|
17-hydroxypregnenolone
|
$307.20 |
$307.20 |
$307.20 |
$92.65
|
|
17-ketosteroids
|
$343.20 |
$343.20 |
$343.20 |
$55.00
|
|
2d tee w or without fol w/con,in
|
$848.40 |
$848.40 |
$848.40 |
$1,724.25
|
|
2d tte w or without fol w/con,co
|
$848.40 |
$848.40 |
$848.40 |
$1,284.00
|
|
3d ech img cgen car anomal
|
$1,419.60 |
$1,419.60 |
$1,419.60 |
$511.60
|
|
3d recon without postprocess indpndt
|
$697.20 |
$697.20 |
$697.20 |
$508.13
|
|
5' nucleotidase - sendout
|
$243.00 |
$243.00 |
$243.00 |
$50.05
|
|
88334 ap bill cytologic exam each additional site
|
$91.20 |
$91.20 |
$91.20 |
$100.10
|
|
Abatacept (with maltose) 250 mg intravenous solution
|
$4,845.00 |
$4,845.00 |
$4,845.00 |
$3,138.72
|
|
Abciximab injection
|
$6,244.80 |
$6,244.80 |
$6,244.80 |
$2,443.52
|
|
Abdominal and Pelvic Blood Vessel Ultrasound (complete)
|
$1,265.40 |
$1,265.40 |
$1,265.40 |
$988.00
|
|
Abdominal and Pelvic Blood Vessel Ultrasound (limited)
|
$1,044.00 |
$1,044.00 |
$1,044.00 |
$662.40
|
|
Abdominal CT scan (with and without contrast)
|
$3,476.40 |
$3,476.40 |
$3,476.40 |
$1,976.94
|
|
Abdominal CT scan (with contrast)
|
$2,772.60 |
$2,772.60 |
$2,772.60 |
$1,667.60
|
|
Abdominal CT scan (without contrast)
|
$2,175.00 |
$2,175.00 |
$2,175.00 |
$1,353.32
|
|
Abdominal MRI (with and without contrast)
|
$4,010.40 |
$4,010.40 |
$4,010.40 |
$2,967.00
|
|
Abdominal MRI (with contrast)
|
$3,051.00 |
$3,051.00 |
$3,051.00 |
$2,240.00
|
|
Abdominal MRI (without contrast)
|
$2,514.00 |
$2,514.00 |
$2,514.00 |
$2,048.36
|
|
Abdominal paracentesis w/image guidance
|
$1,689.00 |
$1,689.00 |
$1,689.00 |
$1,632.96
|
|
Abdominal Ultrasound (complete)
|
$916.80 |
$916.80 |
$916.80 |
$783.00
|
|
Abdominal Ultrasound (limited)
|
$690.60 |
$690.60 |
$690.60 |
$586.43
|
|
Abdominal X-ray (2 views)
|
$327.00 |
$327.00 |
$327.00 |
$318.20
|
|
Abdominal X-ray Series (acute, with chest view)
|
$504.00 |
$504.00 |
$504.00 |
$418.63
|
|
Abdominal X-ray (single view)
|
$538.20 |
$538.20 |
$538.20 |
$260.00
|
|
Abd paracentesis/w/o image guide 49082
|
$971.40 |
$971.40 |
$971.40 |
$1,148.40
|
|
Ablation cryo abd perit om
|
$122.40 |
$122.40 |
$122.40 |
$2,312.80
|
|
Ablation of upper extremity nerves rf
|
$825.60 |
$825.60 |
$825.60 |
$832.50
|
|
Abobotulinumtoxina
|
$4,582.80 |
$4,582.80 |
$4,582.80 |
$1,541.21
|
|
Abscess drain retroperitoneal surg code
|
$5,568.60 |
$5,568.60 |
$5,568.60 |
$3,050.40
|
|
Acetaminophen 10 mg/ml soln 100 ml glass cont
|
$160.80 |
$160.80 |
$160.80 |
$72.74
|
|
Acetazolamide 500 mg solution for injection
|
$256.80 |
$256.80 |
$256.80 |
$122.55
|
|
Acetone qualitative
|
$59.40 |
$59.40 |
$59.40 |
$46.80
|
|
Acetylcholine receptor modulating antibody
|
$388.20 |
$388.20 |
$388.20 |
$67.50
|
|
Acetylcysteine 200 mg/ml (20 %) intravenous solution
|
$1,044.60 |
$1,044.60 |
$1,044.60 |
$218.79
|
|
Acetylcysteine non-comp unit
|
$92.80 |
$92.80 |
$92.80 |
$31.21
|
|
Acute hepatitis panel
|
$762.60 |
$762.60 |
$762.60 |
$284.95
|
|
Acute venous thrombus image
|
$479.40 |
$479.40 |
$479.40 |
$1,426.73
|
|
Acyclovir 5 mg/ml in ns IV syringe (neo/ped) - cnr
|
$74.40 |
$74.40 |
$74.40 |
$64.45
|
|
Adapter b 8 channel 10cm
|
$3,454.80 |
$3,454.80 |
$3,454.80 |
$5,109.58
|
|
Adenosine 3 mg/250 ml bag for osm
|
$382.20 |
$382.20 |
$382.20 |
$271.98
|
|
Adenovirus antibody,serum - quest
|
$91.80 |
$91.80 |
$91.80 |
$58.00
|
|
Adhesive, liquid or equal
|
$2,338.80 |
$2,338.80 |
$2,338.80 |
$14.40
|
|
Adh-sendout
|
$310.20 |
$310.20 |
$310.20 |
$118.79
|
|
Admelog u-100 insulin lispro 100 unit/ml subcutaneous solution
|
$120.00 |
$120.00 |
$120.00 |
$193.40
|
|
Admin ecg contrast agent
|
$294.60 |
$294.60 |
$294.60 |
$120.78
|
|
Administration chemotherapy IV infusion each additional hour
|
$223.20 |
$223.20 |
$223.20 |
$230.35
|
|
Administration chemotherapy IV infusion each addl sequential infusion diff substance/drug >1 hr
|
$223.20 |
$223.20 |
$223.20 |
$298.98
|
|
Administration chemotherapy IV infusion up to 1 hour single/initial substance/drug
|
$808.20 |
$808.20 |
$808.20 |
$668.98
|
|
Administration chemotherapy IV push single/initial substance/drug
|
$508.20 |
$508.20 |
$508.20 |
$439.20
|
|
Administration chemotherapy subcutaneous/im anti neoplastic hormonal
|
$223.20 |
$223.20 |
$223.20 |
$212.80
|
|
Administration chemotherapy subcutaneous/im anti neoplastic non hormonal
|
$164.40 |
$164.40 |
$164.40 |
$256.49
|
|
Administration immunization each additional vaccine
|
$12.60 |
$12.60 |
$12.60 |
$47.40
|
|
Administration vaccine hepatitis b
|
$12.60 |
$12.60 |
$12.60 |
$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
|
|
_afb id by dna probe rflx ast
|
$141.00 |
$141.00 |
$141.00 |
$104.50
|
|
_afb org id by sequencing rflx ast-sendout
|
$1,507.80 |
$1,507.80 |
$1,507.80 |
$300.00
|
|
Agalsidase beta 35 mg intravenous solution
|
$27,295.80 |
$27,295.80 |
$27,295.80 |
$14,475.20
|
|
Albumin body fluid quantitative each specimen
|
$63.60 |
$63.60 |
$63.60 |
$47.45
|
|
Albumin (human), 25%, 50ml
|
$304.00 |
$304.00 |
$304.00 |
$244.70
|
|
Albumin (human), 5%, 250 ml
|
$682.40 |
$682.40 |
$682.40 |
$252.77
|
|
Albumin (microalbumin) 24 hour urine quantitative
|
$349.20 |
$349.20 |
$349.20 |
$58.17
|
|
Albumin serum plasma or whole blood
|
$66.60 |
$66.60 |
$66.60 |
$43.00
|
|
Albuterol ipratrop non-comp
|
$13.80 |
$13.80 |
$13.80 |
$5.67
|
|
Albuterol non-comp con
|
$5.00 |
$5.00 |
$5.00 |
$6.07
|
|
Albuterol non-comp unit
|
$10.00 |
$10.00 |
$10.00 |
$5.40
|
|
Aldesleukin injection
|
$6,538.20 |
$6,538.20 |
$6,538.20 |
$9,030.11
|
|
Alemtuzumab 12 mg/1.2 ml intravenous solution
|
$8,173.80 |
$8,173.80 |
$8,173.80 |
$47,974.31
|
|
Alginate dressing <=16 sq in
|
$75.00 |
$75.00 |
$75.00 |
$16.56
|
|
Alginate drsg >16 <=48 sq in
|
$139.80 |
$139.80 |
$139.80 |
$43.72
|
|
Alginate drsg wound filler
|
$105.60 |
$105.60 |
$105.60 |
$15.79
|
|
Alkaline phosphatase
|
$130.80 |
$130.80 |
$130.80 |
$46.80
|
|
Allergen alpha lactalbumin ige
|
$25.80 |
$25.80 |
$25.80 |
$48.57
|
|
Allergen egg white ige
|
$86.40 |
$86.40 |
$86.40 |
$38.00
|
|
Allograft amniotic activebarrier 200 2x2cm-q4100-cost per sheet
|
$2,221.80 |
$2,221.80 |
$2,221.80 |
$9,900.02
|
|
Allograft dermis 20x25x1mm decell w/matracell arthroflex
|
$2,027.40 |
$2,027.40 |
$2,027.40 |
$6,285.56
|
|
Allograft graftjacket 2x12cm-q4107-cost per sq cm
|
$4,885.20 |
$4,885.20 |
$4,885.20 |
$4,677.40
|
|
Alpha-1-proteinase inhibitor (human) 1,000 mg (+/-) IV solution
|
$29.80 |
$29.80 |
$29.80 |
$13.14
|
|
Alpha-fetoprotein afp-l3 frac & total
|
$147.00 |
$147.00 |
$147.00 |
$198.60
|
|
Alpha-fetoprotein amniotic
|
$160.20 |
$160.20 |
$160.20 |
$89.04
|
|
Alpha-fetoprotein tumor marker
|
$139.20 |
$139.20 |
$139.20 |
$106.00
|
|
Alprostadil for injection
|
$550.20 |
$550.20 |
$550.20 |
$511.41
|
|
Alteplase 100 mg infusion from pyxis vial
|
$40,758.00 |
$40,758.00 |
$40,758.00 |
$15,857.45
|
|
Alt/sgpt
|
$133.80 |
$133.80 |
$133.80 |
$47.50
|
|
Aluminum - quest
|
$319.20 |
$319.20 |
$319.20 |
$83.05
|
|
Amikacin 4 mg/ml intravitreal injection - cnr
|
$26.80 |
$26.80 |
$26.80 |
$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
|
$8.00 |
$8.00 |
$8.00 |
$37.33
|
|
Aminolevulinic acid delta
|
$178.80 |
$178.80 |
$178.80 |
$87.12
|
|
Aminophylline 25 mg/ml intravenous solution (wrapper)
|
$70.20 |
$70.20 |
$70.20 |
$47.06
|
|
Amiodarone 50 mg/ml intravenous solution
|
$224.40 |
$224.40 |
$224.40 |
$55.86
|
|
Ammonia
|
$126.00 |
$126.00 |
$126.00 |
$119.70
|
|
Amniotic fluid scan
|
$202.80 |
$202.80 |
$202.80 |
$49.01
|
|
Amphotericin b in d5w IV syringe 0.1 mg/ml (neo/ped) - cnr
|
$176.40 |
$176.40 |
$176.40 |
$123.53
|
|
Amphotericin b liposomal in d5w IV syringe 1 mg/ml (neo/ped) - cnr
|
$1,050.00 |
$1,050.00 |
$1,050.00 |
$519.03
|
|
Ampicillin 1 gram solution for injection
|
$77.40 |
$77.40 |
$77.40 |
$56.70
|
|
Ampicillin-sulbactam 1.5 gram solution for injection
|
$67.20 |
$67.20 |
$67.20 |
$54.57
|
|
Amplification real-time pcr dna markers infectious disease bacterial vaginosis and vaginitis
|
$280.20 |
$280.20 |
$280.20 |
$262.99
|
|
Amylase
|
$113.40 |
$113.40 |
$113.40 |
$90.00
|
|
Ana ds-dna
|
$374.40 |
$374.40 |
$374.40 |
$55.24
|
