|
Albuterol non-comp unit
|
$9.00 |
$9.00 |
$9.00 |
$5.61
|
|
Alcohol (ethanol) any specimen except urine/breath
|
$67.20 |
$67.20 |
$67.20 |
$93.60
|
|
Alkaline phosphatase
|
$60.60 |
$60.60 |
$60.60 |
$46.40
|
|
Allergen alpha lactalbumin ige
|
$60.60 |
$60.60 |
$60.60 |
$48.00
|
|
Allergen egg white ige
|
$41.40 |
$41.40 |
$41.40 |
$38.00
|
|
Allograft 160mg placental salera mini membrane
|
$10,875.82 |
$10,875.82 |
$10,875.82 |
$6,611.20
|
|
Allograft allowrap 4x4cm dry 16sqcm
|
$21,446.86 |
$21,446.86 |
$21,446.86 |
$5,401.92
|
|
Allograft amnioexcel plus 17mm disk
|
$26,911.88 |
$26,911.88 |
$26,911.88 |
$2,250.00
|
|
Allograft dermis 20x25x1mm decell w/matracell arthroflex
|
$16,737.01 |
$16,737.01 |
$16,737.01 |
$6,414.50
|
|
Allograft ecm allopatch hd dehydr thick 0.8-1.7mmx2x5cm-cost per sq cm
|
$75,977.82 |
$75,977.82 |
$75,977.82 |
$23,373.60
|
|
Allograft epieffect 2x3cm-q4186-cost per sq cm
|
$51,007.51 |
$51,007.51 |
$51,007.51 |
$874.65
|
|
Allograft graftjacket 2x12cm-q4107-cost per sq cm
|
$43,165.69 |
$43,165.69 |
$43,165.69 |
$4,677.40
|
|
Allograft membrn amnio 1x2cm hu ambriodry
|
$40,756.80 |
$40,756.80 |
$40,756.80 |
$4,725.00
|
|
Allograft umbil cord+amniotic membrane-q4148-cost per sq cm
|
$13,361.12 |
$13,361.12 |
$13,361.12 |
$4,561.83
|
|
Allograft umbilical epicord 15 sq cm-q4187-cost per sq cm
|
$15,260.60 |
$15,260.60 |
$15,260.60 |
$1,495.63
|
|
Alpha-1-proteinase inhibitor (human) 1,000 mg (+/-) IV solution
|
$2,250.00 |
$2,250.00 |
$2,250.00 |
$12.50
|
|
Alpha-fetoprotein afp-l3 frac & total
|
$330.60 |
$330.60 |
$330.60 |
$175.20
|
|
Alpha-fetoprotein amniotic
|
$104.40 |
$104.40 |
$104.40 |
$96.20
|
|
Alpha-fetoprotein tumor marker
|
$134.40 |
$134.40 |
$134.40 |
$106.00
|
|
Alprostadil for injection
|
$1,087.16 |
$1,087.16 |
$1,087.16 |
$519.93
|
|
Alteplase 100 mg infusion from pyxis vial
|
$56,498.32 |
$56,498.32 |
$56,498.32 |
$15,857.45
|
|
Alt/sgpt
|
$70.80 |
$70.80 |
$70.80 |
$47.45
|
|
Aluminum - quest
|
$130.80 |
$130.80 |
$130.80 |
$83.05
|
|
Alveoloplasty each quadrant
|
$13,872.26 |
$13,872.26 |
$13,872.26 |
$3,892.00
|
|
Alys cplx sp/pn npgt w/prgrm
|
$60.60 |
$60.60 |
$60.60 |
$434.00
|
|
Amikacin 4 mg/ml intravitreal injection - cnr
|
$49.76 |
$49.76 |
$49.76 |
$39.84
|
|
Amino acids quant 2-5
|
$97.20 |
$97.20 |
$97.20 |
$104.00
|
|
Aminocaproic acid 5 g/250 ml 0.9% nacl IV - cnr
|
$46.74 |
$46.74 |
$46.74 |
$37.14
|
|
Aminolevulinic acid delta
|
$127.20 |
$127.20 |
$127.20 |
$85.15
|
|
Aminophylline 25 mg/ml intravenous solution (wrapper)
|
$25.67 |
$25.67 |
$25.67 |
$45.02
|
|
Amiodarone 50 mg/ml intravenous solution
|
$24.00 |
$24.00 |
$24.00 |
$55.86
|
|
Ammonia
|
$130.20 |
$130.20 |
$130.20 |
$119.70
|
|
Amp f/th 1/2 jt/phalanx w/neurect local flap
|
$4,135.80 |
$4,135.80 |
$4,135.80 |
$3,730.53
|
|
Amphetamine confirm urine -sendout
|
$152.40 |
$152.40 |
$152.40 |
$92.61
|
|
Amphotericin b in d5w IV syringe 0.1 mg/ml (neo/ped) - cnr
|
$308.16 |
$308.16 |
$308.16 |
$117.75
|
|
Amphotericin b liposomal in d5w IV syringe 1 mg/ml (neo/ped) - cnr
|
$661.52 |
$661.52 |
$661.52 |
$543.85
|
|
Ampicillin 1 gram solution for injection
|
$178.47 |
$178.47 |
$178.47 |
$56.70
|
|
Ampicillin-sulbactam 1.5 gram solution for injection
|
$102.40 |
$102.40 |
$102.40 |
$53.86
|
|
Amputation toe interphalangeal joint
|
$13,442.96 |
$13,442.96 |
$13,442.96 |
$3,998.20
|
|
Amylase
|
$103.20 |
$103.20 |
$103.20 |
$89.04
|
|
Analysis complx cranial nerve pulse gen prgrmg 95977
|
$60.60 |
$60.60 |
$60.60 |
$338.40
|
|
Analysis gene f2 20210g>a variant
|
$352.20 |
$352.20 |
$352.20 |
$219.60
|
|
Analysis gene f5 leiden variant
|
$637.20 |
$637.20 |
$637.20 |
$230.40
|
|
Analysis; simple cranial nerv pulse gen prgrmg 95976
|
$90.60 |
$90.60 |
$90.60 |
$122.20
|
|
Analyze neurostimulator simple w/reprogramming 95971
|
$60.60 |
$60.60 |
$60.60 |
$396.48
|
|
Anca screen with reflex to titer -quest
|
$135.60 |
$135.60 |
$135.60 |
$103.20
|
|
An cholangiogram percutaneous compl
|
$6,114.00 |
$6,114.00 |
$6,114.00 |
$2,626.65
|
|
An fluoro guide for cvp
|
$750.00 |
$750.00 |
$750.00 |
$515.00
|
|
Angio balloon ctrl dialysis seg add-on
|
$17,579.23 |
$17,579.23 |
$17,579.23 |
$5,341.83
|
|
Angioplasty fem/pop unilat 37224
|
$34,458.52 |
$34,458.52 |
$34,458.52 |
$8,772.38
|
|
Angiotensin ii 0.5 mg/ml soln 1 ml vial
|
$1,953.64 |
$1,953.64 |
$1,953.64 |
$3,080.85
|
|
Angio trnslmnl balloon same artery ea addl
|
$11,460.00 |
$11,460.00 |
$11,460.00 |
$4,604.00
|
|
Angio trnslmnl balloon same artery ini
|
$14,608.20 |
$14,608.20 |
$14,608.20 |
$9,074.63
|
|
Angio trnslmnl balloon same vein ea addl
|
$8,971.20 |
$8,971.20 |
$8,971.20 |
$4,390.75
|
|
Angio trnslmnl balloon same vein ini
|
$25,456.72 |
$25,456.72 |
$25,456.72 |
$8,466.00
|
|
Anidulafungin injection
|
$1,225.52 |
$1,225.52 |
$1,225.52 |
$312.30
|
|
Ankle X-ray
|
$520.80 |
$520.80 |
$520.80 |
$353.60
|
|
Annual Physical, Established Patient (age 18-39)
|
$224.40 |
$224.40 |
$224.40 |
$141.00
|
|
Annual Physical, Established Patient (age 40-64)
|
$224.40 |
$224.40 |
$224.40 |
$158.76
|
|
Annual Physical, New Patient (age 18-39)
|
$83.40 |
$83.40 |
$83.40 |
$143.25
|
|
Annual Physical, New Patient (age 40-64)
|
$83.40 |
$83.40 |
$83.40 |
$165.10
|
|
Anoscopy and biopsy
|
$15,392.41 |
$15,392.41 |
$15,392.41 |
$1,395.28
|
|
Anterior asis pad
|
$307.85 |
$307.85 |
$307.85 |
$187.13
|
|
Anterior swing band
|
$1,094.18 |
$1,094.18 |
$1,094.18 |
$665.14
|
|
Anterior thoracic derotation
|
$367.12 |
$367.12 |
$367.12 |
$223.16
|
|
Anterior thoracic extension
|
$847.82 |
$847.82 |
$847.82 |
$496.80
|
|
Antibody elution rbc reference
|
$150.60 |
$150.60 |
$150.60 |
$175.50
|
|
Antibody htlv-i
|
$102.00 |
$102.00 |
$102.00 |
$49.53
|
|
Antibody htlv-ii
|
$83.40 |
$83.40 |
$83.40 |
$42.00
|
|
Antibody identification platelet antibodies heparin-pf4 igg
|
$190.20 |
$190.20 |
$190.20 |
$218.30
|
|
Antibody id rbc panel
|
$675.60 |
$675.60 |
$675.60 |
$274.56
|
|
Antibody influenza virus
|
$79.80 |
$79.80 |
$79.80 |
$53.95
|
|
Antibody screen rbc
|
$105.00 |
$105.00 |
$105.00 |
$100.00
|
|
Antihemophilic factor-vwf 250 unit-600 unit intravenous solution
|
$14,850.00 |
$14,850.00 |
$14,850.00 |
$6.10
|
|
Anti-inhibitor
|
$10,125.00 |
$10,125.00 |
$10,125.00 |
$8.33
|
|
Anti mog serum - sendout
|
$519.60 |
$519.60 |
$519.60 |
$159.00
|
|
Antineutrophil cytoplasmic antibody titer each antibody
|
$42.00 |
$42.00 |
$42.00 |
$40.00
|
|
Ant instr 2-3 vert segm 22845
|
$45,177.74 |
$45,177.74 |
$45,177.74 |
$1,748.00
|
|
Ant instrumentation/4-7 vert seg 22846
|
$41,991.86 |
$41,991.86 |
$41,991.86 |
$1,430.40
|
|
Antinuclear antibodies
|
$126.00 |
$126.00 |
$126.00 |
$89.40
|
|
Antinuclear antibodies titer
|
$82.80 |
$82.80 |
$82.80 |
$77.00
|
|
Antiphosphatidylserine antibody
|
$96.00 |
$96.00 |
$96.00 |
$65.97
|
|
Antistreptolysin o titer
|
$75.60 |
$75.60 |
$75.60 |
$51.45
|
|
Antithrombin iii activity
|
$167.40 |
$167.40 |
$167.40 |
$114.00
|
|
Anti-thymocyte glob (equine)(1:1000) intradermal test dose
|
$18,979.91 |
$18,979.91 |
$18,979.91 |
$7,704.70
|
|
Apheresis plasma
|
$1,285.80 |
$1,285.80 |
$1,285.80 |
$3,188.50
|
|
Apl(pml-rara) quant - sendout
|
$454.80 |
$454.80 |
$454.80 |
$482.95
|
|
Appendix Removal (Laparoscopic)
|
$20,973.79 |
$20,973.79 |
$20,973.79 |
$6,870.89
|
|
App high cost ss f/n/g/h/f <100sq cm addl <25sq cm
|
$26,122.27 |
$26,122.27 |
$26,122.27 |
$463.65
|
|
App high cost ss t/a/l >100sq cm 1st 100sq cm
|
$56,911.09 |
$56,911.09 |
$56,911.09 |
$3,345.60
|
|
App high cost ss t/a/l <100sq cm addl <25sq cm
|
$74,860.98 |
$74,860.98 |
$74,860.98 |
$498.81
|
|
Application finger splntstatic 29130
|
$334.20 |
$334.20 |
$334.20 |
$208.16
|
|
Application long leg splint 29505
|
$334.20 |
$334.20 |
$334.20 |
$338.25
|
|
Application lower leg splint 29515
|
$334.20 |
$334.20 |
$334.20 |
$330.48
|
|
Application multi layer compression below knee (both sides)
|
$343.20 |
$343.20 |
$343.20 |
$373.20
|
|
Application of forearm cast 29075
|
$761.40 |
$761.40 |
$761.40 |
$339.30
|
|
Application of long arm cast 29065
|
$573.60 |
$573.60 |
$573.60 |
$395.00
|
|
Application of long leg cast 29345
|
$761.40 |
$761.40 |
$761.40 |
$455.00
|
|
Application of paste boot 29580
|
$313.20 |
$313.20 |
$313.20 |
$331.74
|
|
Application short leg cast 29405
|
$761.40 |
$761.40 |
$761.40 |
$388.80
|
