|
Adjmt/revj ext fixj sys anes
|
$5,886.74 |
$5,886.74 |
$5,886.74 |
$8,261.40
|
|
Adj tis trans/see area/10.1-30sqcm 14041
|
$3,903.05 |
$3,903.05 |
$3,903.05 |
$3,397.11
|
|
Admelog u-100 insulin lispro 100 unit/ml subcutaneous solution
|
$1,784.40 |
$1,784.40 |
$1,784.40 |
$193.40
|
|
Admin ecg contrast agent
|
$276.93 |
$276.93 |
$276.93 |
$120.78
|
|
Administration chemotherapy IV infusion each additional hour
|
$200.88 |
$200.88 |
$200.88 |
$230.35
|
|
Administration chemotherapy IV infusion each addl sequential infusion diff substance/drug >1 hr
|
$401.17 |
$401.17 |
$401.17 |
$298.98
|
|
Administration chemotherapy IV infusion up to 1 hour single/initial substance/drug
|
$521.90 |
$521.90 |
$521.90 |
$668.98
|
|
Administration chemotherapy IV push single/initial substance/drug
|
$534.39 |
$534.39 |
$534.39 |
$439.20
|
|
Administration chemotherapy subcutaneous/im anti neoplastic hormonal
|
$179.24 |
$179.24 |
$179.24 |
$212.80
|
|
Administration chemotherapy subcutaneous/im anti neoplastic non hormonal
|
$306.40 |
$306.40 |
$306.40 |
$256.49
|
|
Administration immunization each additional component
|
$22.38 |
$22.38 |
$22.38 |
$29.20
|
|
Administration immunization each additional vaccine
|
$43.55 |
$43.55 |
$43.55 |
$47.40
|
|
Administration immunization first component each vaccine
|
$46.00 |
$46.00 |
$46.00 |
$46.40
|
|
Administration immunization intranasal/oral route 1 vaccine
|
$50.40 |
$50.40 |
$50.40 |
$48.00
|
|
Administration immunization intranasal/oral route each additional vaccine
|
$35.28 |
$35.28 |
$35.28 |
$30.24
|
|
Administration rsv monoclonal ab seasonal dose im w/counseling
|
$29.65 |
$29.65 |
$29.65 |
$44.80
|
|
Administration vaccine hepatitis b
|
$44.44 |
$44.44 |
$44.44 |
$53.00
|
|
Administration vaccine influenza virus
|
$15.00 |
$15.00 |
$15.00 |
$51.07
|
|
Administration vaccine pneumococcal
|
$45.91 |
$45.91 |
$45.91 |
$49.68
|
|
Administration vaccine rsv monoclonal ab seasonal dose im
|
$26.66 |
$26.66 |
$26.66 |
$41.45
|
|
Ado-trastuzumab emtansine 100 mg intravenous solution
|
$11,350.31 |
$11,350.31 |
$11,350.31 |
$11,350.31
|
|
Adrenal cortex & medulla img
|
$4,684.17 |
$4,684.17 |
$4,684.17 |
$1,987.70
|
|
Adrenalin epinephrine inject
|
$7.76 |
$7.76 |
$7.76 |
$231.47
|
|
Aep hearing status deter i&r
|
$308.40 |
$308.40 |
$308.40 |
$303.00
|
|
Aep neurodiagnostic i&r
|
$746.20 |
$746.20 |
$746.20 |
$583.80
|
|
Aep thrshld est mlt freq i&r
|
$746.20 |
$746.20 |
$746.20 |
$635.00
|
|
_afb id by dna probe rflx ast
|
$292.41 |
$292.41 |
$292.41 |
$104.50
|
|
#afb mycobacteria suscep. #1
|
$38.75 |
$38.75 |
$38.75 |
$34.72
|
|
_afb org id by sequencing rflx ast-sendout
|
$459.54 |
$459.54 |
$459.54 |
$300.00
|
|
Afo molded to patient plasti
|
$443.40 |
$443.40 |
$443.40 |
$697.20
|
|
Afo rig ant tib tcf/= custom
|
$1,225.69 |
$1,225.69 |
$1,225.69 |
$1,843.53
|
|
Afo tib fx semi-rigid l2114
|
$121.64 |
$121.64 |
$121.64 |
$817.60
|
|
After cataract laser surgery
|
$1,637.51 |
$1,637.51 |
$1,637.51 |
$1,373.11
|
|
Agalsidase beta 35 mg intravenous solution
|
$13,418.51 |
$13,418.51 |
$13,418.51 |
$14,475.20
|
|
Air conduction bilat
|
$159.21 |
$159.21 |
$159.21 |
$134.00
|
|
Air injection into abdomen 49400
|
$330.02 |
$330.02 |
$330.02 |
$525.60
|
|
Airway resistance by impulse oscillometry 94728
|
$370.15 |
$370.15 |
$370.15 |
$297.00
|
|
Albumin body fluid quantitative each specimen
|
$61.52 |
$61.52 |
$61.52 |
$47.45
|
|
Albumin (human), 25%, 50ml
|
$327.39 |
$327.39 |
$327.39 |
$244.70
|
|
Albumin (human), 5%, 250 ml
|
$258.00 |
$258.00 |
$258.00 |
$252.77
|
|
Albumin ischemia modified
|
$50.28 |
$50.28 |
$50.28 |
$85.60
|
|
Albumin (microalbumin) 24 hour urine quantitative
|
$77.51 |
$77.51 |
$77.51 |
$58.17
|
|
Albumin serum plasma or whole blood
|
$56.80 |
$56.80 |
$56.80 |
$43.00
|
|
Albuterol non-comp unit
|
$0.96 |
$0.96 |
$0.96 |
$5.40
|
|
Alcohol (ethanol) any specimen except urine/breath
|
$50.23 |
$50.23 |
$50.23 |
$96.00
|
|
Alcohol/subs interv 15-30mn
|
$112.58 |
$112.58 |
$112.58 |
$56.70
|
|
Alcohol/subs interv >30 min
|
$128.30 |
$128.30 |
$128.30 |
$190.13
|
|
Aldesleukin injection
|
$8,460.48 |
$8,460.48 |
$8,460.48 |
$9,030.11
|
|
Alkaline phosphatase
|
$57.10 |
$57.10 |
$57.10 |
$46.80
|
|
Allergen alpha lactalbumin ige
|
$100.50 |
$100.50 |
$100.50 |
$48.57
|
|
Allergen egg white ige
|
$260.57 |
$260.57 |
$260.57 |
$38.00
|
|
Allergen specific ige qual multi scrn ea
|
$45.30 |
$45.30 |
$45.30 |
$24.00
|
|
Allergy injections; 2 or more 95117
|
$69.80 |
$69.80 |
$69.80 |
$45.00
|
|
Allergy injection; single 95115
|
$46.80 |
$46.80 |
$46.80 |
$46.80
|
|
Allergy Skin Testing
|
$14.40 |
$14.40 |
$14.40 |
$47.44
|
|
Allg patch or app # of tests 95044
|
$72.75 |
$72.75 |
$72.75 |
$423.37
|
|
Allgrft implnt knee w/scope
|
$10,629.07 |
$10,629.07 |
$10,629.07 |
$6,411.60
|
|
Allograft allowrap 4x4cm dry 16sqcm
|
$617.65 |
$617.65 |
$617.65 |
$5,399.16
|
|
Allograft amnioexcel plus 17mm disk
|
$0.01 |
$0.01 |
$0.01 |
$497.95
|
|
Allograft dermis 20x25x1mm decell w/matracell arthroflex
|
$1,002.56 |
$1,002.56 |
$1,002.56 |
$6,285.56
|
|
Allograft ecm allopatch hd dehydr thick 0.8-1.7mmx2x5cm-cost per sq cm
|
$17,608.49 |
$17,608.49 |
$17,608.49 |
$20,311.34
|
|
Allograft epieffect 2x3cm-q4186-cost per sq cm
|
$13,249.84 |
$13,249.84 |
$13,249.84 |
$858.66
|
|
Allograft graftjacket 2x12cm-q4107-cost per sq cm
|
$5,705.88 |
$5,705.88 |
$5,705.88 |
$4,677.40
|
|
Allograft umbilical epicord 15 sq cm-q4187-cost per sq cm
|
$646.80 |
$646.80 |
$646.80 |
$1,225.35
|
|
All tstg perq&iq drugs/biol
|
$58.63 |
$58.63 |
$58.63 |
$64.80
|
|
All tstg perq&iq w/venoms
|
$47.65 |
$47.65 |
$47.65 |
$41.34
|
|
Alpha-1-proteinase inhibitor (human) 1,000 mg (+/-) IV solution
|
$18.72 |
$18.72 |
$18.72 |
$13.14
|
|
Alpha-fetoprotein afp-l3 frac & total
|
$303.14 |
$303.14 |
$303.14 |
$198.60
|
|
Alpha-fetoprotein amniotic
|
$102.49 |
$102.49 |
$102.49 |
$89.04
|
|
Alpha-fetoprotein tumor marker
|
$252.87 |
$252.87 |
$252.87 |
$106.00
|
|
Alprostadil for injection
|
$460.40 |
$460.40 |
$460.40 |
$511.41
|
|
Als 1
|
$285.77 |
$285.77 |
$285.77 |
$853.44
|
|
Als1-emergency
|
$457.49 |
$457.49 |
$457.49 |
$1,103.37
|
|
Als 2
|
$764.16 |
$764.16 |
$764.16 |
$1,288.56
|
|
Alteplase 100 mg infusion from pyxis vial
|
$15,857.45 |
$15,857.45 |
$15,857.45 |
$15,857.45
|
|
Alt/sgpt
|
$56.15 |
$56.15 |
$56.15 |
$47.50
|
|
Aluminum - quest
|
$127.37 |
$127.37 |
$127.37 |
$83.05
|
|
Alveoloplasty each quadrant
|
$2,821.15 |
$2,821.15 |
$2,821.15 |
$3,892.00
|
|
Alys cplx sp/pn npgt w/prgrm
|
$614.16 |
$614.16 |
$614.16 |
$411.45
|
|
Amantadine (symmetrel)-sendout
|
$747.00 |
$747.00 |
$747.00 |
$179.70
|
|
Ambl bp mntr w/sw a/r
|
$334.74 |
$334.74 |
$334.74 |
$320.45
|
|
Amikacin 4 mg/ml intravitreal injection - cnr
|
$58.80 |
$58.80 |
$58.80 |
$39.84
|
|
Amines vaginal fluid qual
|
$18.15 |
$18.15 |
$18.15 |
$12.00
|
|
Amino acid screen, urine
|
$138.60 |
$138.60 |
$138.60 |
$77.00
|
|
Amino acid single qual
|
$72.03 |
$72.03 |
$72.03 |
$36.00
|
|
Amino acids quant 2-5
|
$138.03 |
$138.03 |
$138.03 |
$112.00
|
|
Aminocaproic acid 5 g/250 ml 0.9% nacl IV - cnr
|
$43.01 |
$43.01 |
$43.01 |
$37.33
|
|
Aminolevulinic acid delta
|
$131.00 |
$131.00 |
$131.00 |
$87.12
|
|
Aminophylline 25 mg/ml intravenous solution (wrapper)
|
$59.47 |
$59.47 |
$59.47 |
$47.06
|
|
Amiodarone 50 mg/ml intravenous solution
|
$166.32 |
$166.32 |
$166.32 |
$55.86
|
|
Amitriptyline (elavil) -sendout
|
$96.35 |
$96.35 |
$96.35 |
$87.45
|
|
Ammonia
|
$145.94 |
$145.94 |
$145.94 |
$119.70
|
|
Amniocentesisdiagnostic 59000
|
$762.70 |
$762.70 |
$762.70 |
$942.60
|
|
Amniocentesis therapeutic
|
$1,034.46 |
$1,034.46 |
$1,034.46 |
$791.05
|
|
Amniotic fluid scan
|
$49.01 |
$49.01 |
$49.01 |
$49.01
|
|
Amobarbital 125 mg inj
|
$1,319.49 |
$1,319.49 |
$1,319.49 |
$1,283.59
|
|
Amp f/th 1/2 jt/phalanx w/neurect local flap
|
$3,653.51 |
$3,653.51 |
$3,653.51 |
$3,786.00
|
|
Amphetamine confirm urine -sendout
|
$343.50 |
$343.50 |
$343.50 |
$93.61
|
|
Amphetamines 5 or more
|
$144.00 |
$144.00 |
$144.00 |
$90.48
|
|
Amphotericin b in d5w IV syringe 0.1 mg/ml (neo/ped) - cnr
|
$175.80 |
$175.80 |
$175.80 |
$123.53
|
