|
Abdominal CT scan (with and without contrast)
|
$5,079.39 |
$5,079.39 |
$5,079.39 |
$2,049.00
|
|
Abdominal CT scan (with contrast)
|
$4,701.85 |
$4,701.85 |
$4,701.85 |
$1,683.63
|
|
Abdominal CT scan (without contrast)
|
$4,079.16 |
$4,079.16 |
$4,079.16 |
$1,358.76
|
|
Abdominal Ultrasound (complete)
|
$1,356.39 |
$1,356.39 |
$1,356.39 |
$759.57
|
|
Abdominal Ultrasound (limited)
|
$1,242.44 |
$1,242.44 |
$1,242.44 |
$603.33
|
|
Acetaminophen 10 mg/ml soln 100 ml glass cont
|
$139.05 |
$139.05 |
$139.05 |
$125.63
|
|
Acetaminophen level
|
$302.10 |
$302.10 |
$302.10 |
$117.01
|
|
Acetazolamide 500 mg solution for injection
|
$246.40 |
$246.40 |
$246.40 |
$133.60
|
|
Acetylcholine receptor modulating antibody
|
$149.46 |
$149.46 |
$149.46 |
$65.60
|
|
Acetylcysteine 200 mg/ml (20 %) intravenous solution
|
$110.18 |
$110.18 |
$110.18 |
$323.77
|
|
Acute hepatitis panel
|
$841.45 |
$841.45 |
$841.45 |
$284.70
|
|
Acyclovir 5 mg/ml in ns IV syringe (neo/ped) - cnr
|
$50.85 |
$50.85 |
$50.85 |
$50.70
|
|
Adenosine 3 mg/250 ml bag for osm
|
$762.46 |
$762.46 |
$762.46 |
$219.86
|
|
Adh-sendout
|
$433.43 |
$433.43 |
$433.43 |
$109.28
|
|
Admelog u-100 insulin lispro 100 unit/ml subcutaneous solution
|
$42.99 |
$42.99 |
$42.99 |
$124.70
|
|
Administration immunization 1 vaccine
|
$215.25 |
$215.25 |
$215.25 |
$70.52
|
|
Administration immunization each additional vaccine
|
$34.95 |
$34.95 |
$34.95 |
$46.23
|
|
Administration vaccine influenza virus
|
$566.00 |
$566.00 |
$566.00 |
$49.50
|
|
Albumin (human), 25%, 50ml
|
$1,217.81 |
$1,217.81 |
$1,217.81 |
$295.80
|
|
Albumin, human 25 % intravenous solution
|
$765.64 |
$765.64 |
$765.64 |
$488.08
|
|
Albumin (human), 5%, 250 ml
|
$1,229.57 |
$1,229.57 |
$1,229.57 |
$295.80
|
|
Albumin (microalbumin) 24 hour urine quantitative
|
$223.41 |
$223.41 |
$223.41 |
$57.60
|
|
Albumin serum plasma or whole blood
|
$93.53 |
$93.53 |
$93.53 |
$43.50
|
|
Albuterol ipratrop non-comp
|
$24.95 |
$24.95 |
$24.95 |
$22.45
|
|
Albuterol non-comp unit
|
$7.18 |
$7.18 |
$7.18 |
$9.59
|
|
Alcohol (ethanol) any specimen except urine/breath
|
$357.06 |
$357.06 |
$357.06 |
$93.60
|
|
Alkaline phosphatase
|
$160.38 |
$160.38 |
$160.38 |
$46.20
|
|
Allergen alpha lactalbumin ige
|
$219.91 |
$219.91 |
$219.91 |
$56.35
|
|
Allergen egg white ige
|
$145.91 |
$145.91 |
$145.91 |
$41.00
|
|
Allograft epieffect 2x3cm-q4186-cost per sq cm
|
$1,722.91 |
$1,722.91 |
$1,722.91 |
$905.18
|
|
Alpha-fetoprotein tumor marker
|
$271.79 |
$271.79 |
$271.79 |
$99.00
|
|
Alteplase 100 mg infusion from pyxis vial
|
$766.25 |
$766.25 |
$766.25 |
$2,600.22
|
|
Alt/sgpt
|
$85.90 |
$85.90 |
$85.90 |
$49.00
|
|
Aminophylline 25 mg/ml intravenous solution (wrapper)
|
$42.10 |
$42.10 |
$42.10 |
$41.59
|
|
Amiodarone 150 mg/100 ml (1.5 mg/ml) in dextrose, iso-osmotic IV
|
$603.78 |
$603.78 |
$603.78 |
$202.10
|
|
Amiodarone 50 mg/ml intravenous solution
|
$101.75 |
$101.75 |
$101.75 |
$47.44
|
|
Amivantamab-vmjw 50 mg/ml intravenous solution
|
$11,477.86 |
$11,477.86 |
$11,477.86 |
$15,167.75
|
|
Ammonia
|
$232.94 |
$232.94 |
$232.94 |
$120.90
|
|
Ampicillin 1 gram solution for injection
|
$100.41 |
$100.41 |
$100.41 |
$57.76
|
|
Ampicillin-sulbactam 1.5 gram solution for injection
|
$198.60 |
$198.60 |
$198.60 |
$51.93
|
|
Amplification real-time pcr dna markers infectious disease bacterial vaginosis and vaginitis
|
$788.97 |
$788.97 |
$788.97 |
$312.00
|
|
Amylase
|
$228.48 |
$228.48 |
$228.48 |
$93.00
|
|
Analysis gene f5 leiden variant
|
$899.90 |
$899.90 |
$899.90 |
$226.60
|
|
Angiotensin ii 0.5 mg/ml soln 1 ml vial
|
$14,669.95 |
$14,669.95 |
$14,669.95 |
$6,736.02
|
|
Ankle X-ray
|
$663.23 |
$663.23 |
$663.23 |
$339.44
|
|
Antibody elution rbc reference
|
$428.52 |
$428.52 |
$428.52 |
$176.54
|
|
Antibody htlv/hiv confirm test
|
$942.82 |
$942.82 |
$942.82 |
$141.74
|
|
Antibody id rbc panel
|
$338.66 |
$338.66 |
$338.66 |
$291.75
|
|
Antibody screen rbc
|
$161.24 |
$161.24 |
$161.24 |
$105.00
|
|
Anti mog serum - sendout
|
$419.64 |
$419.64 |
$419.64 |
$140.62
|
|
Antineutrophil cytoplasmic antibody screen each antibody
|
$185.22 |
$185.22 |
$185.22 |
$50.88
|
|
Antinuclear antibodies
|
$291.80 |
$291.80 |
$291.80 |
$91.70
|
|
Antinuclear antibodies titer
|
$377.90 |
$377.90 |
$377.90 |
$80.25
|
|
App high cost ss f/n/g/h/f <100sq cm addl <25sq cm
|
$1,317.32 |
$1,317.32 |
$1,317.32 |
$549.08
|
|
Application finger splntstatic 29130
|
$735.49 |
$735.49 |
$735.49 |
$216.80
|
|
Application long leg splint 29505
|
$1,798.42 |
$1,798.42 |
$1,798.42 |
$340.80
|
|
Application lower leg splint 29515
|
$1,064.78 |
$1,064.78 |
$1,064.78 |
$355.85
|
|
Application multi layer compression below knee (both sides)
|
$673.45 |
$673.45 |
$673.45 |
$397.00
|
|
Application of forearm cast 29075
|
$1,578.53 |
$1,578.53 |
$1,578.53 |
$379.20
|
|
Application of paste boot 29580
|
$1,062.85 |
$1,062.85 |
$1,062.85 |
$331.74
|
|
Application short leg cast 29405
|
$1,000.10 |
$1,000.10 |
$1,000.10 |
$393.98
|
|
Application skin substitute graft face/scalp/neck/genit/hnd/ft <100 sq cm 1st 25 sq cm
|
$2,634.67 |
$2,634.67 |
$2,634.67 |
$2,148.25
|
|
Application skin substitute graft trunk/arms/legs <100 sq cm 1st 25 sq cm
|
$2,873.35 |
$2,873.35 |
$2,873.35 |
$2,120.95
|
|
Apply intrcav radiat compl
|
$9,218.31 |
$9,218.31 |
$9,218.31 |
$1,717.51
|
|
Apply intrcav radiat interm
|
$7,013.06 |
$7,013.06 |
$7,013.06 |
$1,338.48
|
|
Apply intrcav radiat simple
|
$7,013.06 |
$7,013.06 |
$7,013.06 |
$1,001.00
|
|
Apply rigid leg cast 29445
|
$1,509.32 |
$1,509.32 |
$1,509.32 |
$608.00
|
|
Aprepitant 130 mg/18 ml (7.2 mg/ml) intravenous emulsion
|
$1,244.67 |
$1,244.67 |
$1,244.67 |
$943.40
|
|
Aqua therapy w/exercise/ea 15 min 97113
|
$340.77 |
$340.77 |
$340.77 |
$98.90
|
|
Aquatic exercise - group charge
|
$191.40 |
$191.40 |
$191.40 |
$87.60
|
|
Arsenic trioxide 2 mg/ml intravenous solution
|
$280.53 |
$280.53 |
$280.53 |
$1,303.25
|
|
Arthrocentesis/aspiration/injection intermediate joint/bursa without ultrasound guidance right
|
$592.94 |
$592.94 |
$592.94 |
$567.78
|
|
Arthrocentesis/aspiration/injection major joint/bursa w/ultrasound guidance (both sides)
|
$984.66 |
$984.66 |
$984.66 |
$910.79
|
|
Arthrocentesis/aspiration/inj major joint/bursa without Ultrasound guidance (both sides)
|
$658.01 |
$658.01 |
$658.01 |
$698.58
|
|
Assay of salicylate
|
$282.53 |
$282.53 |
$282.53 |
$105.95
|
|
Assessment leukocyte fecal qualitative/semiquantitative
|
$161.70 |
$161.70 |
$161.70 |
$49.80
|
|
Ast/sgot
|
$83.96 |
$83.96 |
$83.96 |
$45.65
|
|
Atezolizumab 60 mg/ml intravenous solution (wrapper)
|
$11,254.66 |
$11,254.66 |
$11,254.66 |
$31,208.35
|
|
Atropine 0.1 mg/ml injection syringe
|
$81.29 |
$81.29 |
$81.29 |
$43.01
|
|
Avulsion nail plate partial/complete simple single nail plate
|
$514.22 |
$514.22 |
$514.22 |
$342.55
|
|
Azacitidine injection
|
$166.03 |
$166.03 |
$166.03 |
$912.29
|
|
Azithromycin 500 mg intravenous solution
|
$101.40 |
$101.40 |
$101.40 |
$52.69
|
|
Bacterial vaginosis pcr
|
$210.60 |
$210.60 |
$210.60 |
$298.04
|
|
Bendamustine 25 mg/ml intravenous solution (bendeka)
|
$2,584.84 |
$2,584.84 |
$2,584.84 |
$6,720.38
|
|
Benign lesion paring 2-4
|
$429.38 |
$429.38 |
$429.38 |
$275.49
|
|
#_benzodiazconfur
|
$209.03 |
$209.03 |
$209.03 |
$99.72
|
|
Benztropine 1 mg/ml injection solution
|
$100.96 |
$100.96 |
$100.96 |
$121.88
|
|
Beta-2 microglobulin
|
$290.34 |
$290.34 |
$290.34 |
$84.66
|
|
Betamethasone acetate and sodium phos 6 mg/ml suspension for injection
|
$122.37 |
$122.37 |
$122.37 |
$75.12
|
|
Bevacizumab 25 mg/ml intravenous solution
|
$3,439.40 |
$3,439.40 |
$3,439.40 |
$4,905.00
|
|
Bevacizumab-awwb 25 mg/ml intravenous solution
|
$636.47 |
$636.47 |
$636.47 |
$3,871.35
|
|
Bevacizumab injection
|
$693.24 |
$693.24 |
$693.24 |
$1,011.80
|
|
Bilateral n block inj trigeminal 64400
|
$1,426.83 |
$1,426.83 |
$1,426.83 |
$593.45
|
|
Bilirubin direct
|
$133.68 |
$133.68 |
$133.68 |
$49.29
|
|
Bilirubin total
|
$118.39 |
$118.39 |
$118.39 |
$51.39
|
|
Biopsy bone trocar/needle superficial
|
$2,505.32 |
$2,505.32 |
$2,505.32 |
$1,694.59
|
|
Blood Clotting (PT/INR) Test
|
$279.69 |
$279.69 |
$279.69 |
$51.35
|
|
Blood Clotting (PTT) Test
|
$265.85 |
$265.85 |
$265.85 |
$72.15
|
|
Blood Count (CBC) Test
|
$268.66 |
$268.66 |
$268.66 |
$72.41
|
|
Blood Count (CBC) Test (without differential)
|
$185.46 |
$185.46 |
$185.46 |
$62.28
|