|
Albumin serum plasma or whole blood
|
$110.40 |
$110.40 |
$110.40 |
$40.80
|
|
Albuterol ipratrop non-comp
|
$6.00 |
$6.00 |
$6.00 |
$5.40
|
|
Albuterol non-comp unit
|
$6.00 |
$6.00 |
$6.00 |
$5.61
|
|
Alcohol (ethanol) any specimen except urine/breath
|
$67.20 |
$67.20 |
$67.20 |
$93.60
|
|
Alemtuzumab 12 mg/1.2 ml intravenous solution
|
$89,232.73 |
$89,232.73 |
$89,232.73 |
$47,974.31
|
|
Alkaline phosphatase
|
$37.20 |
$37.20 |
$37.20 |
$46.40
|
|
Allergen alpha lactalbumin ige
|
$45.60 |
$45.60 |
$45.60 |
$48.00
|
|
Allergen egg white ige
|
$45.00 |
$45.00 |
$45.00 |
$38.00
|
|
Allergy injections; 2 or more 95117
|
$25.20 |
$25.20 |
$25.20 |
$43.75
|
|
Allergy injection; single 95115
|
$20.40 |
$20.40 |
$20.40 |
$42.75
|
|
Allograft 160mg placental salera mini membrane
|
$13,097.84 |
$13,097.84 |
$13,097.84 |
$6,611.20
|
|
Allograft allowrap 4x4cm dry 16sqcm
|
$25,828.63 |
$25,828.63 |
$25,828.63 |
$5,401.92
|
|
Allograft amnioexcel plus 17mm disk
|
$32,410.20 |
$32,410.20 |
$32,410.20 |
$2,250.00
|
|
Allograft dermis 20x25x1mm decell w/matracell arthroflex
|
$20,156.53 |
$20,156.53 |
$20,156.53 |
$6,414.50
|
|
Allograft ecm allopatch hd dehydr thick 0.8-1.7mmx2x5cm-cost per sq cm
|
$91,500.74 |
$91,500.74 |
$91,500.74 |
$23,373.60
|
|
Allograft epieffect 2x3cm-q4186-cost per sq cm
|
$61,428.79 |
$61,428.79 |
$61,428.79 |
$874.65
|
|
Allograft graftjacket 2x12cm-q4107-cost per sq cm
|
$51,984.80 |
$51,984.80 |
$51,984.80 |
$4,677.40
|
|
Allograft membrn amnio 1x2cm hu ambriodry
|
$49,083.76 |
$49,083.76 |
$49,083.76 |
$4,725.00
|
|
Allograft umbil cord+amniotic membrane-q4148-cost per sq cm
|
$16,090.91 |
$16,090.91 |
$16,090.91 |
$4,561.83
|
|
Allograft umbilical epicord 15 sq cm-q4187-cost per sq cm
|
$18,378.47 |
$18,378.47 |
$18,378.47 |
$1,495.63
|
|
Alpha-1-proteinase inhibitor (human) 1,000 mg (+/-) IV solution
|
$3,456.00 |
$3,456.00 |
$3,456.00 |
$12.50
|
|
Alpha-fetoprotein afp-l3 frac & total
|
$399.00 |
$399.00 |
$399.00 |
$175.20
|
|
Alpha-fetoprotein tumor marker
|
$181.80 |
$181.80 |
$181.80 |
$106.00
|
|
Alteplase 100 mg infusion from pyxis vial
|
$83,163.40 |
$83,163.40 |
$83,163.40 |
$15,857.45
|
|
Alt/sgpt
|
$54.00 |
$54.00 |
$54.00 |
$47.45
|
|
Aluminum - quest
|
$95.40 |
$95.40 |
$95.40 |
$83.05
|
|
Amantadine (symmetrel)-sendout
|
$105.60 |
$105.60 |
$105.60 |
$169.80
|
|
Aminocaproic acid 5 g/250 ml 0.9% nacl IV - cnr
|
$97.15 |
$97.15 |
$97.15 |
$37.14
|
|
Aminolevulinic acid delta
|
$95.40 |
$95.40 |
$95.40 |
$85.15
|
|
Aminophylline 25 mg/ml intravenous solution (wrapper)
|
$48.00 |
$48.00 |
$48.00 |
$45.02
|
|
Amiodarone 50 mg/ml intravenous solution
|
$48.00 |
$48.00 |
$48.00 |
$55.86
|
|
Ammonia
|
$178.80 |
$178.80 |
$178.80 |
$119.70
|
|
Amp f/th 1/2 jt/phalanx w/neurect local flap
|
$2,481.60 |
$2,481.60 |
$2,481.60 |
$3,730.53
|
|
Amphotericin b in d5w IV syringe 0.1 mg/ml (neo/ped) - cnr
|
$453.60 |
$453.60 |
$453.60 |
$117.75
|
|
Amphotericin b liposomal in d5w IV syringe 1 mg/ml (neo/ped) - cnr
|
$1,542.35 |
$1,542.35 |
$1,542.35 |
$543.85
|
|
Ampicillin 1 gram solution for injection
|
$52.22 |
$52.22 |
$52.22 |
$56.70
|
|
Ampicillin-sulbactam 1.5 gram solution for injection
|
$77.21 |
$77.21 |
$77.21 |
$53.86
|
|
Amp metatarsal w/toe single 28810
|
$23,531.39 |
$23,531.39 |
$23,531.39 |
$4,271.00
|
|
Amputation toe interphalangeal joint
|
$28,360.57 |
$28,360.57 |
$28,360.57 |
$3,998.20
|
|
Amputation toe metatarsophalangeal joint
|
$15,641.54 |
$15,641.54 |
$15,641.54 |
$3,839.54
|
|
Amylase
|
$148.20 |
$148.20 |
$148.20 |
$89.04
|
|
Anal pressure record
|
$2,751.96 |
$2,751.96 |
$2,751.96 |
$834.90
|
|
Analysis complx cranial nerve pulse gen prgrmg 95977
|
$181.80 |
$181.80 |
$181.80 |
$338.40
|
|
Analysis gene f2 20210g>a variant
|
$683.40 |
$683.40 |
$683.40 |
$219.60
|
|
Analysis gene f5 leiden variant
|
$775.20 |
$775.20 |
$775.20 |
$230.40
|
|
Analysis; simple cranial nerv pulse gen prgrmg 95976
|
$74.40 |
$74.40 |
$74.40 |
$122.20
|
|
Anaplsma phgcytophlm amp prb
|
$115.80 |
$115.80 |
$115.80 |
$85.80
|
|
Anca screen with reflex to titer -quest
|
$92.40 |
$92.40 |
$92.40 |
$103.20
|
|
An cholangiogram percutaneous compl
|
$7,291.80 |
$7,291.80 |
$7,291.80 |
$2,626.65
|
|
An fluoro guide for cvp
|
$755.40 |
$755.40 |
$755.40 |
$515.00
|
|
Angioplasty fem/pop unilat 37224
|
$92,678.36 |
$92,678.36 |
$92,678.36 |
$8,772.38
|
|
Angioplasty tib/pero/unilat/ea add 37232
|
$55,791.08 |
$55,791.08 |
$55,791.08 |
$5,950.50
|
|
Angiotensin ii 0.5 mg/ml soln 1 ml vial
|
$359.10 |
$359.10 |
$359.10 |
$3,080.85
|
|
Angio tib/peroneal/init ves/unila 37228
|
$55,791.08 |
$55,791.08 |
$55,791.08 |
$10,522.96
|
|
Angio trnslmnl balloon same artery ini
|
$12,111.00 |
$12,111.00 |
$12,111.00 |
$9,074.63
|
|
Anidulafungin injection
|
$1,803.91 |
$1,803.91 |
$1,803.91 |
$312.30
|
|
Ankle X-ray
|
$569.40 |
$569.40 |
$569.40 |
$353.60
|
|
Annual Physical, Established Patient (age 40-64)
|
$213.60 |
$213.60 |
$213.60 |
$158.76
|
|
Anterior asis pad
|
$370.74 |
$370.74 |
$370.74 |
$187.13
|
|
Anterior swing band
|
$1,317.74 |
$1,317.74 |
$1,317.74 |
$665.14
|
|
Anterior thoracic derotation
|
$442.12 |
$442.12 |
$442.12 |
$223.16
|
|
Anterior thoracic extension
|
$1,021.03 |
$1,021.03 |
$1,021.03 |
$496.80
|
|
Antibody elution rbc reference
|
$154.80 |
$154.80 |
$154.80 |
$175.50
|
|
Antibody htlv-i
|
$52.20 |
$52.20 |
$52.20 |
$49.53
|
|
Antibody htlv-ii
|
$86.40 |
$86.40 |
$86.40 |
$42.00
|
|
Antibody identification platelet antibodies heparin-pf4 igg
|
$99.60 |
$99.60 |
$99.60 |
$218.30
|
|
Antibody id rbc panel
|
$675.60 |
$675.60 |
$675.60 |
$274.56
|
|
Antibody screen rbc
|
$124.80 |
$124.80 |
$124.80 |
$100.00
|
|
Antihemophilic factor-vwf 250 unit-600 unit intravenous solution
|
$22,809.60 |
$22,809.60 |
$22,809.60 |
$6.10
|
|
Anti-inhibitor
|
$38,880.00 |
$38,880.00 |
$38,880.00 |
$8.33
|
|
Anti mog serum - sendout
|
$495.00 |
$495.00 |
$495.00 |
$159.00
|
|
Antineutrophil cytoplasmic antibody titer each antibody
|
$42.00 |
$42.00 |
$42.00 |
$40.00
|
|
Ant instr 2-3 vert segm 22845
|
$68,288.78 |
$68,288.78 |
$68,288.78 |
$1,748.00
|
|
Ant instrumentation/4-7 vert seg 22846
|
$87,672.79 |
$87,672.79 |
$87,672.79 |
$1,430.40
|
|
Antinuclear antibodies
|
$145.20 |
$145.20 |
$145.20 |
$89.40
|
|
Antiphosphatidylserine antibody
|
$50.40 |
$50.40 |
$50.40 |
$65.97
|
|
Antistreptolysin o titer
|
$91.20 |
$91.20 |
$91.20 |
$51.45
|
|
Antithrombin iii activity
|
$77.40 |
$77.40 |
$77.40 |
$114.00
|
|
Antithrombin iii injection
|
$12,844.80 |
$12,844.80 |
$12,844.80 |
$12.34
|
|
Anti-thymocyte glob (equine)(1:1000) intradermal test dose
|
$29,153.15 |
$29,153.15 |
$29,153.15 |
$7,704.70
|
|
Apheresis plasma
|
$3,655.80 |
$3,655.80 |
$3,655.80 |
$3,188.50
|
|
Apheresis rbc
|
$2,833.80 |
$2,833.80 |
$2,833.80 |
$3,146.15
|
|
Apheresis wbc
|
$4,722.60 |
$4,722.60 |
$4,722.60 |
$2,968.80
|
|
Apl(pml-rara) quant - sendout
|
$1,061.40 |
$1,061.40 |
$1,061.40 |
$482.95
|
|
Appendix Removal (Laparoscopic)
|
$25,936.15 |
$25,936.15 |
$25,936.15 |
$6,870.89
|
|
Appl hip spica cast 1 leg
|
$237.00 |
$237.00 |
$237.00 |
$499.20
|
|
Application finger splntstatic 29130
|
$477.60 |
$477.60 |
$477.60 |
$208.16
|
|
Application long leg splint 29505
|
$477.60 |
$477.60 |
$477.60 |
$338.25
|
|
Application lower leg splint 29515
|
$477.60 |
$477.60 |
$477.60 |
$330.48
|
|
Application multi layer compression below knee (both sides)
|
$579.60 |
$579.60 |
$579.60 |
$373.20
|
|
Application of cylinder cast 29365
|
$237.00 |
$237.00 |
$237.00 |
$420.00
|
|
Application of forearm cast 29075
|
$237.00 |
$237.00 |
$237.00 |
$339.30
|
|
Application of long arm cast 29065
|
$237.00 |
$237.00 |
$237.00 |
$395.00
|
|
Application of long leg cast
|
$237.00 |
$237.00 |
$237.00 |
$426.00
|
|
Application of long leg cast 29345
|
$237.00 |
$237.00 |
$237.00 |
$455.00
|
|
Application of paste boot 29580
|
$376.80 |
$376.80 |
$376.80 |
$331.74
|
|
Application short leg cast 29405
|
$237.00 |
$237.00 |
$237.00 |
$388.80
|
|
Application skin substitute graft face/scalp/neck/genit/hnd/ft <100 sq cm 1st 25 sq cm
|
$18,820.49 |
$18,820.49 |
$18,820.49 |
$2,148.25
|
|
Application skin substitute graft trunk/arms/legs <100 sq cm 1st 25 sq cm
|
$1,335.00 |
$1,335.00 |
$1,335.00 |
$2,164.64
|
|
Applicator tag rfid localizer 12gx7cm
|
$12,971.51 |
$12,971.51 |
$12,971.51 |
$744.90
|
