|
Alcohol (ethanol) any specimen except urine/breath
|
$147.50 |
$147.50 |
$147.50 |
$93.60
|
|
Alcohol/subs interv 15-30mn
|
$43.00 |
$43.00 |
$43.00 |
$51.52
|
|
Alginate dressing <=16 sq in
|
$75.50 |
$75.50 |
$75.50 |
$18.20
|
|
Alkaline phosphatase
|
$19.50 |
$19.50 |
$19.50 |
$46.40
|
|
Allergen alpha lactalbumin ige
|
$180.00 |
$180.00 |
$180.00 |
$48.00
|
|
Allergen egg white ige
|
$280.00 |
$280.00 |
$280.00 |
$38.00
|
|
Allergy injections; 2 or more 95117
|
$37.00 |
$37.00 |
$37.00 |
$43.75
|
|
Allergy injection; single 95115
|
$33.00 |
$33.00 |
$33.00 |
$42.75
|
|
Allograft amnioexcel plus 17mm disk
|
$143.50 |
$143.50 |
$143.50 |
$2,250.00
|
|
Allograft amniotic activebarrier 200 2x2cm-q4100-cost per sheet
|
$0.01 |
$0.01 |
$0.01 |
$9,018.12
|
|
Allograft dermis 20x25x1mm decell w/matracell arthroflex
|
$4,200.70 |
$4,200.70 |
$4,200.70 |
$6,414.50
|
|
Allograft graftjacket 2x12cm-q4107-cost per sq cm
|
$151.50 |
$151.50 |
$151.50 |
$4,677.40
|
|
All tstg perq&iq drugs/biol
|
$50.50 |
$50.50 |
$50.50 |
$64.80
|
|
Alpha-fetoprotein amniotic
|
$28.50 |
$28.50 |
$28.50 |
$96.20
|
|
Alpha-fetoprotein tumor marker
|
$175.50 |
$175.50 |
$175.50 |
$106.00
|
|
Alprostadil for injection
|
$14.00 |
$14.00 |
$14.00 |
$519.93
|
|
Alteplase 100 mg infusion from pyxis vial
|
$16,169.78 |
$16,169.78 |
$16,169.78 |
$15,857.45
|
|
Alt/sgpt
|
$12.00 |
$12.00 |
$12.00 |
$47.45
|
|
Aluminum - quest
|
$25.00 |
$25.00 |
$25.00 |
$83.05
|
|
Alys cplx sp/pn npgt w/prgrm
|
$825.75 |
$825.75 |
$825.75 |
$434.00
|
|
Amantadine (symmetrel)-sendout
|
$142.00 |
$142.00 |
$142.00 |
$169.80
|
|
Amikacin 4 mg/ml intravitreal injection - cnr
|
$1.50 |
$1.50 |
$1.50 |
$39.84
|
|
Aminolevulinic acid delta
|
$61.50 |
$61.50 |
$61.50 |
$85.15
|
|
Aminolevulinic acid hcl top
|
$885.00 |
$885.00 |
$885.00 |
$640.56
|
|
Aminophylline 25 mg/ml intravenous solution (wrapper)
|
$32.22 |
$32.22 |
$32.22 |
$45.02
|
|
Amiodarone 150 mg/100 ml (1.5 mg/ml) in dextrose, iso-osmotic IV
|
$120.00 |
$120.00 |
$120.00 |
$119.07
|
|
Amiodarone 50 mg/ml intravenous solution
|
$11.26 |
$11.26 |
$11.26 |
$55.86
|
|
Amitriptyline (elavil) -sendout
|
$29.50 |
$29.50 |
$29.50 |
$87.45
|
|
Ammonia
|
$35.00 |
$35.00 |
$35.00 |
$119.70
|
|
Amniocentesisdiagnostic 59000
|
$1,058.50 |
$1,058.50 |
$1,058.50 |
$942.60
|
|
Amniocentesis therapeutic
|
$420.00 |
$420.00 |
$420.00 |
$785.85
|
|
Amp f/th 1/2 jt/phalanx w/neurect local flap
|
$3,760.50 |
$3,760.50 |
$3,760.50 |
$3,730.53
|
|
Amphetamine confirm urine -sendout
|
$21.50 |
$21.50 |
$21.50 |
$92.61
|
|
Amphetamines 5 or more
|
$57.00 |
$57.00 |
$57.00 |
$82.96
|
|
Ampicillin 1 gram solution for injection
|
$4.55 |
$4.55 |
$4.55 |
$56.70
|
|
Ampicillin-sulbactam 1.5 gram solution for injection
|
$8.33 |
$8.33 |
$8.33 |
$53.86
|
|
Amp metatarsal w/toe single 28810
|
$4,490.00 |
$4,490.00 |
$4,490.00 |
$4,271.00
|
|
Amputation leg thr tib/fib 27880
|
$3,161.00 |
$3,161.00 |
$3,161.00 |
$2,241.60
|
|
Amputation thru metatarsal
|
$2,309.00 |
$2,309.00 |
$2,309.00 |
$3,839.54
|
|
Amputation toe interphalangeal joint
|
$3,760.50 |
$3,760.50 |
$3,760.50 |
$3,998.20
|
|
Amputation toe metatarsophalangeal joint
|
$4,409.50 |
$4,409.50 |
$4,409.50 |
$3,839.54
|
|
Amylase
|
$237.00 |
$237.00 |
$237.00 |
$89.04
|
|
Analgesics non-opioid 3-5
|
$5.00 |
$5.00 |
$5.00 |
$16.24
|
|
Analgesics non-opioid definitive assay 1 or 2 acetaminophen
|
$45.00 |
$45.00 |
$45.00 |
$117.01
|
|
Anal/urinary muscle study
|
$229.50 |
$229.50 |
$229.50 |
$407.00
|
|
Anal/urinary muscle study
|
$287.00 |
$287.00 |
$287.00 |
$576.00
|
|
Analysis complx cranial nerve pulse gen prgrmg 95977
|
$173.00 |
$173.00 |
$173.00 |
$338.40
|
|
Analysis gene f2 20210g>a variant
|
$504.00 |
$504.00 |
$504.00 |
$219.60
|
|
Analysis gene f5 leiden variant
|
$165.00 |
$165.00 |
$165.00 |
$230.40
|
|
Analysis; simple cranial nerv pulse gen prgrmg 95976
|
$68.00 |
$68.00 |
$68.00 |
$122.20
|
|
Analyze neurostimulator simple w/reprogramming 95971
|
$128.00 |
$128.00 |
$128.00 |
$396.48
|
|
Anaplsma phgcytophlm amp prb
|
$206.88 |
$206.88 |
$206.88 |
$85.80
|
|
Anca screen with reflex to titer -quest
|
$35.00 |
$35.00 |
$35.00 |
$103.20
|
|
An cholangiogram percutaneous compl
|
$4,431.00 |
$4,431.00 |
$4,431.00 |
$2,626.65
|
|
An fluoro guide for cvp
|
$383.00 |
$383.00 |
$383.00 |
$515.00
|
|
Angio balloon ctrl dialysis seg add-on
|
$553.00 |
$553.00 |
$553.00 |
$5,341.83
|
|
Angiotensin ii 0.5 mg/ml soln 1 ml vial
|
$186.00 |
$186.00 |
$186.00 |
$3,080.85
|
|
Angio tib/peroneal/init ves/unila 37228
|
$7,110.50 |
$7,110.50 |
$7,110.50 |
$10,522.96
|
|
Angio trnslmnl balloon same artery ea addl
|
$533.50 |
$533.50 |
$533.50 |
$4,604.00
|
|
Angio trnslmnl balloon same artery ini
|
$4,134.00 |
$4,134.00 |
$4,134.00 |
$9,074.63
|
|
Angio trnslmnl balloon same vein ea addl
|
$533.50 |
$533.50 |
$533.50 |
$4,390.75
|
|
Angio trnslmnl balloon same vein ini
|
$3,789.00 |
$3,789.00 |
$3,789.00 |
$8,466.00
|
|
Ankle arthroscopy/surgery
|
$1,988.76 |
$1,988.76 |
$1,988.76 |
$3,839.54
|
|
Ankle arthroscopy/surgery
|
$3,818.00 |
$3,818.00 |
$3,818.00 |
$3,839.54
|
|
Ankle arthroscopy/surgery
|
$2,057.67 |
$2,057.67 |
$2,057.67 |
$3,839.54
|
|
Ankle X-ray
|
$176.00 |
$176.00 |
$176.00 |
$353.60
|
|
Anl sp inf pmp w/mdreprg&fil
|
$353.00 |
$353.00 |
$353.00 |
$627.94
|
|
Annual alcohol screen 15 min
|
$43.00 |
$43.00 |
$43.00 |
$40.00
|
|
Anora (draw only)
|
$12.50 |
$12.50 |
$12.50 |
$33.58
|
|
Ant colporrhaphy/rpr cyctocele 57240
|
$1,754.83 |
$1,754.83 |
$1,754.83 |
$5,463.96
|
|
Antibody bacterium, not elsewhere specified
|
$34.00 |
$34.00 |
$34.00 |
$57.81
|
|
Antibody elution rbc reference
|
$185.00 |
$185.00 |
$185.00 |
$175.50
|
|
Antibody identification platelet antibodies heparin-pf4 igg
|
$455.00 |
$455.00 |
$455.00 |
$218.30
|
|
Antibody id rbc panel
|
$364.50 |
$364.50 |
$364.50 |
$274.56
|
|
Antibody screen rbc
|
$123.00 |
$123.00 |
$123.00 |
$100.00
|
|
Antibody tetanus
|
$20.50 |
$20.50 |
$20.50 |
$53.95
|
|
Anticoag mgmt pt warfarin
|
$16.00 |
$16.00 |
$16.00 |
$26.40
|
|
Antidepressant not specified
|
$5.00 |
$5.00 |
$5.00 |
$61.80
|
|
Antidepressants class 3-5
|
$5.00 |
$5.00 |
$5.00 |
$59.46
|
|
Antiepileptics nos 4-6
|
$5.00 |
$5.00 |
$5.00 |
$16.24
|
|
Antigen therapy services
|
$54.00 |
$54.00 |
$54.00 |
$73.84
|
|
Antigen therapy services
|
$54.00 |
$54.00 |
$54.00 |
$83.72
|
|
Antigen therapy services
|
$83.00 |
$83.00 |
$83.00 |
$101.40
|
|
Antigen therapy services
|
$83.00 |
$83.00 |
$83.00 |
$96.72
|
|
Antigen therapy services
|
$83.00 |
$83.00 |
$83.00 |
$130.00
|
|
Antigen therapy services
|
$6.00 |
$6.00 |
$6.00 |
$70.07
|
|
Anti mog serum - sendout
|
$785.00 |
$785.00 |
$785.00 |
$159.00
|
|
Antineutrophil cytoplasmic antibody screen each antibody
|
$10.00 |
$10.00 |
$10.00 |
$37.05
|
|
Antineutrophil cytoplasmic antibody titer each antibody
|
$86.00 |
$86.00 |
$86.00 |
$40.00
|
|
Ant instr 2-3 vert segm 22845
|
$3,224.88 |
$3,224.88 |
$3,224.88 |
$1,748.00
|
|
Antinuclear antibodies
|
$47.00 |
$47.00 |
$47.00 |
$89.40
|
|
Antinuclear antibodies titer
|
$28.50 |
$28.50 |
$28.50 |
$77.00
|
|
Antiphosphatidylserine antibody
|
$22.50 |
$22.50 |
$22.50 |
$65.97
|
|
Antipsychotics nos 7/more
|
$5.00 |
$5.00 |
$5.00 |
$16.24
|
|
Antistreptolysin o titer
|
$10.00 |
$10.00 |
$10.00 |
$51.45
|
|
Antithrombin iii activity
|
$39.50 |
$39.50 |
$39.50 |
$114.00
|
|
Apheresis rbc
|
$474.00 |
$474.00 |
$474.00 |
$3,146.15
|
|
Appendix Removal (Laparoscopic)
|
$5,634.00 |
$5,634.00 |
$5,634.00 |
$6,870.89
|
|
App high cost ss f/n/g/h/f >100sq cm 1st 100sq cm
|
$2,371.50 |
$2,371.50 |
$2,371.50 |
$2,114.00
|
|
App high cost ss f/n/g/h/f >100sq cm addl 100sq cm
|
$313.50 |
$313.50 |
$313.50 |
$851.85
|
