|
2d tte w or without fol w/con,co
|
$1,085.40 |
$1,085.40 |
$1,085.40 |
$1,284.00
|
|
3-d radiotherapy plan
|
$5,947.20 |
$5,947.20 |
$5,947.20 |
$5,002.69
|
|
3d recon without postprocess indpndt
|
$1,285.80 |
$1,285.80 |
$1,285.80 |
$508.13
|
|
5% dextrose and 0.45% saline
|
$94.40 |
$94.40 |
$94.40 |
$48.00
|
|
5% dextrose with potassium
|
$188.00 |
$188.00 |
$188.00 |
$85.20
|
|
5' nucleotidase - sendout
|
$105.00 |
$105.00 |
$105.00 |
$50.05
|
|
88334 ap bill cytologic exam each additional site
|
$88.20 |
$88.20 |
$88.20 |
$100.10
|
|
Abatacept (with maltose) 250 mg intravenous solution
|
$212.80 |
$212.80 |
$212.80 |
$3,138.72
|
|
#a/b/c/c/h pnl-candida albicans ab
|
$124.20 |
$124.20 |
$124.20 |
$53.95
|
|
Abd/low ext cath 1st
|
$3,582.00 |
$3,582.00 |
$3,582.00 |
$2,015.85
|
|
Abd/low ext cath 2nd
|
$4,581.60 |
$4,581.60 |
$4,581.60 |
$2,016.00
|
|
Abd/low ext cath 3rd
|
$5,095.20 |
$5,095.20 |
$5,095.20 |
$2,475.45
|
|
Abd/low ext cath addl
|
$745.20 |
$745.20 |
$745.20 |
$913.75
|
|
Abdominal and Pelvic Blood Vessel Ultrasound (complete)
|
$946.80 |
$946.80 |
$946.80 |
$988.00
|
|
Abdominal and Pelvic Blood Vessel Ultrasound (limited)
|
$1,195.80 |
$1,195.80 |
$1,195.80 |
$662.40
|
|
Abdominal CT scan (with and without contrast)
|
$3,154.20 |
$3,154.20 |
$3,154.20 |
$1,976.94
|
|
Abdominal CT scan (with contrast)
|
$2,836.20 |
$2,836.20 |
$2,836.20 |
$1,667.60
|
|
Abdominal CT scan (without contrast)
|
$1,810.20 |
$1,810.20 |
$1,810.20 |
$1,353.32
|
|
Abdominal MRI (with and without contrast)
|
$6,049.20 |
$6,049.20 |
$6,049.20 |
$2,967.00
|
|
Abdominal MRI (with contrast)
|
$4,936.20 |
$4,936.20 |
$4,936.20 |
$2,240.00
|
|
Abdominal MRI (without contrast)
|
$3,834.60 |
$3,834.60 |
$3,834.60 |
$2,048.36
|
|
Abdominal paracentesis w/image guidance
|
$3,379.20 |
$3,379.20 |
$3,379.20 |
$1,632.96
|
|
Abdominal Ultrasound (complete)
|
$949.20 |
$949.20 |
$949.20 |
$783.00
|
|
Abdominal Ultrasound (limited)
|
$1,597.80 |
$1,597.80 |
$1,597.80 |
$586.43
|
|
Abdominal X-ray (2 views)
|
$424.20 |
$424.20 |
$424.20 |
$318.20
|
|
Abdominal X-ray Series (acute, with chest view)
|
$711.60 |
$711.60 |
$711.60 |
$418.63
|
|
Abdominal X-ray (single view)
|
$424.20 |
$424.20 |
$424.20 |
$260.00
|
|
Abd paracentesis/w/o image guide 49082
|
$2,943.00 |
$2,943.00 |
$2,943.00 |
$1,148.40
|
|
Abl1 gene
|
$3,340.80 |
$3,340.80 |
$3,340.80 |
$683.20
|
|
Ablation of upper extremity nerves rf
|
$84.60 |
$84.60 |
$84.60 |
$832.50
|
|
Abobotulinumtoxina
|
$64.60 |
$64.60 |
$64.60 |
$1,541.21
|
|
Abscess drain retroperitoneal surg code
|
$7,281.60 |
$7,281.60 |
$7,281.60 |
$3,050.40
|
|
Absorpt drg >16<=48 in w/bdr
|
$1.80 |
$1.80 |
$1.80 |
$5.99
|
|
Absorpt drg <=16 sq in w/bdr
|
$14.40 |
$14.40 |
$14.40 |
$13.80
|
|
Acetaminophen 10 mg/ml soln 100 ml glass cont
|
$0.80 |
$0.80 |
$0.80 |
$72.74
|
|
Acetazolamide 500 mg solution for injection
|
$104.80 |
$104.80 |
$104.80 |
$122.55
|
|
Acetylcholine receptor modulating antibody
|
$304.80 |
$304.80 |
$304.80 |
$67.50
|
|
Acetylcysteine 200 mg/ml (20 %) intravenous solution
|
$974.40 |
$974.40 |
$974.40 |
$218.79
|
|
Acetylcysteine non-comp unit
|
$199.20 |
$199.20 |
$199.20 |
$31.21
|
|
Acute hepatitis panel
|
$457.20 |
$457.20 |
$457.20 |
$284.95
|
|
Acyclovir 5 mg/ml in ns IV syringe (neo/ped) - cnr
|
$627.00 |
$627.00 |
$627.00 |
$64.45
|
|
#acylcarnitineprfl
|
$174.00 |
$174.00 |
$174.00 |
$121.55
|
|
Adapter b 8 channel 10cm
|
$3,876.00 |
$3,876.00 |
$3,876.00 |
$5,109.58
|
|
Adenosine 3 mg/250 ml bag for osm
|
$150.60 |
$150.60 |
$150.60 |
$271.98
|
|
Adenovirus antibody,serum - quest
|
$205.80 |
$205.80 |
$205.80 |
$58.00
|
|
Adj gastric band via subq port
|
$96.00 |
$96.00 |
$96.00 |
$1,666.86
|
|
Admelog u-100 insulin lispro 100 unit/ml subcutaneous solution
|
$450.00 |
$450.00 |
$450.00 |
$193.40
|
|
Administration chemotherapy IV infusion each additional hour
|
$538.20 |
$538.20 |
$538.20 |
$230.35
|
|
Administration chemotherapy IV infusion each addl sequential infusion diff substance/drug >1 hr
|
$538.20 |
$538.20 |
$538.20 |
$298.98
|
|
Administration chemotherapy IV infusion up to 1 hour single/initial substance/drug
|
$811.80 |
$811.80 |
$811.80 |
$668.98
|
|
Administration chemotherapy IV push single/initial substance/drug
|
$575.40 |
$575.40 |
$575.40 |
$439.20
|
|
Administration chemotherapy subcutaneous/im anti neoplastic hormonal
|
$537.60 |
$537.60 |
$537.60 |
$212.80
|
|
Administration chemotherapy subcutaneous/im anti neoplastic non hormonal
|
$537.60 |
$537.60 |
$537.60 |
$256.49
|
|
Administration immunization each additional vaccine
|
$12.00 |
$12.00 |
$12.00 |
$47.40
|
|
Administration vaccine hepatitis b
|
$12.00 |
$12.00 |
$12.00 |
$53.00
|
|
Administration vaccine influenza virus
|
$12.00 |
$12.00 |
$12.00 |
$51.07
|
|
Administration vaccine pneumococcal
|
$12.00 |
$12.00 |
$12.00 |
$49.68
|
|
Ado-trastuzumab emtansine 100 mg intravenous solution
|
$106.20 |
$106.20 |
$106.20 |
$11,350.31
|
|
Adrenalin epinephrine inject
|
$82.80 |
$82.80 |
$82.80 |
$231.47
|
|
Afamelanotide implant, 1 mg
|
$6,529.20 |
$6,529.20 |
$6,529.20 |
$78,638.30
|
|
_afb id by dna probe rflx ast
|
$198.00 |
$198.00 |
$198.00 |
$104.50
|
|
_afb org id by sequencing rflx ast-sendout
|
$1,290.00 |
$1,290.00 |
$1,290.00 |
$300.00
|
|
Agalsidase beta 35 mg intravenous solution
|
$1,000.80 |
$1,000.80 |
$1,000.80 |
$14,475.20
|
|
Albumin body fluid quantitative each specimen
|
$75.00 |
$75.00 |
$75.00 |
$47.45
|
|
Albumin (human), 25%, 50ml
|
$1,212.00 |
$1,212.00 |
$1,212.00 |
$244.70
|
|
Albumin (human), 5%, 250 ml
|
$624.80 |
$624.80 |
$624.80 |
$252.77
|
|
Albumin (microalbumin) 24 hour urine quantitative
|
$52.20 |
$52.20 |
$52.20 |
$58.17
|
|
Albumin serum plasma or whole blood
|
$81.00 |
$81.00 |
$81.00 |
$43.00
|
|
Albuterol ipratrop non-comp
|
$17.20 |
$17.20 |
$17.20 |
$5.67
|
|
Albuterol non-comp con
|
$5.00 |
$5.00 |
$5.00 |
$6.07
|
|
Albuterol non-comp unit
|
$21.20 |
$21.20 |
$21.20 |
$5.40
|
|
Alginate dressing <=16 sq in
|
$78.60 |
$78.60 |
$78.60 |
$16.56
|
|
Alginate drsg >16 <=48 sq in
|
$96.00 |
$96.00 |
$96.00 |
$43.72
|
|
Alkaline phosphatase
|
$93.00 |
$93.00 |
$93.00 |
$46.80
|
|
Allergen alpha lactalbumin ige
|
$63.00 |
$63.00 |
$63.00 |
$48.57
|
|
Allergen egg white ige
|
$63.00 |
$63.00 |
$63.00 |
$38.00
|
|
Allograft amniotic activebarrier 200 2x2cm-q4100-cost per sheet
|
$4,449.60 |
$4,449.60 |
$4,449.60 |
$9,900.02
|
|
Allograft dermis 20x25x1mm decell w/matracell arthroflex
|
$9,274.20 |
$9,274.20 |
$9,274.20 |
$6,285.56
|
|
Allograft membrn amnio 1x2cm hu ambriodry
|
$1,869.00 |
$1,869.00 |
$1,869.00 |
$5,096.00
|
|
Alpha-fetoprotein afp-l3 frac & total
|
$1,434.60 |
$1,434.60 |
$1,434.60 |
$198.60
|
|
Alpha-fetoprotein amniotic
|
$138.00 |
$138.00 |
$138.00 |
$89.04
|
|
Alpha-fetoprotein tumor marker
|
$235.20 |
$235.20 |
$235.20 |
$106.00
|
|
Alteplase 100 mg infusion from pyxis vial
|
$427.20 |
$427.20 |
$427.20 |
$15,857.45
|
|
Alt/sgpt
|
$93.00 |
$93.00 |
$93.00 |
$47.50
|
|
Aluminum - quest
|
$236.40 |
$236.40 |
$236.40 |
$83.05
|
|
Amikacin 4 mg/ml intravitreal injection - cnr
|
$12.00 |
$12.00 |
$12.00 |
$39.84
|
|
Amino acids quant 2-5
|
$170.40 |
$170.40 |
$170.40 |
$112.00
|
|
Aminocaproic acid 5 g/250 ml 0.9% nacl IV - cnr
|
$13.00 |
$13.00 |
$13.00 |
$37.33
|
|
Aminolevulinic acid delta
|
$103.20 |
$103.20 |
$103.20 |
$87.12
|
|
Aminophylline 25 mg/ml intravenous solution (wrapper)
|
$62.00 |
$62.00 |
$62.00 |
$47.06
|
|
Amiodarone 50 mg/ml intravenous solution
|
$177.60 |
$177.60 |
$177.60 |
$55.86
|
|
Ammonia
|
$115.80 |
$115.80 |
$115.80 |
$119.70
|
|
Amphotericin b lipid complex
|
$115.20 |
$115.20 |
$115.20 |
$226.80
|
|
Amphotericin b liposomal in d5w IV syringe 1 mg/ml (neo/ped) - cnr
|
$2,418.00 |
$2,418.00 |
$2,418.00 |
$519.03
|
|
Ampicillin 1 gram solution for injection
|
$88.80 |
$88.80 |
$88.80 |
$56.70
|
|
Ampicillin-sulbactam 1.5 gram solution for injection
|
$102.40 |
$102.40 |
$102.40 |
$54.57
|
|
Amplification real-time pcr dna markers infectious disease bacterial vaginosis and vaginitis
|
$242.40 |
$242.40 |
$242.40 |
$262.99
|
|
Amylase
|
$162.00 |
$162.00 |
$162.00 |
$90.00
|
|
Analysis gene f2 20210g>a variant
|
$2,503.20 |
$2,503.20 |
$2,503.20 |
$226.85
|
|
Analysis gene f5 leiden variant
|
$1,191.60 |
$1,191.60 |
$1,191.60 |
$249.60
|
