|
5% dextrose and 0.45% saline
|
$75.60 |
$75.60 |
$75.60 |
$48.00
|
|
Abdominal paracentesis w/image guidance
|
$1,440.80 |
$1,440.80 |
$1,440.80 |
$1,636.80
|
|
Abdominal Ultrasound (complete)
|
$1,272.00 |
$1,272.00 |
$1,272.00 |
$785.25
|
|
Abdominal Ultrasound (limited)
|
$910.40 |
$910.40 |
$910.40 |
$581.10
|
|
Acetaminophen 10 mg/ml soln 100 ml glass cont
|
$84.60 |
$84.60 |
$84.60 |
$73.44
|
|
Acetaminophen 120 mg rectal suppository
|
$2.80 |
$2.80 |
$2.80 |
$75.09
|
|
Acetazolamide 500 mg solution for injection
|
$280.60 |
$280.60 |
$280.60 |
$122.55
|
|
Acetylcholine receptor modulating antibody
|
$49.60 |
$49.60 |
$49.60 |
$66.28
|
|
Acute hepatitis panel
|
$198.40 |
$198.40 |
$198.40 |
$284.70
|
|
Acyclovir 5 mg/ml in ns IV syringe (neo/ped) - cnr
|
$36.00 |
$36.00 |
$36.00 |
$64.15
|
|
Admelog u-100 insulin lispro 100 unit/ml subcutaneous solution
|
$1,877.60 |
$1,877.60 |
$1,877.60 |
$197.05
|
|
Administration vaccine influenza virus
|
$17.60 |
$17.60 |
$17.60 |
$48.73
|
|
Administration vaccine pneumococcal
|
$17.60 |
$17.60 |
$17.60 |
$48.73
|
|
Albumin (human), 25%, 50ml
|
$217.40 |
$217.40 |
$217.40 |
$235.92
|
|
Albumin (human), 5%, 250 ml
|
$163.20 |
$163.20 |
$163.20 |
$246.00
|
|
Albumin (microalbumin) 24 hour urine quantitative
|
$24.00 |
$24.00 |
$24.00 |
$57.60
|
|
Albumin serum plasma or whole blood
|
$20.80 |
$20.80 |
$20.80 |
$42.40
|
|
Alkaline phosphatase
|
$21.60 |
$21.60 |
$21.60 |
$46.80
|
|
Allograft graftjacket 2x12cm-q4107-cost per sq cm
|
$5,063.89 |
$5,063.89 |
$5,063.89 |
$4,677.40
|
|
Alteplase 100 mg infusion from pyxis vial
|
$1,223.20 |
$1,223.20 |
$1,223.20 |
$15,857.45
|
|
Alt/sgpt
|
$22.40 |
$22.40 |
$22.40 |
$47.40
|
|
Amiodarone 50 mg/ml intravenous solution
|
$55.00 |
$55.00 |
$55.00 |
$55.86
|
|
Ammonia
|
$60.80 |
$60.80 |
$60.80 |
$119.70
|
|
Ampicillin 1 gram solution for injection
|
$31.60 |
$31.60 |
$31.60 |
$58.35
|
|
Ampicillin-sulbactam 1.5 gram solution for injection
|
$41.60 |
$41.60 |
$41.60 |
$54.57
|
|
Amylase
|
$26.40 |
$26.40 |
$26.40 |
$89.04
|
|
Anaplsma phgcytophlm amp prb
|
$162.40 |
$162.40 |
$162.40 |
$82.65
|
|
An fluoro guide for cvp
|
$824.80 |
$824.80 |
$824.80 |
$515.00
|
|
Ankle X-ray
|
$291.20 |
$291.20 |
$291.20 |
$352.80
|
|
Antibody identification platelet antibodies heparin-pf4 igg
|
$120.00 |
$120.00 |
$120.00 |
$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
|
|
Antinuclear antibodies
|
$49.60 |
$49.60 |
$49.60 |
$90.00
|
|
Antinuclear antibodies titer
|
$46.40 |
$46.40 |
$46.40 |
$79.86
|
|
Application lower leg splint 29515
|
$375.20 |
$375.20 |
$375.20 |
$334.20
|
|
Application multi layer compression below knee (both sides)
|
$236.80 |
$236.80 |
$236.80 |
$370.92
|
|
Application of forearm cast 29075
|
$458.40 |
$458.40 |
$458.40 |
$356.50
|
|
Appl modality 1/> areas vasopneumatic devices 97016
|
$189.60 |
$189.60 |
$189.60 |
$76.80
|
|
Aquatic exercise - group charge
|
$79.20 |
$79.20 |
$79.20 |
$87.15
|
|
Arterial blood draw/perc 36620
|
$1,788.00 |
$1,788.00 |
$1,788.00 |
$485.69
|
|
Arthrocentesis/aspiration/inj major joint/bursa without Ultrasound guidance (both sides)
|
$660.00 |
$660.00 |
$660.00 |
$726.66
|
|
Ast/sgot
|
$21.60 |
$21.60 |
$21.60 |
$45.60
|
|
Azathioprine 50 mg tablet
|
$1.40 |
$1.40 |
$1.40 |
$3.25
|
|
Azithromycin 500 mg intravenous solution
|
$23.40 |
$23.40 |
$23.40 |
$36.36
|
|
Baclofen 2,000 mcg/ml intrathecal solution (wrapper)
|
$4,612.80 |
$4,612.80 |
$4,612.80 |
$1,667.48
|
|
Baclofen eval charges
|
$138.40 |
$138.40 |
$138.40 |
$87.50
|
|
Bacterial vaginosis pcr
|
$292.00 |
$292.00 |
$292.00 |
$287.04
|
|
#bac vag cand-c. albicans naa
|
$140.00 |
$140.00 |
$140.00 |
$109.20
|
|
Betamethasone acetate and sodium phos 6 mg/ml suspension for injection
|
$358.00 |
$358.00 |
$358.00 |
$65.00
|
|
Bilirubin direct
|
$24.80 |
$24.80 |
$24.80 |
$50.40
|
|
Bilirubin total
|
$10.00 |
$10.00 |
$10.00 |
$53.84
|
|
Binder abdominal lg 12 x 62-74
|
$80.80 |
$80.80 |
$80.80 |
$50.14
|
|
Blood Clotting (PT/INR) Test
|
$15.00 |
$15.00 |
$15.00 |
$53.30
|
|
Blood Clotting (PTT) Test
|
$30.00 |
$30.00 |
$30.00 |
$73.80
|
|
Blood Count (CBC) Test
|
$15.00 |
$15.00 |
$15.00 |
$74.70
|
|
Blood Count (CBC) Test (without differential)
|
$15.00 |
$15.00 |
$15.00 |
$61.80
|
|
Blood Culture Test
|
$42.40 |
$42.40 |
$42.40 |
$145.60
|
|
Blood draw capillary 36416
|
$19.20 |
$19.20 |
$19.20 |
$20.00
|
|
Blood gases o2 saturation direct measurement
|
$331.20 |
$331.20 |
$331.20 |
$226.20
|
|
Blood occult fecal hemoglobin immunoassay qualitative 1-3 simultaneous determinations diagnostic
|
$36.00 |
$36.00 |
$36.00 |
$57.60
|
|
Blood occult feces colorectal neoplasm screening qualitative
|
$15.00 |
$15.00 |
$15.00 |
$33.15
|
|
Blood split unit
|
$768.00 |
$768.00 |
$768.00 |
$282.88
|
|
Blood typing abo
|
$146.00 |
$146.00 |
$146.00 |
$84.75
|
|
Blood typing rbc ag non abo/rh ea
|
$257.60 |
$257.60 |
$257.60 |
$206.33
|
|
Blood typing rh (d)
|
$43.00 |
$43.00 |
$43.00 |
$57.14
|
|
Borrelia burgdorferi (lyme disease) antibody nonspecific
|
$70.40 |
$70.40 |
$70.40 |
$91.20
|
|
Borrelia miyamotoi amp prb
|
$162.40 |
$162.40 |
$162.40 |
$81.20
|
|
Brain MRI (with and without contrast)
|
$701.50 |
$701.50 |
$701.50 |
$2,837.12
|
|
Brain MRI (without contrast)
|
$455.00 |
$455.00 |
$455.00 |
$1,932.50
|
|
Bumetanide in d5w IV syringe 0.04 mg/ml (neo/ped) - cnr
|
$46.40 |
$46.40 |
$46.40 |
$24.08
|
|
Bundled special stain group 1 microorganisms
|
$210.40 |
$210.40 |
$210.40 |
$154.70
|
|
Bundled special stain group 2
|
$144.00 |
$144.00 |
$144.00 |
$170.65
|
|
Bupivacaine 0.1 % epidural pca - 1 hour dose limit
|
$29.00 |
$29.00 |
$29.00 |
$33.08
|
|
Calcitonin (salmon) 200 unit/ml injection solution
|
$3,341.00 |
$3,341.00 |
$3,341.00 |
$2,177.05
|
|
Calcium chloride 100 mg/ml (10 %) intravenous syringe
|
$108.20 |
$108.20 |
$108.20 |
$47.09
|
|
Calcium gluconate 2 gram/100 ml in sodium chloride,iso-osm IV solution
|
$184.20 |
$184.20 |
$184.20 |
$91.60
|
|
Calcium ionized
|
$55.20 |
$55.20 |
$55.20 |
$89.88
|
|
Calcium total
|
$21.60 |
$21.60 |
$21.60 |
$50.00
|
|
Carbamazepine total therapeutic drug level
|
$60.80 |
$60.80 |
$60.80 |
$122.85
|
|
Carbon dioxide
|
$19.20 |
$19.20 |
$19.20 |
$42.66
|
|
Carotid Artery Ultrasound (Duplex)
|
$1,321.60 |
$1,321.60 |
$1,321.60 |
$997.10
|
|
Cefazolin 10 mg/10 ml (dilution #2) IV desensitization - cnr
|
$48.60 |
$48.60 |
$48.60 |
$40.39
|
|
Cefepime 1 gram solution for injection
|
$66.80 |
$66.80 |
$66.80 |
$44.99
|
|
Ceftaroline fosamil 600 mg intravenous solution
|
$1,675.20 |
$1,675.20 |
$1,675.20 |
$602.45
|
|
Ceftazidime 4.5 mg/0.2 ml intraocular injection - cnr
|
$45.80 |
$45.80 |
$45.80 |
$59.79
|
|
Ceftazidime and avibactam
|
$2,742.40 |
$2,742.40 |
$2,742.40 |
$904.66
|
|
Ceftriaxone 1 gram solution for injection
|
$45.20 |
$45.20 |
$45.20 |
$84.15
|
|
Cell count body fluid
|
$19.20 |
$19.20 |
$19.20 |
$63.52
|
|
Cell count w differential body fluid
|
$23.20 |
$23.20 |
$23.20 |
$93.23
|
|
Change g-tube to g-j perc
|
$2,888.00 |
$2,888.00 |
$2,888.00 |
$2,198.40
|
|
Change of windpipe airway 31502
|
$567.20 |
$567.20 |
$567.20 |
$398.43
|
|
Chest CT scan (with contrast)
|
$470.00 |
$470.00 |
$470.00 |
$1,658.80
|
|
Chest CT scan (without contrast)
|
$285.00 |
$285.00 |
$285.00 |
$1,350.03
|
|
Chest X-ray
|
$322.40 |
$322.40 |
$322.40 |
$295.03
|
|
Chest X-ray (single view)
|
$292.80 |
$292.80 |
$292.80 |
$241.20
|
|
Chg radiologic exam esophagus double contrast
|
$236.80 |
$236.80 |
$236.80 |
$512.00
|
|
Chloride
|
$18.40 |
$18.40 |
$18.40 |
$40.95
|
|
Chloride 24 hour urine
|
$24.00 |
$24.00 |
$24.00 |
$50.40
|
|
Chlorothiazide sodium 500 mg intravenous solution
|
$243.20 |
$243.20 |
$243.20 |
$369.74
|
|
Cholesterol (Lipid) Test
|
$40.00 |
$40.00 |
$40.00 |
$115.80
|
