|
88334 ap bill cytologic exam each additional site
|
$87.90 |
$87.90 |
$87.90 |
$97.65
|
|
Abdominal CT scan (with and without contrast)
|
$3,578.40 |
$3,578.40 |
$3,578.40 |
$1,992.00
|
|
Abdominal CT scan (with contrast)
|
$861.90 |
$861.90 |
$861.90 |
$1,669.00
|
|
Abdominal CT scan (without contrast)
|
$2,631.60 |
$2,631.60 |
$2,631.60 |
$1,358.76
|
|
Abdominal MRI (with and without contrast)
|
$4,792.80 |
$4,792.80 |
$4,792.80 |
$2,999.67
|
|
Abdominal MRI (with contrast)
|
$1,434.90 |
$1,434.90 |
$1,434.90 |
$2,210.00
|
|
Abdominal MRI (without contrast)
|
$2,122.50 |
$2,122.50 |
$2,122.50 |
$2,048.36
|
|
Abdominal pad
|
$198.97 |
$198.97 |
$198.97 |
$151.32
|
|
Abdominal paracentesis w/image guidance
|
$344.40 |
$344.40 |
$344.40 |
$1,655.36
|
|
Abdominal Ultrasound (complete)
|
$1,428.90 |
$1,428.90 |
$1,428.90 |
$785.55
|
|
Abdominal Ultrasound (limited)
|
$1,334.40 |
$1,334.40 |
$1,334.40 |
$581.94
|
|
Abd paracentesis/w/o image guide 49082
|
$860.40 |
$860.40 |
$860.40 |
$1,145.00
|
|
Abduct control hip semi-flex
|
$507.15 |
$507.15 |
$507.15 |
$499.86
|
|
Abduction bar jointed adjust
|
$604.36 |
$604.36 |
$604.36 |
$595.67
|
|
Abduction rotation bar shoe
|
$213.72 |
$213.72 |
$213.72 |
$210.65
|
|
Abduct rotation bar without shoe
|
$195.43 |
$195.43 |
$195.43 |
$192.62
|
|
Abl1 gene
|
$496.20 |
$496.20 |
$496.20 |
$668.85
|
|
Ablation of upper extremity nerves rf
|
$594.00 |
$594.00 |
$594.00 |
$808.50
|
|
Acetaminophen level
|
$36.00 |
$36.00 |
$36.00 |
$103.75
|
|
Acetazolamide 500 mg solution for injection
|
$539.53 |
$539.53 |
$539.53 |
$122.55
|
|
Acetone qualitative
|
$88.80 |
$88.80 |
$88.80 |
$45.65
|
|
Acetylcholine receptor modulating antibody
|
$109.20 |
$109.20 |
$109.20 |
$62.50
|
|
Acetylcysteine 200 mg/ml (20 %) intravenous solution
|
$72.37 |
$72.37 |
$72.37 |
$216.00
|
|
Acetylcysteine non-comp unit
|
$134.36 |
$134.36 |
$134.36 |
$31.21
|
|
Acne surgery 10040
|
$237.60 |
$237.60 |
$237.60 |
$260.49
|
|
Acute hepatitis panel
|
$508.50 |
$508.50 |
$508.50 |
$286.05
|
|
Acyclovir 5 mg/ml in ns IV syringe (neo/ped) - cnr
|
$208.61 |
$208.61 |
$208.61 |
$63.47
|
|
Adapter b 8 channel 10cm
|
$10,180.73 |
$10,180.73 |
$10,180.73 |
$5,695.04
|
|
Add le poly knee custom kafo
|
$458.27 |
$458.27 |
$458.27 |
$451.68
|
|
Adenosine 3 mg/250 ml bag for osm
|
$84.85 |
$84.85 |
$84.85 |
$235.74
|
|
Admelog u-100 insulin lispro 100 unit/ml subcutaneous solution
|
$819.94 |
$819.94 |
$819.94 |
$183.76
|
|
Administration chemotherapy IV infusion up to 1 hour single/initial substance/drug
|
$460.50 |
$460.50 |
$460.50 |
$657.12
|
|
Administration chemotherapy IV push single/initial substance/drug
|
$358.50 |
$358.50 |
$358.50 |
$439.20
|
|
Administration immunization 1 vaccine
|
$208.50 |
$208.50 |
$208.50 |
$69.00
|
|
Administration immunization each additional vaccine
|
$103.50 |
$103.50 |
$103.50 |
$46.80
|
|
Administration vaccine influenza virus
|
$44.10 |
$44.10 |
$44.10 |
$49.50
|
|
Ado-trastuzumab emtansine 100 mg intravenous solution
|
$28,725.30 |
$28,725.30 |
$28,725.30 |
$11,350.31
|
|
_afb id by dna probe rflx ast
|
$87.60 |
$87.60 |
$87.60 |
$93.52
|
|
#afb mycobacteria suscep. #1
|
$18.30 |
$18.30 |
$18.30 |
$35.51
|
|
_afb org id by sequencing rflx ast-sendout
|
$315.00 |
$315.00 |
$315.00 |
$300.22
|
|
Afo molded ankle gauntlet
|
$1,083.56 |
$1,083.56 |
$1,083.56 |
$1,067.98
|
|
Afo molded plas rig ant tib
|
$2,473.49 |
$2,473.49 |
$2,473.49 |
$2,412.47
|
|
Afo molded to patient plasti
|
$1,034.59 |
$1,034.59 |
$1,034.59 |
$710.45
|
|
Afo rig ant tib tcf/= custom
|
$2,142.14 |
$2,142.14 |
$2,142.14 |
$1,654.77
|
|
Afo sing bar clasp attach sh
|
$673.24 |
$673.24 |
$673.24 |
$663.56
|
|
Afo sing solid stirrup calf
|
$969.28 |
$969.28 |
$969.28 |
$955.35
|
|
Afo sing upright with adjust s
|
$986.19 |
$986.19 |
$986.19 |
$696.71
|
|
Afo spiral molded to pt plas
|
$1,846.20 |
$1,846.20 |
$1,846.20 |
$1,450.86
|
|
Afo sprng wir drsflx calf bd
|
$684.90 |
$684.90 |
$684.90 |
$675.05
|
|
Afo supramalleolar custom
|
$1,350.85 |
$1,350.85 |
$1,350.85 |
$1,331.42
|
|
Afo tib fx cast plaster mold
|
$1,892.19 |
$1,892.19 |
$1,892.19 |
$1,864.98
|
|
Afo tibial fracture rigid
|
$1,850.28 |
$1,850.28 |
$1,850.28 |
$1,654.77
|
|
Afo tibial fracture soft
|
$1,211.12 |
$1,211.12 |
$1,211.12 |
$1,060.02
|
|
Afo, walk boot type, cus fab
|
$3,809.40 |
$3,809.40 |
$3,809.40 |
$2,903.60
|
|
Afo w/ankle joint, prefab
|
$1,533.60 |
$1,533.60 |
$1,533.60 |
$795.02
|
|
Ak/knee disartic pelvic band
|
$188.26 |
$188.26 |
$188.26 |
$185.56
|
|
Ak/knee disartic silesian ba
|
$234.14 |
$234.14 |
$234.14 |
$202.75
|
|
Ak sleeve susp neoprene/equa
|
$424.16 |
$424.16 |
$424.16 |
$275.52
|
|
Albumin body fluid quantitative each specimen
|
$10.20 |
$10.20 |
$10.20 |
$45.18
|
|
Albumin (human), 25%, 50ml
|
$951.30 |
$951.30 |
$951.30 |
$244.70
|
|
Albumin (microalbumin) 24 hour urine quantitative
|
$208.80 |
$208.80 |
$208.80 |
$55.90
|
|
Albumin serum plasma or whole blood
|
$159.60 |
$159.60 |
$159.60 |
$40.00
|
|
Albuterol ipratrop non-comp
|
$6.00 |
$6.00 |
$6.00 |
$5.40
|
|
Albuterol non-comp con
|
$6.00 |
$6.00 |
$6.00 |
$6.07
|
|
Albuterol non-comp unit
|
$6.00 |
$6.00 |
$6.00 |
$5.61
|
|
Alcohol (ethanol) any specimen except urine/breath
|
$33.60 |
$33.60 |
$33.60 |
$91.00
|
|
Alkaline phosphatase
|
$159.60 |
$159.60 |
$159.60 |
$45.75
|
|
Allergen alpha lactalbumin ige
|
$33.00 |
$33.00 |
$33.00 |
$47.65
|
|
Allergen egg white ige
|
$22.50 |
$22.50 |
$22.50 |
$37.05
|
|
Allograft 160mg placental salera mini membrane
|
$6,707.64 |
$6,707.64 |
$6,707.64 |
$6,611.20
|
|
Allograft allowrap 4x4cm dry 16sqcm
|
$13,227.30 |
$13,227.30 |
$13,227.30 |
$5,401.92
|
|
Allograft amnioexcel plus 17mm disk
|
$16,597.84 |
$16,597.84 |
$16,597.84 |
$2,386.00
|
|
Allograft dermis 20x25x1mm decell w/matracell arthroflex
|
$10,322.51 |
$10,322.51 |
$10,322.51 |
$6,414.50
|
|
Allograft ecm allopatch hd dehydr thick 0.8-1.7mmx2x5cm-cost per sq cm
|
$46,859.15 |
$46,859.15 |
$46,859.15 |
$23,373.60
|
|
Allograft epieffect 2x3cm-q4186-cost per sq cm
|
$31,458.77 |
$31,458.77 |
$31,458.77 |
$989.09
|
|
Allograft graftjacket 2x12cm-q4107-cost per sq cm
|
$26,622.34 |
$26,622.34 |
$26,622.34 |
$4,677.40
|
|
Allograft membrn amnio 1x2cm hu ambriodry
|
$25,136.66 |
$25,136.66 |
$25,136.66 |
$4,725.00
|
|
Allograft umbil cord+amniotic membrane-q4148-cost per sq cm
|
$8,240.44 |
$8,240.44 |
$8,240.44 |
$4,561.83
|
|
Allograft umbilical epicord 15 sq cm-q4187-cost per sq cm
|
$9,411.94 |
$9,411.94 |
$9,411.94 |
$1,495.63
|
|
Alpha-fetoprotein afp-l3 frac & total
|
$199.50 |
$199.50 |
$199.50 |
$175.20
|
|
Alpha-fetoprotein tumor marker
|
$213.90 |
$213.90 |
$213.90 |
$103.74
|
|
Alteplase 100 mg infusion from pyxis vial
|
$119,596.90 |
$119,596.90 |
$119,596.90 |
$15,857.45
|
|
Alt/sgpt
|
$159.60 |
$159.60 |
$159.60 |
$46.75
|
|
Aminophylline 25 mg/ml intravenous solution (wrapper)
|
$48.00 |
$48.00 |
$48.00 |
$45.02
|
|
Amiodarone 50 mg/ml intravenous solution
|
$59.81 |
$59.81 |
$59.81 |
$55.86
|
|
Ammonia
|
$320.10 |
$320.10 |
$320.10 |
$119.70
|
|
Amp f/th 1/2 jt/phalanx w/neurect local flap
|
$1,240.80 |
$1,240.80 |
$1,240.80 |
$3,735.51
|
|
Ampicillin 1 gram solution for injection
|
$182.14 |
$182.14 |
$182.14 |
$56.70
|
|
Ampicillin-sulbactam 1.5 gram solution for injection
|
$72.78 |
$72.78 |
$72.78 |
$53.57
|
|
Amputation toe metatarsophalangeal joint
|
$3,060.30 |
$3,060.30 |
$3,060.30 |
$3,839.54
|
|
Amylase
|
$306.00 |
$306.00 |
$306.00 |
$89.04
|
|
Ana ds-dna
|
$60.90 |
$60.90 |
$60.90 |
$56.50
|
|
Analysis gene f2 20210g>a variant
|
$74.40 |
$74.40 |
$74.40 |
$219.13
|
|
Analysis gene f5 leiden variant
|
$74.40 |
$74.40 |
$74.40 |
$230.40
|
|
Angiotensin ii 0.5 mg/ml soln 1 ml vial
|
$172.80 |
$172.80 |
$172.80 |
$3,080.85
|
|
Anidulafungin injection
|
$2,594.20 |
$2,594.20 |
$2,594.20 |
$312.30
|
|
Ankle X-ray
|
$591.30 |
$591.30 |
$591.30 |
$351.45
|
|
Anterior asis pad
|
$189.86 |
$189.86 |
$189.86 |
$187.13
|
|
Anterior swing band
|
$674.84 |
$674.84 |
$674.84 |
$665.14
|
|
Anterior thoracic derotation
|
$226.42 |
$226.42 |
$226.42 |
$223.16
|
