|
3d recon without postprocess indpndt
|
$602.40 |
$602.40 |
$602.40 |
$508.13
|
|
5% dextrose and 0.45% saline
|
$120.00 |
$120.00 |
$120.00 |
$48.00
|
|
88334 ap bill cytologic exam each additional site
|
$117.60 |
$117.60 |
$117.60 |
$100.10
|
|
Abatacept (with maltose) 250 mg intravenous solution
|
$1,718.76 |
$1,718.76 |
$1,718.76 |
$3,138.72
|
|
Abdominal and Pelvic Blood Vessel Ultrasound (complete)
|
$1,174.40 |
$1,174.40 |
$1,174.40 |
$988.00
|
|
Abdominal and Pelvic Blood Vessel Ultrasound (limited)
|
$868.80 |
$868.80 |
$868.80 |
$662.40
|
|
Abdominal CT scan (with and without contrast)
|
$2,796.00 |
$2,796.00 |
$2,796.00 |
$1,976.94
|
|
Abdominal CT scan (with contrast)
|
$2,896.80 |
$2,896.80 |
$2,896.80 |
$1,667.60
|
|
Abdominal CT scan (without contrast)
|
$2,237.60 |
$2,237.60 |
$2,237.60 |
$1,353.32
|
|
Abdominal MRI (with and without contrast)
|
$3,828.80 |
$3,828.80 |
$3,828.80 |
$2,967.00
|
|
Abdominal MRI (without contrast)
|
$2,930.40 |
$2,930.40 |
$2,930.40 |
$2,048.36
|
|
Abdominal paracentesis w/image guidance
|
$1,840.00 |
$1,840.00 |
$1,840.00 |
$1,632.96
|
|
Abdominal Ultrasound (complete)
|
$965.60 |
$965.60 |
$965.60 |
$783.00
|
|
Abdominal Ultrasound (limited)
|
$705.60 |
$705.60 |
$705.60 |
$586.43
|
|
Abdominal X-ray (2 views)
|
$484.00 |
$484.00 |
$484.00 |
$318.20
|
|
Abdominal X-ray Series (acute, with chest view)
|
$628.00 |
$628.00 |
$628.00 |
$418.63
|
|
Abdominal X-ray (single view)
|
$348.80 |
$348.80 |
$348.80 |
$260.00
|
|
Abd paracentesis/w/o image guide 49082
|
$1,499.20 |
$1,499.20 |
$1,499.20 |
$1,148.40
|
|
Acetaminophen 10 mg/ml soln 100 ml glass cont
|
$138.76 |
$138.76 |
$138.76 |
$72.74
|
|
Acetaminophen level
|
$161.60 |
$161.60 |
$161.60 |
$116.80
|
|
Acetone qualitative
|
$28.00 |
$28.00 |
$28.00 |
$46.80
|
|
Acetylcholine receptor modulating antibody
|
$95.20 |
$95.20 |
$95.20 |
$67.50
|
|
Acetylcysteine 200 mg/ml (20 %) intravenous solution
|
$90.84 |
$90.84 |
$90.84 |
$218.79
|
|
Acetylcysteine non-comp unit
|
$20.84 |
$20.84 |
$20.84 |
$31.21
|
|
Aco med nutria tx/group, ea 30 min 97804aco
|
$55.20 |
$55.20 |
$55.20 |
$38.50
|
|
Acute hepatitis panel
|
$265.60 |
$265.60 |
$265.60 |
$284.95
|
|
Acyclovir 400 mg tablet
|
$4.10 |
$4.10 |
$4.10 |
$54.77
|
|
Acyclovir 5 mg/ml in ns IV syringe (neo/ped) - cnr
|
$62.51 |
$62.51 |
$62.51 |
$64.45
|
|
#acylcarnitineprfl
|
$49.60 |
$49.60 |
$49.60 |
$121.55
|
|
Adenosine 3 mg/250 ml bag for osm
|
$67.12 |
$67.12 |
$67.12 |
$271.98
|
|
Admelog u-100 insulin lispro 100 unit/ml subcutaneous solution
|
$22.86 |
$22.86 |
$22.86 |
$193.40
|
|
Administration chemotherapy IV infusion each additional hour
|
$292.00 |
$292.00 |
$292.00 |
$230.35
|
|
Administration chemotherapy IV infusion each addl sequential infusion diff substance/drug >1 hr
|
$401.60 |
$401.60 |
$401.60 |
$298.98
|
|
Administration chemotherapy IV infusion up to 1 hour single/initial substance/drug
|
$930.40 |
$930.40 |
$930.40 |
$668.98
|
|
Administration chemotherapy IV push single/initial substance/drug
|
$570.40 |
$570.40 |
$570.40 |
$439.20
|
|
Administration chemotherapy subcutaneous/im anti neoplastic hormonal
|
$232.80 |
$232.80 |
$232.80 |
$212.80
|
|
Administration chemotherapy subcutaneous/im anti neoplastic non hormonal
|
$297.60 |
$297.60 |
$297.60 |
$256.49
|
|
Administration immunization each additional vaccine
|
$40.80 |
$40.80 |
$40.80 |
$47.40
|
|
Administration immunization intranasal/oral route 1 vaccine
|
$35.20 |
$35.20 |
$35.20 |
$48.00
|
|
Administration immunization intranasal/oral route each additional vaccine
|
$32.80 |
$32.80 |
$32.80 |
$30.24
|
|
Albumin body fluid quantitative each specimen
|
$48.00 |
$48.00 |
$48.00 |
$47.45
|
|
Albumin (human), 25%, 50ml
|
$205.94 |
$205.94 |
$205.94 |
$244.70
|
|
Albumin (microalbumin) 24 hour urine quantitative
|
$141.60 |
$141.60 |
$141.60 |
$58.17
|
|
Albumin serum plasma or whole blood
|
$66.40 |
$66.40 |
$66.40 |
$43.00
|
|
Albuterol ipratrop non-comp
|
$3.92 |
$3.92 |
$3.92 |
$5.67
|
|
Albuterol non-comp con
|
$70.17 |
$70.17 |
$70.17 |
$6.07
|
|
Albuterol non-comp unit
|
$3.40 |
$3.40 |
$3.40 |
$5.40
|
|
Alcohol (ethanol) any specimen except urine/breath
|
$161.60 |
$161.60 |
$161.60 |
$96.00
|
|
Alkaline phosphatase
|
$73.60 |
$73.60 |
$73.60 |
$46.80
|
|
Allergen egg white ige
|
$48.00 |
$48.00 |
$48.00 |
$38.00
|
|
Allograft dermis 20x25x1mm decell w/matracell arthroflex
|
$350.01 |
$350.01 |
$350.01 |
$6,285.56
|
|
Allograft epieffect 2x3cm-q4186-cost per sq cm
|
$703.20 |
$703.20 |
$703.20 |
$858.66
|
|
Alpha-fetoprotein tumor marker
|
$154.40 |
$154.40 |
$154.40 |
$106.00
|
|
Alprostadil for injection
|
$85.57 |
$85.57 |
$85.57 |
$511.41
|
|
Alteplase 100 mg infusion from pyxis vial
|
$12,850.08 |
$12,850.08 |
$12,850.08 |
$15,857.45
|
|
Alt/sgpt
|
$84.00 |
$84.00 |
$84.00 |
$47.50
|
|
Aminolevulinic acid delta
|
$144.00 |
$144.00 |
$144.00 |
$87.12
|
|
Aminophylline 25 mg/ml intravenous solution (wrapper)
|
$67.97 |
$67.97 |
$67.97 |
$47.06
|
|
Amiodarone 150 mg/100 ml (1.5 mg/ml) in dextrose, iso-osmotic IV
|
$186.20 |
$186.20 |
$186.20 |
$108.13
|
|
Amiodarone 50 mg/ml intravenous solution
|
$61.80 |
$61.80 |
$61.80 |
$55.86
|
|
Ammonia
|
$224.80 |
$224.80 |
$224.80 |
$119.70
|
|
Amphetamine confirm urine -sendout
|
$57.60 |
$57.60 |
$57.60 |
$93.61
|
|
Amphotericin b liposomal in d5w IV syringe 1 mg/ml (neo/ped) - cnr
|
$114.14 |
$114.14 |
$114.14 |
$519.03
|
|
Ampicillin 1 gram solution for injection
|
$62.85 |
$62.85 |
$62.85 |
$56.70
|
|
Ampicillin-sulbactam 1.5 gram solution for injection
|
$67.06 |
$67.06 |
$67.06 |
$54.57
|
|
Amplification real-time pcr dna markers infectious disease bacterial vaginosis and vaginitis
|
$496.00 |
$496.00 |
$496.00 |
$262.99
|
|
Amylase
|
$87.20 |
$87.20 |
$87.20 |
$90.00
|
|
Ana ds-dna
|
$288.80 |
$288.80 |
$288.80 |
$55.24
|
|
Analysis gene f2 20210g>a variant
|
$437.60 |
$437.60 |
$437.60 |
$226.85
|
|
Analysis gene f5 leiden variant
|
$400.00 |
$400.00 |
$400.00 |
$249.60
|
|
Anastrozole 1 mg
|
$1.20 |
$1.20 |
$1.20 |
$22.40
|
|
Anca screen with reflex to titer -quest
|
$172.00 |
$172.00 |
$172.00 |
$101.50
|
|
An fluoro guide for cvp
|
$786.40 |
$786.40 |
$786.40 |
$525.85
|
|
Angiotensin ii 0.5 mg/ml soln 1 ml vial
|
$202.45 |
$202.45 |
$202.45 |
$2,979.43
|
|
Ankle X-ray
|
$388.00 |
$388.00 |
$388.00 |
$356.32
|
|
Ankle X-ray (2 views, both ankles)
|
$342.40 |
$342.40 |
$342.40 |
$282.96
|
|
Anodyne therapy charges pt
|
$66.40 |
$66.40 |
$66.40 |
$42.00
|
|
Anora (draw only)
|
$52.00 |
$52.00 |
$52.00 |
$35.00
|
|
Antibody bacterium, not elsewhere specified
|
$32.00 |
$32.00 |
$32.00 |
$57.85
|
|
Antibody elution rbc reference
|
$166.40 |
$166.40 |
$166.40 |
$177.29
|
|
Antibody htlv/hiv confirm test
|
$298.40 |
$298.40 |
$298.40 |
$131.56
|
|
Antibody identification platelet antibodies heparin-pf4 igg
|
$215.20 |
$215.20 |
$215.20 |
$224.00
|
|
Antibody id rbc panel
|
$320.80 |
$320.80 |
$320.80 |
$291.75
|
|
Antibody screen rbc
|
$115.20 |
$115.20 |
$115.20 |
$108.55
|
|
Antibody tetanus
|
$134.40 |
$134.40 |
$134.40 |
$54.15
|
|
Antineutrophil cytoplasmic antibody screen each antibody
|
$56.80 |
$56.80 |
$56.80 |
$38.50
|
|
Antineutrophil cytoplasmic antibody titer each antibody
|
$40.00 |
$40.00 |
$40.00 |
$42.00
|
|
Antinuclear antibodies
|
$120.80 |
$120.80 |
$120.80 |
$90.00
|
|
Antinuclear antibodies titer
|
$82.40 |
$82.40 |
$82.40 |
$80.04
|
|
Antistreptolysin o titer
|
$84.80 |
$84.80 |
$84.80 |
$54.00
|
|
Antithrombin iii activity
|
$164.00 |
$164.00 |
$164.00 |
$115.15
|
|
Aortic Aneurysm Screening Ultrasound
|
$475.20 |
$475.20 |
$475.20 |
$394.55
|
|
App high cost ss t/a/l <100sq cm addl <25sq cm
|
$1,200.00 |
$1,200.00 |
$1,200.00 |
$512.20
|
|
Application finger splntstatic 29130
|
$285.60 |
$285.60 |
$285.60 |
$208.50
|
|
Application long leg splint 29505
|
$363.20 |
$363.20 |
$363.20 |
$338.25
|
|
Application lower leg splint 29515
|
$363.20 |
$363.20 |
$363.20 |
$340.20
|
|
Application of forearm cast 29075
|
$366.40 |
$366.40 |
$366.40 |
$358.20
|
|
Application of paste boot 29580
|
$348.80 |
$348.80 |
$348.80 |
$340.11
|
|
Application short leg cast 29405
|
$304.00 |
$304.00 |
$304.00 |
$393.98
|
|
Application skin substitute graft face/scalp/neck/genit/hnd/ft <100 sq cm 1st 25 sq cm
|
$2,850.40 |
$2,850.40 |
$2,850.40 |
$2,123.50
|
