|
2d tte w or without fol w/con,co
|
$800.70 |
$800.70 |
$800.70 |
$1,155.75
|
|
3d recon without postprocess indpndt
|
$298.50 |
$298.50 |
$298.50 |
$469.20
|
|
Abdominal CT scan (with and without contrast)
|
$898.50 |
$898.50 |
$898.50 |
$1,992.00
|
|
Abdominal CT scan (with contrast)
|
$898.50 |
$898.50 |
$898.50 |
$1,670.88
|
|
Abdominal CT scan (without contrast)
|
$422.70 |
$422.70 |
$422.70 |
$1,358.76
|
|
Abdominal MRI (with and without contrast)
|
$1,699.80 |
$1,699.80 |
$1,699.80 |
$2,999.67
|
|
Abdominal MRI (with contrast)
|
$2,124.60 |
$2,124.60 |
$2,124.60 |
$2,210.00
|
|
Abdominal MRI (without contrast)
|
$913.50 |
$913.50 |
$913.50 |
$2,048.36
|
|
Abdominal pad
|
$123.64 |
$123.64 |
$123.64 |
$151.32
|
|
Abdominal paracentesis w/image guidance
|
$573.90 |
$573.90 |
$573.90 |
$1,655.36
|
|
Abdominal Ultrasound (complete)
|
$422.70 |
$422.70 |
$422.70 |
$785.55
|
|
Abdominal Ultrasound (limited)
|
$453.30 |
$453.30 |
$453.30 |
$586.43
|
|
Abd paracentesis/w/o image guide 49082
|
$573.90 |
$573.90 |
$573.90 |
$1,145.40
|
|
Abduct control hip semi-flex
|
$315.15 |
$315.15 |
$315.15 |
$499.86
|
|
Abduction bar jointed adjust
|
$375.55 |
$375.55 |
$375.55 |
$595.67
|
|
Abduction rotation bar shoe
|
$132.81 |
$132.81 |
$132.81 |
$210.65
|
|
Abduct rotation bar without shoe
|
$121.44 |
$121.44 |
$121.44 |
$192.62
|
|
Abl1 gene
|
$496.20 |
$496.20 |
$496.20 |
$668.85
|
|
Ablation of upper extremity nerves rf
|
$283.50 |
$283.50 |
$283.50 |
$808.50
|
|
Acetaminophen level
|
$36.00 |
$36.00 |
$36.00 |
$106.00
|
|
Acetazolamide 500 mg solution for injection
|
$262.02 |
$262.02 |
$262.02 |
$122.55
|
|
Acetone qualitative
|
$70.50 |
$70.50 |
$70.50 |
$45.65
|
|
Acetylcholine receptor modulating antibody
|
$109.20 |
$109.20 |
$109.20 |
$62.50
|
|
Acetylcysteine 200 mg/ml (20 %) intravenous solution
|
$22.40 |
$22.40 |
$22.40 |
$216.00
|
|
Acetylcysteine non-comp unit
|
$86.41 |
$86.41 |
$86.41 |
$31.21
|
|
Acne surgery 10040
|
$237.60 |
$237.60 |
$237.60 |
$260.49
|
|
Acute hepatitis panel
|
$264.90 |
$264.90 |
$264.90 |
$286.05
|
|
Adapter b 8 channel 10cm
|
$6,326.39 |
$6,326.39 |
$6,326.39 |
$5,695.04
|
|
Add le poly knee custom kafo
|
$284.77 |
$284.77 |
$284.77 |
$451.68
|
|
Adenosine 3 mg/250 ml bag for osm
|
$36.14 |
$36.14 |
$36.14 |
$234.76
|
|
Admelog u-100 insulin lispro 100 unit/ml subcutaneous solution
|
$941.47 |
$941.47 |
$941.47 |
$183.76
|
|
Administration chemotherapy IV infusion each additional hour
|
$0.01 |
$0.01 |
$0.01 |
$230.35
|
|
Administration chemotherapy IV infusion up to 1 hour single/initial substance/drug
|
$0.01 |
$0.01 |
$0.01 |
$659.36
|
|
Administration chemotherapy IV push single/initial substance/drug
|
$205.80 |
$205.80 |
$205.80 |
$439.20
|
|
Administration immunization 1 vaccine
|
$194.10 |
$194.10 |
$194.10 |
$69.00
|
|
Administration immunization each additional vaccine
|
$164.40 |
$164.40 |
$164.40 |
$46.92
|
|
Administration vaccine influenza virus
|
$13.20 |
$13.20 |
$13.20 |
$49.50
|
|
Ado-trastuzumab emtansine 100 mg intravenous solution
|
$24,129.25 |
$24,129.25 |
$24,129.25 |
$11,350.31
|
|
_afb id by dna probe rflx ast
|
$56.40 |
$56.40 |
$56.40 |
$93.52
|
|
_afb org id by sequencing rflx ast-sendout
|
$328.80 |
$328.80 |
$328.80 |
$300.22
|
|
Afo molded ankle gauntlet
|
$673.33 |
$673.33 |
$673.33 |
$1,067.98
|
|
Afo molded plas rig ant tib
|
$1,537.05 |
$1,537.05 |
$1,537.05 |
$2,412.47
|
|
Afo molded to patient plasti
|
$642.91 |
$642.91 |
$642.91 |
$710.45
|
|
Afo rig ant tib tcf/= custom
|
$1,331.14 |
$1,331.14 |
$1,331.14 |
$1,654.77
|
|
Afo sing bar clasp attach sh
|
$418.36 |
$418.36 |
$418.36 |
$663.56
|
|
Afo sing solid stirrup calf
|
$602.32 |
$602.32 |
$602.32 |
$955.35
|
|
Afo sing upright with adjust s
|
$612.83 |
$612.83 |
$612.83 |
$696.71
|
|
Afo spiral molded to pt plas
|
$1,147.25 |
$1,147.25 |
$1,147.25 |
$1,450.86
|
|
Afo sprng wir drsflx calf bd
|
$425.60 |
$425.60 |
$425.60 |
$675.05
|
|
Afo supramalleolar custom
|
$839.43 |
$839.43 |
$839.43 |
$1,331.42
|
|
Afo tib fx cast plaster mold
|
$1,175.82 |
$1,175.82 |
$1,175.82 |
$1,864.98
|
|
Afo tibial fracture rigid
|
$1,149.78 |
$1,149.78 |
$1,149.78 |
$1,654.77
|
|
Afo tibial fracture soft
|
$752.60 |
$752.60 |
$752.60 |
$1,060.02
|
|
Afo, walk boot type, cus fab
|
$2,367.19 |
$2,367.19 |
$2,367.19 |
$2,903.60
|
|
Afo w/ankle joint, prefab
|
$952.99 |
$952.99 |
$952.99 |
$795.02
|
|
Ak/knee disartic pelvic band
|
$116.99 |
$116.99 |
$116.99 |
$185.56
|
|
Ak/knee disartic silesian ba
|
$145.50 |
$145.50 |
$145.50 |
$202.75
|
|
Ak sleeve susp neoprene/equa
|
$263.58 |
$263.58 |
$263.58 |
$275.52
|
|
Albumin body fluid quantitative each specimen
|
$69.90 |
$69.90 |
$69.90 |
$45.18
|
|
Albumin (human), 25%, 50ml
|
$462.00 |
$462.00 |
$462.00 |
$244.70
|
|
Albumin (microalbumin) 24 hour urine quantitative
|
$114.00 |
$114.00 |
$114.00 |
$55.90
|
|
Albumin serum plasma or whole blood
|
$70.50 |
$70.50 |
$70.50 |
$40.00
|
|
Albuterol ipratrop non-comp
|
$9.00 |
$9.00 |
$9.00 |
$5.40
|
|
Albuterol non-comp con
|
$9.00 |
$9.00 |
$9.00 |
$6.07
|
|
Albuterol non-comp unit
|
$9.00 |
$9.00 |
$9.00 |
$5.61
|
|
Alcohol (ethanol) any specimen except urine/breath
|
$33.60 |
$33.60 |
$33.60 |
$91.00
|
|
Alkaline phosphatase
|
$27.90 |
$27.90 |
$27.90 |
$45.75
|
|
Allergen alpha lactalbumin ige
|
$20.70 |
$20.70 |
$20.70 |
$48.00
|
|
Allergen egg white ige
|
$25.80 |
$25.80 |
$25.80 |
$37.05
|
|
Allograft 160mg placental salera mini membrane
|
$4,168.18 |
$4,168.18 |
$4,168.18 |
$6,611.20
|
|
Allograft allowrap 4x4cm dry 16sqcm
|
$8,219.56 |
$8,219.56 |
$8,219.56 |
$5,401.92
|
|
Allograft amnioexcel plus 17mm disk
|
$10,314.04 |
$10,314.04 |
$10,314.04 |
$2,386.00
|
|
Allograft dermis 20x25x1mm decell w/matracell arthroflex
|
$6,414.50 |
$6,414.50 |
$6,414.50 |
$6,414.50
|
|
Allograft ecm allopatch hd dehydr thick 0.8-1.7mmx2x5cm-cost per sq cm
|
$29,118.67 |
$29,118.67 |
$29,118.67 |
$23,373.60
|
|
Allograft epieffect 2x3cm-q4186-cost per sq cm
|
$19,548.74 |
$19,548.74 |
$19,548.74 |
$989.09
|
|
Allograft graftjacket 2x12cm-q4107-cost per sq cm
|
$16,543.35 |
$16,543.35 |
$16,543.35 |
$4,677.40
|
|
Allograft membrn amnio 1x2cm hu ambriodry
|
$15,620.14 |
$15,620.14 |
$15,620.14 |
$4,725.00
|
|
Allograft umbil cord+amniotic membrane-q4148-cost per sq cm
|
$5,120.68 |
$5,120.68 |
$5,120.68 |
$4,561.83
|
|
Allograft umbilical epicord 15 sq cm-q4187-cost per sq cm
|
$5,848.66 |
$5,848.66 |
$5,848.66 |
$1,495.63
|
|
Alpha-fetoprotein tumor marker
|
$65.10 |
$65.10 |
$65.10 |
$103.74
|
|
Alprostadil for injection
|
$1,117.67 |
$1,117.67 |
$1,117.67 |
$519.93
|
|
Alteplase 100 mg infusion from pyxis vial
|
$58,082.38 |
$58,082.38 |
$58,082.38 |
$15,857.45
|
|
Alt/sgpt
|
$70.50 |
$70.50 |
$70.50 |
$46.75
|
|
Amiodarone 50 mg/ml intravenous solution
|
$19.58 |
$19.58 |
$19.58 |
$55.86
|
|
Ammonia
|
$105.00 |
$105.00 |
$105.00 |
$119.70
|
|
Amp f/th 1/2 jt/phalanx w/neurect local flap
|
$2,067.90 |
$2,067.90 |
$2,067.90 |
$3,760.50
|
|
Ampicillin 1 gram solution for injection
|
$72.60 |
$72.60 |
$72.60 |
$56.70
|
|
Ampicillin-sulbactam 1.5 gram solution for injection
|
$59.40 |
$59.40 |
$59.40 |
$53.57
|
|
Amylase
|
$73.20 |
$73.20 |
$73.20 |
$89.04
|
|
Ana ds-dna
|
$47.40 |
$47.40 |
$47.40 |
$56.50
|
|
Analysis gene f2 20210g>a variant
|
$21.60 |
$21.60 |
$21.60 |
$219.60
|
|
Analysis gene f5 leiden variant
|
$24.90 |
$24.90 |
$24.90 |
$230.40
|
|
An fluoro guide for cvp
|
$581.40 |
$581.40 |
$581.40 |
$510.17
|
|
Angiotensin ii 0.5 mg/ml soln 1 ml vial
|
$990.00 |
$990.00 |
$990.00 |
$3,080.85
|
|
Anidulafungin injection
|
$1,259.87 |
$1,259.87 |
$1,259.87 |
$312.30
|
|
Ankle X-ray
|
$225.90 |
$225.90 |
$225.90 |
$351.45
|
|
Anterior asis pad
|
$117.98 |
$117.98 |
$117.98 |
$187.13
|
|
Anterior swing band
|
$419.35 |
$419.35 |
$419.35 |
$665.14
|
|
Anterior thoracic derotation
|
$140.70 |
$140.70 |
$140.70 |
$223.16
|
|
Anterior thoracic extension
|
$324.93 |
$324.93 |
$324.93 |
$496.80
|
