|
3d recon without postprocess indpndt
|
$735.20 |
$735.20 |
$735.20 |
$508.13
|
|
5% dextrose and 0.45% saline
|
$40.00 |
$40.00 |
$40.00 |
$48.00
|
|
88334 ap bill cytologic exam each additional site
|
$68.80 |
$68.80 |
$68.80 |
$100.10
|
|
Abatacept (with maltose) 250 mg intravenous solution
|
$2,288.00 |
$2,288.00 |
$2,288.00 |
$3,138.72
|
|
Abdominal and Pelvic Blood Vessel Ultrasound (complete)
|
$1,120.80 |
$1,120.80 |
$1,120.80 |
$988.00
|
|
Abdominal CT scan (with and without contrast)
|
$3,036.80 |
$3,036.80 |
$3,036.80 |
$1,976.94
|
|
Abdominal CT scan (with contrast)
|
$2,656.00 |
$2,656.00 |
$2,656.00 |
$1,667.60
|
|
Abdominal CT scan (without contrast)
|
$2,140.00 |
$2,140.00 |
$2,140.00 |
$1,353.32
|
|
Abdominal MRI (with and without contrast)
|
$4,195.20 |
$4,195.20 |
$4,195.20 |
$2,967.00
|
|
Abdominal MRI (with contrast)
|
$3,488.80 |
$3,488.80 |
$3,488.80 |
$2,240.00
|
|
Abdominal MRI (without contrast)
|
$3,030.40 |
$3,030.40 |
$3,030.40 |
$2,048.36
|
|
Abdominal Ultrasound (complete)
|
$1,000.00 |
$1,000.00 |
$1,000.00 |
$783.00
|
|
Abdominal Ultrasound (limited)
|
$750.40 |
$750.40 |
$750.40 |
$586.43
|
|
Abdominal X-ray (2 views)
|
$392.00 |
$392.00 |
$392.00 |
$318.20
|
|
Abdominal X-ray Series (acute, with chest view)
|
$616.80 |
$616.80 |
$616.80 |
$418.63
|
|
Abdominal X-ray (single view)
|
$308.80 |
$308.80 |
$308.80 |
$260.00
|
|
Abd paracentesis/w/o image guide 49082
|
$1,070.40 |
$1,070.40 |
$1,070.40 |
$1,148.40
|
|
Acetaminophen 10 mg/ml soln 100 ml glass cont
|
$75.72 |
$75.72 |
$75.72 |
$72.74
|
|
Acetaminophen level
|
$50.40 |
$50.40 |
$50.40 |
$116.80
|
|
Acetazolamide 500 mg solution for injection
|
$78.55 |
$78.55 |
$78.55 |
$122.55
|
|
Acetylcysteine 200 mg/ml (20 %) intravenous solution
|
$90.84 |
$90.84 |
$90.84 |
$218.79
|
|
Acetylcysteine non-comp unit
|
$31.48 |
$31.48 |
$31.48 |
$31.21
|
|
Acute hepatitis panel
|
$344.00 |
$344.00 |
$344.00 |
$284.95
|
|
Acyclovir 400 mg tablet
|
$402.12 |
$402.12 |
$402.12 |
$54.77
|
|
Acyclovir 5 mg/ml in ns IV syringe (neo/ped) - cnr
|
$61.59 |
$61.59 |
$61.59 |
$64.45
|
|
Adenosine 3 mg/250 ml bag for osm
|
$61.59 |
$61.59 |
$61.59 |
$271.98
|
|
Admelog u-100 insulin lispro 100 unit/ml subcutaneous solution
|
$29.54 |
$29.54 |
$29.54 |
$193.40
|
|
Administration chemotherapy IV infusion each additional hour
|
$310.40 |
$310.40 |
$310.40 |
$230.35
|
|
Administration chemotherapy IV infusion up to 1 hour single/initial substance/drug
|
$988.80 |
$988.80 |
$988.80 |
$668.98
|
|
Administration chemotherapy subcutaneous/im anti neoplastic hormonal
|
$220.80 |
$220.80 |
$220.80 |
$212.80
|
|
Administration chemotherapy subcutaneous/im anti neoplastic non hormonal
|
$278.40 |
$278.40 |
$278.40 |
$256.49
|
|
Administration immunization each additional vaccine
|
$42.40 |
$42.40 |
$42.40 |
$47.40
|
|
Administration immunization intranasal/oral route 1 vaccine
|
$32.80 |
$32.80 |
$32.80 |
$48.00
|
|
Administration immunization intranasal/oral route each additional vaccine
|
$31.20 |
$31.20 |
$31.20 |
$30.24
|
|
_afb id by dna probe rflx ast
|
$69.60 |
$69.60 |
$69.60 |
$104.50
|
|
Albumin body fluid quantitative each specimen
|
$36.00 |
$36.00 |
$36.00 |
$47.45
|
|
Albumin (human), 25%, 50ml
|
$124.15 |
$124.15 |
$124.15 |
$244.70
|
|
Albumin (microalbumin) 24 hour urine quantitative
|
$96.80 |
$96.80 |
$96.80 |
$58.17
|
|
Albumin serum plasma or whole blood
|
$83.20 |
$83.20 |
$83.20 |
$43.00
|
|
Albuterol ipratrop non-comp
|
$4.80 |
$4.80 |
$4.80 |
$5.67
|
|
Albuterol non-comp con
|
$4.80 |
$4.80 |
$4.80 |
$6.07
|
|
Albuterol non-comp unit
|
$5.40 |
$5.40 |
$5.40 |
$5.40
|
|
Alcohol (ethanol) any specimen except urine/breath
|
$98.40 |
$98.40 |
$98.40 |
$96.00
|
|
Alkaline phosphatase
|
$64.00 |
$64.00 |
$64.00 |
$46.80
|
|
Allergen egg white ige
|
$83.20 |
$83.20 |
$83.20 |
$38.00
|
|
Alpha-1-proteinase inhibitor (human) 1,000 mg (+/-) IV solution
|
$796.00 |
$796.00 |
$796.00 |
$13.14
|
|
Alpha-fetoprotein tumor marker
|
$133.60 |
$133.60 |
$133.60 |
$106.00
|
|
Alprostadil for injection
|
$84.80 |
$84.80 |
$84.80 |
$511.41
|
|
Alt/sgpt
|
$68.80 |
$68.80 |
$68.80 |
$47.50
|
|
Aminocaproic acid 5 g/250 ml 0.9% nacl IV - cnr
|
$64.80 |
$64.80 |
$64.80 |
$37.33
|
|
Aminolevulinic acid delta
|
$100.80 |
$100.80 |
$100.80 |
$87.12
|
|
Aminophylline 25 mg/ml intravenous solution (wrapper)
|
$68.80 |
$68.80 |
$68.80 |
$47.06
|
|
Amiodarone 150 mg/100 ml (1.5 mg/ml) in dextrose, iso-osmotic IV
|
$114.96 |
$114.96 |
$114.96 |
$108.13
|
|
Amiodarone 50 mg/ml intravenous solution
|
$61.43 |
$61.43 |
$61.43 |
$55.86
|
|
Ammonia
|
$222.40 |
$222.40 |
$222.40 |
$119.70
|
|
Ampicillin 1 gram solution for injection
|
$63.28 |
$63.28 |
$63.28 |
$56.70
|
|
Ampicillin-sulbactam 1.5 gram solution for injection
|
$62.80 |
$62.80 |
$62.80 |
$54.57
|
|
Amplification real-time pcr dna markers infectious disease bacterial vaginosis and vaginitis
|
$496.00 |
$496.00 |
$496.00 |
$262.99
|
|
Amylase
|
$80.80 |
$80.80 |
$80.80 |
$90.00
|
|
Analysis gene f2 20210g>a variant
|
$192.00 |
$192.00 |
$192.00 |
$226.85
|
|
Analysis gene f5 leiden variant
|
$236.00 |
$236.00 |
$236.00 |
$249.60
|
|
Anca screen with reflex to titer -quest
|
$129.60 |
$129.60 |
$129.60 |
$101.50
|
|
Angiotensin ii 0.5 mg/ml soln 1 ml vial
|
$70.88 |
$70.88 |
$70.88 |
$2,979.43
|
|
Ankle X-ray
|
$368.00 |
$368.00 |
$368.00 |
$356.32
|
|
Ankle X-ray (2 views, both ankles)
|
$308.80 |
$308.80 |
$308.80 |
$282.96
|
|
Anora (draw only)
|
$48.00 |
$48.00 |
$48.00 |
$35.00
|
|
Antibody bacterium, not elsewhere specified
|
$30.40 |
$30.40 |
$30.40 |
$57.85
|
|
Antibody htlv/hiv confirm test
|
$313.60 |
$313.60 |
$313.60 |
$131.56
|
|
Antibody htlv-i
|
$78.40 |
$78.40 |
$78.40 |
$49.53
|
|
Antibody id rbc panel
|
$230.40 |
$230.40 |
$230.40 |
$291.75
|
|
Antibody screen rbc
|
$72.00 |
$72.00 |
$72.00 |
$108.55
|
|
Antibody tetanus
|
$136.80 |
$136.80 |
$136.80 |
$54.15
|
|
Antineutrophil cytoplasmic antibody screen each antibody
|
$48.80 |
$48.80 |
$48.80 |
$38.50
|
|
Antineutrophil cytoplasmic antibody titer each antibody
|
$83.20 |
$83.20 |
$83.20 |
$42.00
|
|
Antinuclear antibodies
|
$64.80 |
$64.80 |
$64.80 |
$90.00
|
|
Antinuclear antibodies titer
|
$60.80 |
$60.80 |
$60.80 |
$80.04
|
|
Antistreptolysin o titer
|
$81.60 |
$81.60 |
$81.60 |
$54.00
|
|
Antithrombin iii activity
|
$290.40 |
$290.40 |
$290.40 |
$115.15
|
|
Aortic Aneurysm Screening Ultrasound
|
$512.80 |
$512.80 |
$512.80 |
$394.55
|
|
Application finger splntstatic 29130
|
$194.40 |
$194.40 |
$194.40 |
$208.50
|
|
Application long leg splint 29505
|
$290.40 |
$290.40 |
$290.40 |
$338.25
|
|
Application lower leg splint 29515
|
$268.00 |
$268.00 |
$268.00 |
$340.20
|
|
Application multi layer compression below knee (both sides)
|
$381.60 |
$381.60 |
$381.60 |
$375.06
|
|
Application of forearm cast 29075
|
$211.20 |
$211.20 |
$211.20 |
$358.20
|
|
Application of long arm cast 29065
|
$253.60 |
$253.60 |
$253.60 |
$396.77
|
|
Application of paste boot 29580
|
$251.20 |
$251.20 |
$251.20 |
$340.11
|
|
Application short leg cast 29405
|
$256.00 |
$256.00 |
$256.00 |
$393.98
|
|
Appl modality 1/> areas paraffin bath 97018
|
$107.20 |
$107.20 |
$107.20 |
$69.00
|
|
Appl modality 1/> areas vasopneumatic devices 97016
|
$112.80 |
$112.80 |
$112.80 |
$75.98
|
|
Apply forearm splintdynamic 29126
|
$276.00 |
$276.00 |
$276.00 |
$255.20
|
|
Apply of finger splint 29131
|
$183.20 |
$183.20 |
$183.20 |
$177.45
|
|
Apply short leg castambul type 29425
|
$241.60 |
$241.60 |
$241.60 |
$404.74
|
|
Arm CT Scan (with contrast, both arms)
|
$2,285.60 |
$2,285.60 |
$2,285.60 |
$1,687.88
|
|
Arm CT Scan (without contrast, both arms)
|
$1,955.20 |
$1,955.20 |
$1,955.20 |
$1,380.00
|
|
Arm or Leg Ultrasound (limited, left side)
|
$505.60 |
$505.60 |
$505.60 |
$426.00
|
|
Arthrocentesis/aspiration/injection intermediate joint/bursa without ultrasound guidance right
|
$484.80 |
$484.80 |
$484.80 |
$609.00
|
|
Asp core fat pad
|
$2,631.20 |
$2,631.20 |
$2,631.20 |
$1,123.50
|
|
Aspirate pleura without imaging 32554
|
$1,015.20 |
$1,015.20 |
$1,015.20 |
$1,195.15
|
|
Assay dir meas fr estradiol
|
$68.00 |
$68.00 |
$68.00 |
$68.00
|
|
Assay of salicylate
|
$60.80 |
$60.80 |
$60.80 |
$96.50
|
