$848.40 |
$848.40 |
$848.40 |
$668.98
|
|
Administration chemotherapy IV push single/initial substance/drug
|
$607.80 |
$607.80 |
$607.80 |
$439.20
|
|
Administration chemotherapy subcutaneous/im anti neoplastic hormonal
|
$150.60 |
$150.60 |
$150.60 |
$212.80
|
|
Administration chemotherapy subcutaneous/im anti neoplastic non hormonal
|
$292.80 |
$292.80 |
$292.80 |
$256.49
|
|
Administration immunization each additional vaccine
|
$17.40 |
$17.40 |
$17.40 |
$47.40
|
|
Administration vaccine hepatitis b
|
$16.20 |
$16.20 |
$16.20 |
$53.00
|
|
Administration vaccine influenza virus
|
$86.40 |
$86.40 |
$86.40 |
$51.07
|
|
Administration vaccine pneumococcal
|
$86.40 |
$86.40 |
$86.40 |
$49.68
|
|
Ado-trastuzumab emtansine 100 mg intravenous solution
|
$15,894.60 |
$15,894.60 |
$15,894.60 |
$11,350.31
|
|
Adrenalin epinephrine inject
|
$381.60 |
$381.60 |
$381.60 |
$231.47
|
|
Agalsidase beta 35 mg intravenous solution
|
$19,490.40 |
$19,490.40 |
$19,490.40 |
$14,475.20
|
|
Air conduction bilat
|
$12.00 |
$12.00 |
$12.00 |
$134.00
|
|
Albumin body fluid quantitative each specimen
|
$39.60 |
$39.60 |
$39.60 |
$47.45
|
|
Albumin (human), 25%, 50ml
|
$61.80 |
$61.80 |
$61.80 |
$244.70
|
|
Albumin (human), 5%, 250 ml
|
$63.00 |
$63.00 |
$63.00 |
$252.77
|
|
Albumin (microalbumin) 24 hour urine quantitative
|
$82.20 |
$82.20 |
$82.20 |
$58.17
|
|
Albumin serum plasma or whole blood
|
$39.60 |
$39.60 |
$39.60 |
$43.00
|
|
Alemtuzumab 12 mg/1.2 ml intravenous solution
|
$289.80 |
$289.80 |
$289.80 |
$47,974.31
|
|
Alkaline phosphatase
|
$40.80 |
$40.80 |
$40.80 |
$46.80
|
|
Allergen egg white ige
|
$1,347.00 |
$1,347.00 |
$1,347.00 |
$38.00
|
|
Allergy injections; 2 or more 95117
|
$41.40 |
$41.40 |
$41.40 |
$45.00
|
|
Allergy injection; single 95115
|
$36.60 |
$36.60 |
$36.60 |
$46.80
|
|
Allgrft implnt knee w/scope
|
$2,334.60 |
$2,334.60 |
$2,334.60 |
$6,411.60
|
|
Allograft allowrap 4x4cm dry 16sqcm
|
$7,558.80 |
$7,558.80 |
$7,558.80 |
$5,399.16
|
|
Allograft amniotic activebarrier 200 2x2cm-q4100-cost per sheet
|
$6,451.80 |
$6,451.80 |
$6,451.80 |
$9,900.02
|
|
Allograft dermis 20x25x1mm decell w/matracell arthroflex
|
$4,333.80 |
$4,333.80 |
$4,333.80 |
$6,285.56
|
|
Allograft epieffect 2x3cm-q4186-cost per sq cm
|
$676.20 |
$676.20 |
$676.20 |
$858.66
|
|
Allograft graftjacket 2x12cm-q4107-cost per sq cm
|
$2,400.60 |
$2,400.60 |
$2,400.60 |
$4,677.40
|
|
Allograft membrn amnio 1x2cm hu ambriodry
|
$2,536.20 |
$2,536.20 |
$2,536.20 |
$5,096.00
|
|
Alpha-1-proteinase inhibitor (human) 1,000 mg (+/-) IV solution
|
$1.20 |
$1.20 |
$1.20 |
$13.14
|
|
Alpha-fetoprotein tumor marker
|
$115.20 |
$115.20 |
$115.20 |
$106.00
|
|
Alprostadil for injection
|
$249.00 |
$249.00 |
$249.00 |
$511.41
|
|
Alteplase 100 mg infusion from pyxis vial
|
$5,517.60 |
$5,517.60 |
$5,517.60 |
$15,857.45
|
|
Alt/sgpt
|
$40.80 |
$40.80 |
$40.80 |
$47.50
|
|
Alys cplx sp/pn npgt w/prgrm
|
$151.20 |
$151.20 |
$151.20 |
$411.45
|
|
Ambl bp mntr w/sw a/r
|
$18.60 |
$18.60 |
$18.60 |
$320.45
|
|
Amifostine
|
$667.20 |
$667.20 |
$667.20 |
$2,121.39
|
|
Amikacin 4 mg/ml intravitreal injection - cnr
|
$15.00 |
$15.00 |
$15.00 |
$39.84
|
|
Amino acid screen, urine
|
$133.80 |
$133.80 |
$133.80 |
$77.00
|
|
Aminolevulinic acid delta
|
$112.20 |
$112.20 |
$112.20 |
$87.12
|
|
Aminophylline 25 mg/ml intravenous solution (wrapper)
|
$16.80 |
$16.80 |
$16.80 |
$47.06
|
|
Amiodarone 150 mg/100 ml (1.5 mg/ml) in dextrose, iso-osmotic IV
|
$57.60 |
$57.60 |
$57.60 |
$108.13
|
|
Amiodarone 50 mg/ml intravenous solution
|
$15.60 |
$15.60 |
$15.60 |
$55.86
|
|
Ammonia
|
$100.80 |
$100.80 |
$100.80 |
$119.70
|
|
Amp f/th 1/2 jt/phalanx w/neurect local flap
|
$1,377.60 |
$1,377.60 |
$1,377.60 |
$3,786.00
|
|
Amphetamine confirm urine -sendout
|
$61.80 |
$61.80 |
$61.80 |
$93.61
|
|
Ampicillin 1 gram solution for injection
|
$21.00 |
$21.00 |
$21.00 |
$56.70
|
|
Ampicillin-sulbactam 1.5 gram solution for injection
|
$18.00 |
$18.00 |
$18.00 |
$54.57
|
|
Amplification real-time pcr dna markers infectious disease bacterial vaginosis and vaginitis
|
$532.20 |
$532.20 |
$532.20 |
$262.99
|
|
Amp metatarsal w/toe single 28810
|
$852.60 |
$852.60 |
$852.60 |
$3,986.00
|
|
Amputate lower leg at knee
|
$1,287.60 |
$1,287.60 |
$1,287.60 |
$3,342.87
|
|
Amputation follow-up surgery
|
$1,336.80 |
$1,336.80 |
$1,336.80 |
$3,766.40
|
|
Amputation leg; tib/fib f/u 27886
|
$1,218.60 |
$1,218.60 |
$1,218.60 |
$1,506.60
|
|
Amputation of lower leg
|
$1,167.60 |
$1,167.60 |
$1,167.60 |
$2,545.40
|
