|
Alemtuzumab 12 mg/1.2 ml intravenous solution
|
$33,418.71 |
$33,418.71 |
$33,418.71 |
|
|
Alkaline phosphatase
|
$28.80 |
$62.40 |
$73.60 |
|
|
Allergen alpha lactalbumin ige
|
$52.00 |
$52.00 |
$66.40 |
|
|
Allergen egg white ige
|
$24.80 |
$48.00 |
$83.20 |
|
|
Allograft amnioexcel plus 17mm disk
|
$1,331.20 |
$1,331.20 |
$1,331.20 |
|
|
Allograft dermis 20x25x1mm decell w/matracell arthroflex
|
$350.01 |
$479.20 |
$1,196.80 |
|
|
Allograft ecm allopatch hd dehydr thick 0.8-1.7mmx2x5cm-cost per sq cm
|
$1,038.40 |
$1,038.40 |
$1,038.40 |
|
|
Allograft epieffect 2x3cm-q4186-cost per sq cm
|
$298.40 |
$703.20 |
$1,491.20 |
|
|
Allograft graftjacket 2x12cm-q4107-cost per sq cm
|
$253.60 |
$253.60 |
$253.60 |
|
|
Allograft membrn amnio 1x2cm hu ambriodry
|
$8,280.00 |
$8,280.00 |
$8,280.00 |
|
|
Allograft umbil cord+amniotic membrane-q4148-cost per sq cm
|
$562.40 |
$562.40 |
$562.40 |
|
|
Allograft umbilical epicord 15 sq cm-q4187-cost per sq cm
|
$901.34 |
$901.34 |
$901.34 |
|
|
All tstg perq&iq drugs/biol
|
$66.40 |
$66.40 |
$66.40 |
|
|
Alpha-1-proteinase inhibitor (human) 1,000 mg (+/-) IV solution
|
$796.00 |
$796.00 |
$1,576.00 |
|
|
Alpha-fetoprotein tumor marker
|
$76.00 |
$133.60 |
$154.40 |
|
|
Alprostadil for injection
|
$84.80 |
$89.99 |
$403.72 |
|
|
Als1-emergency
|
$1,412.80 |
$1,412.80 |
$1,534.40 |
|
|
Als 2
|
$1,836.00 |
$1,836.00 |
$1,836.00 |
|
|
Alteplase 100 mg infusion from pyxis vial
|
$12,473.57 |
$12,473.57 |
$23,176.60 |
|
|
Alt/sgpt
|
$34.40 |
$41.60 |
$84.00 |
|
|
Amikacin 4 mg/ml intravitreal injection - cnr
|
$328.64 |
$328.64 |
$328.64 |
|
|
Aminocaproic acid 5 g/250 ml 0.9% nacl IV - cnr
|
$64.80 |
$64.80 |
$315.41 |
|
|
Aminolevulinic acid delta
|
$100.80 |
$104.00 |
$144.00 |
|
|
Aminophylline 25 mg/ml intravenous solution (wrapper)
|
$65.88 |
$68.68 |
$319.88 |
|
|
Amiodarone 150 mg/100 ml (1.5 mg/ml) in dextrose, iso-osmotic IV
|
$114.96 |
$150.55 |
$325.60 |
|
|
Amiodarone 50 mg/ml intravenous solution
|
$61.29 |
$61.43 |
$324.66 |
|
|
Ammonia
|
$82.40 |
$168.80 |
$224.80 |
|
|
Amniocentesisdiagnostic 59000
|
$675.20 |
$675.20 |
$1,276.00 |
|
|
Amniocentesis therapeutic
|
$751.20 |
$751.20 |
$980.00 |
|
|
Amobarbital 125 mg inj
|
$2,038.73 |
$2,038.73 |
$2,038.73 |
|
|
Amphetamine confirm urine -sendout
|
$57.60 |
$57.60 |
$57.60 |
|
|
Amphotericin b in d5w IV syringe 0.1 mg/ml (neo/ped) - cnr
|
$339.60 |
$339.60 |
$339.60 |
|
|
Amphotericin b liposomal in d5w IV syringe 1 mg/ml (neo/ped) - cnr
|
$114.14 |
$114.14 |
$373.00 |
|
|
Ampicillin 1 gram solution for injection
|
$61.95 |
$62.03 |
$325.98 |
|
|
Ampicillin-sulbactam 1.5 gram solution for injection
|
$62.66 |
$63.92 |
$357.52 |
|
|
Amplification real-time pcr dna markers infectious disease bacterial vaginosis and vaginitis
|
$496.00 |
$496.00 |
$496.00 |
|
|
Amputation toe interphalangeal joint
|
$2,777.60 |
$2,777.60 |
$2,777.60 |
|
|
Amputation toe metatarsophalangeal joint
|
$3,418.40 |
$3,418.40 |
$4,535.20 |
|
|
Amylase
|
$36.00 |
$80.80 |
$87.20 |
|
|
Anabolic steroid 1 or 2
|
$136.00 |
$136.00 |
$136.00 |
|
|
Ana ds-dna
|
$204.80 |
$204.80 |
$288.80 |
|
|
Anal/urinary muscle study
|
$367.20 |
$367.20 |
$367.20 |
|
|
Anal/urinary muscle study
|
$760.00 |
$760.00 |
$760.00 |
|
|
Analysis gene f2 20210g>a variant
|
$192.00 |
$280.00 |
$437.60 |
|
|
Analysis gene f5 leiden variant
|
$192.00 |
$252.00 |
$400.00 |
|
|
Analysis tumor
|
$208.80 |
$208.80 |
$208.80 |
|
|
Anastrozole 1 mg
|
$1.20 |
$1.20 |
$3.76 |
|
|
Anca screen with reflex to titer -quest
|
$111.20 |
$129.60 |
$172.00 |
|
|
An cholangiogram percutaneous compl
|
$1,708.80 |
$1,708.80 |
$3,182.40 |
|
|
An fluoro guide for cvp
|
$722.40 |
$785.60 |
$1,046.40 |
|
|
Angio balloon ctrl dialysis seg add-on
|
$10,348.80 |
$10,348.80 |
$10,480.00 |
|
|
Angiotensin ii 0.5 mg/ml soln 1 ml vial
|
$70.88 |
$165.33 |
$2,797.96 |
|
|
Angio trnslmnl balloon same artery ea addl
|
$7,900.00 |
$7,900.00 |
$9,336.00 |
|
|
Angio trnslmnl balloon same artery ini
|
$14,820.00 |
$14,820.00 |
$14,962.40 |
|
|
Angio trnslmnl balloon same vein ea addl
|
$7,196.00 |
$7,196.00 |
$7,196.00 |
|
|
Angio trnslmnl balloon same vein ini
|
$12,636.00 |
$12,636.00 |
$12,636.00 |
|
|
Anidulafungin injection
|
$309.88 |
$309.88 |
$309.88 |
|
|
Ankle X-ray
|
$272.00 |
$376.80 |
$467.20 |
|
|
Ankle X-ray (2 views, both ankles)
|
$252.00 |
$304.00 |
$342.40 |
|
|
Anl sp inf pmp w/mdreprg&fil
|
$849.60 |
$849.60 |
$849.60 |
|
|
Anodyne therapy charges pt
|
$53.60 |
$66.40 |
$101.60 |
|
|
Anogenital exam child w imag
|
$171.20 |
$171.20 |
$171.20 |
|
|
Anora (draw only)
|
$40.80 |
$48.00 |
$52.00 |
|
|
Anoscopy remove fb 46608
|
$1,429.60 |
$1,443.20 |
$1,610.40 |
|
|
Antibody bacterium, not elsewhere specified
|
$30.40 |
$32.00 |
$32.00 |
|
|
Antibody elution rbc reference
|
$129.60 |
$129.60 |
$166.40 |
|
|
Antibody htlv/hiv confirm test
|
$178.40 |
$224.80 |
$313.60 |
|
|
Antibody htlv-i
|
$78.40 |
$78.40 |
$78.40 |
|
|
Antibody identification platelet antibodies heparin-pf4 igg
|
$187.20 |
$215.20 |
$224.00 |
|
|
Antibody id rbc panel
|
$86.40 |
$258.40 |
$341.60 |
|
|
Antibody screen rbc
|
$14.29 |
$68.80 |
$116.00 |
|
|
Antibody tetanus
|
$92.80 |
$104.80 |
$136.80 |
|
|
Antihemophilic factor-vwf 250 unit-600 unit intravenous solution
|
$1.92 |
$1.92 |
$1.92 |
|
|
Antihemophilic viii/vwf comp
|
$0.36 |
$0.36 |
$0.36 |
|
|
Anti-inhibitor
|
$1.77 |
$1.77 |
$1.77 |
|
|
Antineutrophil cytoplasmic antibody screen each antibody
|
$48.80 |
$56.00 |
$56.80 |
|
|
Antineutrophil cytoplasmic antibody titer each antibody
|
$40.00 |
$56.00 |
$83.20 |
|
|
Antinuclear antibodies
|
$60.00 |
$64.80 |
$120.80 |
|
|
Antinuclear antibodies titer
|
$56.00 |
$60.80 |
$82.40 |
|
|
Antistreptolysin o screen
|
$80.00 |
$80.00 |
$80.00 |
|
|
Antistreptolysin o titer
|
$53.60 |
$81.60 |
$86.40 |
|
|
Antithrombin iii activity
|
$95.20 |
$164.00 |
$290.40 |
|
|
Antithrombin iii injection
|
$2.72 |
$2.72 |
$2.72 |
|
|
Anti-thymocyte glob (equine)(1:1000) intradermal test dose
|
$5,344.19 |
$5,344.19 |
$5,344.19 |
|
|
Antithymocyte globuln rabbit
|
$2,171.17 |
$2,171.17 |
$2,171.17 |
|
|
Aortic Aneurysm Screening Ultrasound
|
$462.40 |
$500.00 |
$623.20 |
|
|
Apheresis plasma
|
$4,280.80 |
$4,280.80 |
$4,280.80 |
|
|
Apheresis platelets
|
$3,225.60 |
$3,225.60 |
$3,672.80 |
|
|
Apheresis rbc
|
$4,264.00 |
$4,264.00 |
$4,264.00 |
|
|
Apheresis wbc
|
$4,450.40 |
$4,450.40 |
$4,450.40 |
|
|
App high cost ss f/n/g/h/f >100sq cm 1st 100sq cm
|
$3,481.60 |
$3,481.60 |
$3,586.40 |
|
|
App high cost ss f/n/g/h/f >100sq cm addl 100sq cm
|
$1,968.80 |
$1,968.80 |
$2,055.20 |
|
|
App high cost ss f/n/g/h/f <100sq cm addl <25sq cm
|
$1,712.00 |
$1,712.00 |
$1,763.20 |
|
|
App high cost ss t/a/l >100sq cm 1st 100sq cm
|
$5,147.20 |
$5,147.20 |
$5,224.80 |
|
|
App high cost ss t/a/l >100sq cm addl 100sq cm
|
$2,744.00 |
$2,744.00 |
$2,744.80 |
|
|
App high cost ss t/a/l <100sq cm addl <25sq cm
|
$1,200.00 |
$1,763.20 |
$1,850.40 |
|
|
Application clubfoot cast
|
$364.00 |
$364.00 |
$364.00 |
|
|
Application finger splntstatic 29130
|
$194.40 |
$204.80 |
$291.20 |
|
|
Application long leg splint 29505
|
$285.60 |
$290.40 |
$363.20 |
|
|
Application lower leg splint 29515
|
$264.80 |
$278.40 |
$396.00 |
|
