|
Administration vaccine influenza virus
|
$12.00 |
$59.00 |
$127.20 |
|
|
Administration vaccine pneumococcal
|
$12.00 |
$59.00 |
$119.50 |
|
|
Administration vaccine rsv monoclonal ab seasonal dose im
|
$20.50 |
$22.00 |
$25.50 |
|
|
Ado-trastuzumab emtansine 100 mg intravenous solution
|
$31,789.33 |
$31,789.33 |
$36,385.38 |
|
|
Adrenal cortex & medulla img
|
$1,416.00 |
$2,324.50 |
$4,881.50 |
|
|
Advance care planning each additional 30 min 99498
|
$22.50 |
$31.00 |
$31.00 |
|
|
Aep hearing status deter i&r
|
$173.00 |
$173.00 |
$451.10 |
|
|
Aep neurodiagnostic i&r
|
$224.50 |
$327.00 |
$327.00 |
|
|
Aep thrshld est mlt freq i&r
|
$327.00 |
$327.00 |
$327.00 |
|
|
_afb id by dna probe rflx ast
|
$128.00 |
$175.00 |
$311.50 |
|
|
#afb mycobacteria suscep. #1
|
$67.80 |
$67.80 |
$81.45 |
|
|
_afb org id by sequencing rflx ast-sendout
|
$489.00 |
$489.00 |
$489.00 |
|
|
Afo molded ankle gauntlet
|
$2,551.70 |
$2,551.70 |
$2,551.70 |
|
|
Afo molded plas rig ant tib
|
$5,824.89 |
$5,824.89 |
$5,824.89 |
|
|
Afo molded to patient plasti
|
$382.50 |
$382.50 |
$2,436.40 |
|
|
Afo rig ant tib tcf/= custom
|
$852.00 |
$1,686.00 |
$5,044.59 |
|
|
Afo sing bar clasp attach sh
|
$1,585.43 |
$1,585.43 |
$1,585.43 |
|
|
Afo sing solid stirrup calf
|
$2,282.59 |
$2,282.59 |
$2,282.59 |
|
|
Afo sing upright with adjust s
|
$2,322.41 |
$2,322.41 |
$2,322.41 |
|
|
Afo spiral molded to pt plas
|
$4,347.68 |
$4,347.68 |
$4,347.68 |
|
|
Afo sprng wir drsflx calf bd
|
$1,612.90 |
$1,612.90 |
$1,612.90 |
|
|
Afo supramalleolar custom
|
$704.50 |
$1,349.00 |
$3,181.15 |
|
|
Afo tib fx cast plaster mold
|
$4,455.97 |
$4,455.97 |
$4,455.97 |
|
|
Afo tibial fracture rigid
|
$4,357.27 |
$4,357.27 |
$4,357.27 |
|
|
Afo tibial fracture soft
|
$2,852.10 |
$2,852.10 |
$2,852.10 |
|
|
Afo, walk boot type, cus fab
|
$8,970.86 |
$8,970.86 |
$8,970.86 |
|
|
Afo w/ankle joint, prefab
|
$3,611.52 |
$3,611.52 |
$3,611.52 |
|
|
After cataract laser surgery
|
$511.50 |
$758.00 |
$11,982.16 |
|
|
Air conduction bilat
|
$108.00 |
$108.00 |
$108.00 |
|
|
Air injection into abdomen 49400
|
$236.00 |
$470.50 |
$747.50 |
|
|
Airway resistance by impulse oscillometry 94728
|
$297.00 |
$366.50 |
$850.50 |
|
|
Ak/knee disartic pelvic band
|
$443.35 |
$443.35 |
$443.35 |
|
|
Ak/knee disartic silesian ba
|
$551.38 |
$551.38 |
$551.38 |
|
|
Ak sleeve susp neoprene/equa
|
$384.00 |
$384.00 |
$998.87 |
|
|
Albumin body fluid quantitative each specimen
|
$22.00 |
$63.00 |
$298.00 |
|
|
Albumin (human), 25%, 50ml
|
$386.83 |
$432.92 |
$676.26 |
|
|
Albumin (human), 5%, 250 ml
|
$338.39 |
$610.79 |
$683.55 |
|
|
Albumin, human 5 % intravenous solution
|
$435.00 |
$435.00 |
$435.00 |
|
|
Albumin (microalbumin) 24 hour urine quantitative
|
$52.00 |
$84.60 |
$342.00 |
|
|
Albumin serum plasma or whole blood
|
$22.00 |
$47.40 |
$135.00 |
|
|
Albuterol ipratrop non-comp
|
$27.00 |
$27.00 |
$130.00 |
|
|
Albuterol non-comp con
|
$27.00 |
$27.00 |
$27.00 |
|
|
Albuterol non-comp unit
|
$27.00 |
$27.00 |
$27.00 |
|
|
Alcohol (ethanol) any specimen except urine/breath
|
$54.60 |
$185.00 |
$432.50 |
|
|
Aldesleukin injection
|
$15,979.00 |
$15,979.00 |
$15,979.00 |
|
|
Alemtuzumab 12 mg/1.2 ml intravenous solution
|
$89,232.73 |
$89,232.73 |
$89,232.73 |
|
|
Alginate dressing <=16 sq in
|
$37.00 |
$53.00 |
$59.00 |
|
|
Alginate drsg >16 <=48 sq in
|
$58.00 |
$83.50 |
$853.00 |
|
|
Alkaline phosphatase
|
$22.00 |
$49.20 |
$330.50 |
|
|
Allergen alpha lactalbumin ige
|
$14.00 |
$187.00 |
$187.00 |
|
|
Allergen egg white ige
|
$27.00 |
$81.50 |
$117.00 |
|
|
Allergen specific ige qual multi scrn ea
|
$217.00 |
$217.00 |
$217.00 |
|
|
Allergy injections; 2 or more 95117
|
$25.00 |
$34.50 |
$34.50 |
|
|
Allergy injection; single 95115
|
$25.00 |
$34.50 |
$34.50 |
|
|
Allergy Skin Testing
|
$488.00 |
$602.50 |
$602.50 |
|
|
Allg patch or app # of tests 95044
|
$4.50 |
$5.50 |
$5.50 |
|
|
Allograft 160mg placental salera mini membrane
|
$31.50 |
$41.00 |
$15,796.01 |
|
|
Allograft allowrap 4x4cm dry 16sqcm
|
$31,149.36 |
$31,149.36 |
$31,149.36 |
|
|
Allograft amnioexcel plus 17mm disk
|
$341.50 |
$341.50 |
$39,086.74 |
|
|
Allograft amniotic activebarrier 200 2x2cm-q4100-cost per sheet
|
$7,013.50 |
$7,095.00 |
$12,168.00 |
|
|
Allograft dermis 20x25x1mm decell w/matracell arthroflex
|
$382.00 |
$422.00 |
$24,308.79 |
|
|
Allograft ecm allopatch hd dehydr thick 0.8-1.7mmx2x5cm-cost per sq cm
|
$226.00 |
$226.00 |
$110,350.00 |
|
|
Allograft epieffect 2x3cm-q4186-cost per sq cm
|
$571.50 |
$571.50 |
$74,083.19 |
|
|
Allograft graftjacket 2x12cm-q4107-cost per sq cm
|
$885.50 |
$885.50 |
$62,693.73 |
|
|
Allograft membrn amnio 1x2cm hu ambriodry
|
$8,300.00 |
$11,575.00 |
$59,195.07 |
|
|
Allograft umbil cord+amniotic membrane-q4148-cost per sq cm
|
$19,405.65 |
$19,405.65 |
$19,405.65 |
|
|
Allograft umbilical epicord 15 sq cm-q4187-cost per sq cm
|
$451.50 |
$451.50 |
$22,164.45 |
|
|
Alpha-fetoprotein afp-l3 frac & total
|
$166.50 |
$230.00 |
$302.00 |
|
|
Alpha-fetoprotein amniotic
|
$42.50 |
$58.00 |
$87.00 |
|
|
Alpha-fetoprotein tumor marker
|
$69.50 |
$128.50 |
$467.50 |
|
|
Alprostadil for injection
|
$1,407.22 |
$1,407.22 |
$1,574.86 |
|
|
Alteplase 100 mg infusion from pyxis vial
|
$239.39 |
$73,130.99 |
$81,843.35 |
|
|
Alt/sgpt
|
$18.50 |
$63.00 |
$330.50 |
|
|
Altuviiio per factor viii iu
|
$28,501.59 |
$28,501.59 |
$28,501.59 |
|
|
Aluminum - quest
|
$38.00 |
$94.80 |
$350.00 |
|
|
Alveoloplasty each quadrant
|
$9,037.33 |
$9,037.33 |
$9,037.33 |
|
|
Alys cplx sp/pn npgt w/prgrm
|
$138.50 |
$171.00 |
$576.00 |
|
|
Amantadine (symmetrel)-sendout
|
$124.00 |
$373.00 |
$553.00 |
|
|
Amifostine
|
$6,909.00 |
$6,909.00 |
$6,909.00 |
|
|
Amikacin 4 mg/ml intravitreal injection - cnr
|
$96.82 |
$108.35 |
$538.00 |
|
|
Amino acid screen, urine
|
$516.00 |
$516.00 |
$516.00 |
|
|
Amino acids quant 2-5
|
$74.40 |
$74.40 |
$74.40 |
|
|
Aminocaproic acid 5 g/250 ml 0.9% nacl IV - cnr
|
$39.58 |
$67.70 |
$397.00 |
|
|
Aminolevulinic acid delta
|
$78.00 |
$114.60 |
$1,023.00 |
|
|
Aminophylline 25 mg/ml intravenous solution (wrapper)
|
$45.00 |
$45.00 |
$220.00 |
|
|
Amiodarone 150 mg/100 ml (1.5 mg/ml) in dextrose, iso-osmotic IV
|
$269.75 |
$269.75 |
$269.75 |
|
|
Amiodarone 50 mg/ml intravenous solution
|
$45.00 |
$45.00 |
$45.00 |
|
|
Amitriptyline (elavil) -sendout
|
$54.00 |
$87.50 |
$322.00 |
|
|
Ammonia
|
$74.00 |
$126.00 |
$581.00 |
|
|
Amniocentesisdiagnostic 59000
|
$376.00 |
$520.00 |
$1,745.50 |
|
|
Amniocentesis therapeutic
|
$414.00 |
$572.50 |
$572.50 |
|
|
Amp f/th 1/2 jt/phalanx w/neurect local flap
|
$2,226.00 |
$3,078.50 |
$7,289.40 |
|
|
Amphetamine confirm urine -sendout
|
$17.00 |
$71.40 |
$149.50 |
|
|
Amphetamines 5 or more
|
$80.50 |
$87.00 |
$97.50 |
|
|
Amphotericin b in d5w IV syringe 0.1 mg/ml (neo/ped) - cnr
|
$321.00 |
$321.00 |
$446.40 |
|
|
Amphotericin b liposomal in d5w IV syringe 1 mg/ml (neo/ped) - cnr
|
$797.40 |
$797.40 |
$892.39 |
|
|
Ampicillin 1 gram solution for injection
|
$75.85 |
$573.19 |
$641.47 |
|
|
Ampicillin-sulbactam 1.5 gram solution for injection
|
$29.90 |
$76.76 |
$85.91 |
|
|
Amp metatarsal w/toe single 28810
|
$2,757.00 |
$3,743.00 |
$12,726.90 |
|
|
Amputate metacarpal bone 26910
|
$3,528.50 |
$4,878.50 |
$4,878.50 |
|
