|
Afo rig ant tib tcf/= custom
|
$1,988.00 |
$1,988.00 |
$1,988.00 |
$1,875.66
|
|
Afo supramalleolar custom
|
$344.00 |
$344.00 |
$344.00 |
$1,182.83
|
|
Afo tib fx semi-rigid l2114
|
$347.60 |
$347.60 |
$347.60 |
$817.60
|
|
Afo tibial fracture rigid
|
$417.20 |
$417.20 |
$417.20 |
$1,489.57
|
|
Afo tibial fracture soft
|
$283.20 |
$283.20 |
$283.20 |
$1,060.02
|
|
Afo, walk boot type, cus fab
|
$935.60 |
$935.60 |
$935.60 |
$2,859.19
|
|
Afo w/ankle joint, prefab
|
$286.80 |
$286.80 |
$286.80 |
$741.72
|
|
After cataract laser surgery
|
$1,180.80 |
$1,180.80 |
$1,180.80 |
$1,373.11
|
|
Air conduction bilat
|
$134.00 |
$134.00 |
$134.00 |
$133.00
|
|
Air injection into abdomen 49400
|
$494.40 |
$494.40 |
$494.40 |
$520.00
|
|
Airway resistance by impulse oscillometry 94728
|
$289.20 |
$289.20 |
$289.20 |
$289.20
|
|
Albumin body fluid quantitative each specimen
|
$15.20 |
$15.20 |
$15.20 |
$46.41
|
|
Albumin (human), 25%, 50ml
|
$85.76 |
$85.76 |
$85.76 |
$235.92
|
|
Albumin (human), 5%, 250 ml
|
$62.65 |
$62.65 |
$62.65 |
$251.66
|
|
Albumin (microalbumin) 24 hour urine quantitative
|
$14.40 |
$14.40 |
$14.40 |
$57.20
|
|
Albumin serum plasma or whole blood
|
$12.40 |
$12.40 |
$12.40 |
$42.00
|
|
Albuterol ipratrop non-comp
|
$0.40 |
$0.40 |
$0.40 |
$5.28
|
|
Alcohol (ethanol) any specimen except urine/breath
|
$40.00 |
$40.00 |
$40.00 |
$94.90
|
|
Alginate drsg >16 <=48 sq in
|
$58.40 |
$58.40 |
$58.40 |
$43.72
|
|
Alkaline phosphatase
|
$12.40 |
$12.40 |
$12.40 |
$46.80
|
|
Allergen alpha lactalbumin ige
|
$48.00 |
$48.00 |
$48.00 |
$48.57
|
|
Allergen egg white ige
|
$9.60 |
$9.60 |
$9.60 |
$37.05
|
|
Allograft 160mg placental salera mini membrane
|
$5,128.00 |
$5,128.00 |
$5,128.00 |
$5,481.00
|
|
Allograft dermis 20x25x1mm decell w/matracell arthroflex
|
$9,065.60 |
$9,065.60 |
$9,065.60 |
$6,414.50
|
|
Allograft ecm allopatch hd dehydr thick 0.8-1.7mmx2x5cm-cost per sq cm
|
$13,082.80 |
$13,082.80 |
$13,082.80 |
$19,637.03
|
|
Allograft epieffect 2x3cm-q4186-cost per sq cm
|
$1,708.40 |
$1,708.40 |
$1,708.40 |
$874.65
|
|
Allograft graftjacket 2x12cm-q4107-cost per sq cm
|
$6,262.00 |
$6,262.00 |
$6,262.00 |
$4,677.40
|
|
Allograft membrn amnio 1x2cm hu ambriodry
|
$7,488.00 |
$7,488.00 |
$7,488.00 |
$5,096.00
|
|
Alpha-fetoprotein afp-l3 frac & total
|
$149.60 |
$149.60 |
$149.60 |
$189.15
|
|
Alpha-fetoprotein amniotic
|
$42.00 |
$42.00 |
$42.00 |
$89.04
|
|
Alpha-fetoprotein tumor marker
|
$42.00 |
$42.00 |
$42.00 |
$103.80
|
|
Alprostadil for injection
|
$0.67 |
$0.67 |
$0.67 |
$512.20
|
|
Als 1
|
$132.40 |
$132.40 |
$132.40 |
$853.44
|
|
Als 2
|
$779.60 |
$779.60 |
$779.60 |
$1,288.56
|
|
Alteplase 100 mg infusion from pyxis vial
|
$146.30 |
$146.30 |
$146.30 |
$15,857.45
|
|
Alt/sgpt
|
$12.40 |
$12.40 |
$12.40 |
$47.40
|
|
Aluminum - quest
|
$59.20 |
$59.20 |
$59.20 |
$81.49
|
|
Alys cplx sp/pn npgt w/prgrm
|
$336.40 |
$336.40 |
$336.40 |
$411.45
|
|
Amantadine (symmetrel)-sendout
|
$124.00 |
$124.00 |
$124.00 |
$179.70
|
|
Ambl bp mntr w/sw a/r
|
$276.80 |
$276.80 |
$276.80 |
$320.45
|
|
Amino acid screen, urine
|
$34.40 |
$34.40 |
$34.40 |
$77.00
|
|
Amino acid single qual
|
$38.40 |
$38.40 |
$38.40 |
$36.00
|
|
Amino acids quant 2-5
|
$27.60 |
$27.60 |
$27.60 |
$113.60
|
|
Aminolevulinic acid delta
|
$41.60 |
$41.60 |
$41.60 |
$85.15
|
|
Aminophylline 25 mg/ml intravenous solution (wrapper)
|
$47.40 |
$47.40 |
$47.40 |
$46.02
|
|
Amiodarone 150 mg/100 ml (1.5 mg/ml) in dextrose, iso-osmotic IV
|
$16.23 |
$16.23 |
$16.23 |
$114.61
|
|
Amiodarone 50 mg/ml intravenous solution
|
$7.02 |
$7.02 |
$7.02 |
$55.86
|
|
Amitriptyline (elavil) -sendout
|
$40.40 |
$40.40 |
$40.40 |
$84.56
|
|
Ammonia
|
$36.40 |
$36.40 |
$36.40 |
$119.00
|
|
Amniocentesisdiagnostic 59000
|
$849.60 |
$849.60 |
$849.60 |
$923.50
|
|
Amniocentesis therapeutic
|
$856.80 |
$856.80 |
$856.80 |
$791.05
|
|
Amniotic fluid scan
|
$19.60 |
$19.60 |
$19.60 |
$49.01
|
|
Amphetamine confirm urine -sendout
|
$113.20 |
$113.20 |
$113.20 |
$93.61
|
|
Amphetamines 5 or more
|
$122.00 |
$122.00 |
$122.00 |
$90.48
|
|
Ampicillin 1 gram solution for injection
|
$33.26 |
$33.26 |
$33.26 |
$58.35
|
|
Ampicillin-sulbactam 1.5 gram solution for injection
|
$64.94 |
$64.94 |
$64.94 |
$54.57
|
|
Amylase
|
$16.00 |
$16.00 |
$16.00 |
$89.04
|
|
Anabolic steroid 1 or 2
|
$70.40 |
$70.40 |
$70.40 |
$80.08
|
|
Anabolic steroid 3 or more
|
$117.20 |
$117.20 |
$117.20 |
$27.20
|
|
Ana ds-dna
|
$31.60 |
$31.60 |
$31.60 |
$55.25
|
|
Analgesics non-opioid 3-5
|
$122.00 |
$122.00 |
$122.00 |
$16.24
|
|
Analgesics non-opioid 6/more
|
$20.00 |
$20.00 |
$20.00 |
$16.24
|
|
Analgesics non-opioid definitive assay 1 or 2 acetaminophen
|
$91.20 |
$91.20 |
$91.20 |
$113.28
|
|
Anal/urinary muscle study
|
$320.80 |
$320.80 |
$320.80 |
$407.00
|
|
Analysis complx cranial nerve pulse gen prgrmg 95977
|
$320.40 |
$320.40 |
$320.40 |
$335.85
|
|
Analysis gene f2 20210g>a variant
|
$82.40 |
$82.40 |
$82.40 |
$221.52
|
|
Analysis gene f5 leiden variant
|
$86.00 |
$86.00 |
$86.00 |
$237.60
|
|
Analysis; simple cranial nerv pulse gen prgrmg 95976
|
$226.00 |
$226.00 |
$226.00 |
$123.84
|
|
Analyze neurostimulator simple w/reprogramming 95971
|
$364.40 |
$364.40 |
$364.40 |
$375.00
|
|
Anaplsma phgcytophlm amp prb
|
$62.40 |
$62.40 |
$62.40 |
$82.65
|
|
Anca screen with reflex to titer -quest
|
$37.60 |
$37.60 |
$37.60 |
$99.00
|
|
An cholangiogram percutaneous compl
|
$1,926.00 |
$1,926.00 |
$1,926.00 |
$2,494.35
|
|
Androstanediol
|
$67.60 |
$67.60 |
$67.60 |
$131.04
|
|
An fluoro guide for cvp
|
$355.20 |
$355.20 |
$355.20 |
$515.00
|
|
Angio balloon ctrl dialysis seg add-on
|
$1,970.40 |
$1,970.40 |
$1,970.40 |
$5,500.00
|
|
Angiotensin ii
|
$51.60 |
$51.60 |
$51.60 |
$55.44
|
|
Angiotensin ii 0.5 mg/ml soln 1 ml vial
|
$37.20 |
$37.20 |
$37.20 |
$2,792.09
|
|
Angio trnslmnl balloon same artery ea addl
|
$1,754.80 |
$1,754.80 |
$1,754.80 |
$4,560.40
|
|
Angio trnslmnl balloon same artery ini
|
$3,998.00 |
$3,998.00 |
$3,998.00 |
$9,074.63
|
|
Angio trnslmnl balloon same vein ea addl
|
$1,754.80 |
$1,754.80 |
$1,754.80 |
$4,390.75
|
|
Angio trnslmnl balloon same vein ini
|
$3,998.00 |
$3,998.00 |
$3,998.00 |
$8,466.00
|
|
Anidulafungin injection
|
$1.43 |
$1.43 |
$1.43 |
$312.30
|
|
Ankle X-ray
|
$250.40 |
$250.40 |
$250.40 |
$352.80
|
|
Ank symes mold sckt sach ft
|
$1,682.40 |
$1,682.40 |
$1,682.40 |
$2,996.00
|
|
Anl sp inf pmp w/mdreprg&fil
|
$696.40 |
$696.40 |
$696.40 |
$627.94
|
|
Anogenital exam child w imag
|
$430.80 |
$430.80 |
$430.80 |
$277.99
|
|
Anoscopy and biopsy
|
$2,810.00 |
$2,810.00 |
$2,810.00 |
$1,670.25
|
|
Anterior swing band
|
$142.40 |
$142.40 |
$142.40 |
$506.45
|
|
Anterior thoracic extension
|
$158.80 |
$158.80 |
$158.80 |
$496.80
|
|
Antibody bacterium, not elsewhere specified
|
$32.40 |
$32.40 |
$32.40 |
$57.81
|
|
Antibody elution rbc reference
|
$170.40 |
$170.40 |
$170.40 |
$175.50
|
|
Antibody htlv/hiv confirm test
|
$48.40 |
$48.40 |
$48.40 |
$130.00
|
|
Antibody identification platelet antibodies heparin-pf4 igg
|
$43.20 |
$43.20 |
$43.20 |
$219.30
|
|
Antibody id rbc panel
|
$236.40 |
$236.40 |
$236.40 |
$290.21
|
|
Antibody influenza virus
|
$34.00 |
$34.00 |
$34.00 |
$53.90
|
|
Antibody lymphocytic choriomeningitis
|
$35.20 |
$35.20 |
$35.20 |
$46.20
|
|
Antibody screen rbc
|
$70.00 |
$70.00 |
$70.00 |
$106.00
|
|
Antibody tetanus
|
$24.00 |
$24.00 |
$24.00 |
$54.00
|
|
Antidepressant not specified
|
$119.60 |
$119.60 |
$119.60 |
$72.14
|
|
Antidepressants class 3-5
|
$122.00 |
$122.00 |
$122.00 |
$72.14
|
