|
Administration immunization each additional vaccine
|
$35.60 |
$35.60 |
$43.95 |
$46.89
|
|
Administration immunization intranasal/oral route 1 vaccine
|
$42.08 |
$46.00 |
$46.00 |
$48.00
|
|
Administration immunization intranasal/oral route each additional vaccine
|
$25.35 |
$46.00 |
$46.00 |
$30.24
|
|
Administration rsv monoclonal ab seasonal dose im w/counseling
|
$283.20 |
$283.20 |
$283.20 |
$42.00
|
|
Administration vaccine hepatitis b
|
$38.80 |
$38.80 |
$44.84 |
$51.80
|
|
Administration vaccine influenza virus
|
$24.80 |
$24.80 |
$43.95 |
$48.73
|
|
Administration vaccine pneumococcal
|
$38.80 |
$38.80 |
$43.95 |
$48.73
|
|
Administration vaccine rsv monoclonal ab seasonal dose im
|
$283.20 |
$283.20 |
$283.20 |
$41.45
|
|
Ado-trastuzumab emtansine 100 mg intravenous solution
|
$121.82 |
$121.82 |
$121.82 |
$11,350.31
|
|
_afb id by dna probe rflx ast
|
$50.40 |
$50.40 |
$112.56 |
$103.37
|
|
#afb mycobacteria suscep. #1
|
$14.40 |
$14.40 |
$27.92 |
$34.74
|
|
_afb org id by sequencing rflx ast-sendout
|
$258.56 |
$292.00 |
$292.00 |
$293.02
|
|
Afo molded ankle gauntlet
|
$275.60 |
$275.60 |
$275.60 |
$765.51
|
|
Afo molded plas rig ant tib
|
$612.00 |
$612.00 |
$612.00 |
$2,022.34
|
|
Afo molded to patient plasti
|
$311.20 |
$311.20 |
$311.20 |
$757.77
|
|
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
|
$54.88 |
$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
|
|
Agalsidase beta 35 mg intravenous solution
|
$365.59 |
$469.12 |
$40,673.71 |
$14,475.20
|
|
Air conduction bilat
|
$134.00 |
$134.00 |
$134.00 |
$133.00
|
|
Air injection into abdomen 49400
|
$266.22 |
$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 |
$26.62 |
$46.41
|
|
Albumin (human), 25%, 50ml
|
$85.76 |
$86.48 |
$4,725.33 |
$235.92
|
|
Albumin (human), 5%, 250 ml
|
$60.12 |
$71.28 |
$393.78 |
$251.66
|
|
Albumin (microalbumin) 24 hour urine quantitative
|
$14.40 |
$14.40 |
$41.43 |
$57.20
|
|
Albumin serum plasma or whole blood
|
$12.40 |
$12.40 |
$24.95 |
$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
|
|
Alcohol/subs interv 15-30mn
|
$51.36 |
$51.36 |
$51.36 |
$54.00
|
|
Alcohol/subs interv >30 min
|
$102.70 |
$102.70 |
$102.70 |
$189.21
|
|
Aldesleukin injection
|
$11,139.10 |
$11,139.10 |
$11,139.10 |
$9,030.11
|
|
Alginate dressing <=16 sq in
|
$12.84 |
$12.84 |
$12.84 |
$16.56
|
|
Alginate drsg >16 <=48 sq in
|
$19.87 |
$58.40 |
$58.40 |
$43.72
|
|
Alkaline phosphatase
|
$12.40 |
$12.40 |
$23.84 |
$46.80
|
|
Allergen alpha lactalbumin ige
|
$31.71 |
$48.00 |
$48.00 |
$48.57
|
|
Allergen egg white ige
|
$9.60 |
$9.60 |
$27.19 |
$37.05
|
|
Allergen specific ige qual multi scrn ea
|
$22.46 |
$22.46 |
$22.46 |
$24.00
|
|
Allg patch or app # of tests 95044
|
$446.81 |
$446.81 |
$446.81 |
$411.95
|
|
Allograft 160mg placental salera mini membrane
|
$5,128.00 |
$5,128.00 |
$5,644.77 |
$5,481.00
|
|
Allograft amniotic activebarrier 200 2x2cm-q4100-cost per sheet
|
$784.40 |
$784.40 |
$8,629.25 |
$9,018.12
|
|
Allograft dermis 20x25x1mm decell w/matracell arthroflex
|
$5,817.57 |
$9,065.60 |
$9,065.60 |
$6,414.50
|
|
Allograft ecm allopatch hd dehydr thick 0.8-1.7mmx2x5cm-cost per sq cm
|
$2,749.74 |
$13,082.80 |
$13,082.80 |
$19,637.03
|
|
Allograft epieffect 2x3cm-q4186-cost per sq cm
|
$1,708.40 |
$1,708.40 |
$24,386.98 |
$874.65
|
|
Allograft graftjacket 2x12cm-q4107-cost per sq cm
|
$4,549.20 |
$6,262.00 |
$6,262.00 |
$4,677.40
|
|
Allograft membrn amnio 1x2cm hu ambriodry
|
$5,689.44 |
$7,488.00 |
$7,488.00 |
$5,096.00
|
|
Allograft umbil cord+amniotic membrane-q4148-cost per sq cm
|
$6,347.72 |
$6,347.72 |
$6,347.72 |
$5,152.95
|
|
Allograft umbilical epicord 15 sq cm-q4187-cost per sq cm
|
$7,546.73 |
$7,546.73 |
$7,546.73 |
$2,202.93
|
|
Alpha-1-proteinase inhibitor (human) 1,000 mg (+/-) IV solution
|
$7.45 |
$7.45 |
$7,094.26 |
$12.50
|
|
Alpha-fetoprotein afp-l3 frac & total
|
$149.60 |
$149.60 |
$236.91 |
$189.15
|
|
Alpha-fetoprotein amniotic
|
$42.00 |
$42.00 |
$78.35 |
$89.04
|
|
Alpha-fetoprotein tumor marker
|
$42.00 |
$42.00 |
$88.04 |
$103.80
|
|
Alprostadil for injection
|
$165.47 |
$165.47 |
$165.47 |
$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
|
$145.72 |
$230.28 |
$13,602.78 |
$15,857.45
|
|
Alt/sgpt
|
$12.40 |
$12.40 |
$39.21 |
$47.40
|
|
Aluminum - quest
|
$59.20 |
$59.20 |
$119.86 |
$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
|
|
Amifostine
|
$1,637.16 |
$1,637.16 |
$1,637.16 |
$2,121.39
|
|
Amikacin 4 mg/ml intravitreal injection - cnr
|
$3.18 |
$35.62 |
$190.71 |
$40.28
|
|
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
|
|
Aminocaproic acid 5 g/250 ml 0.9% nacl IV - cnr
|
$5.76 |
$5.76 |
$48.29 |
$37.14
|
|
Aminolevulinic acid delta
|
$41.60 |
$41.60 |
$144.11 |
$85.15
|
|
Aminophylline 25 mg/ml intravenous solution (wrapper)
|
$2,189.45 |
$2,189.45 |
$2,189.45 |
$46.02
|
|
Amiodarone 50 mg/ml intravenous solution
|
$7.82 |
$10.44 |
$221.48 |
$55.86
|
|
Amitriptyline (elavil) -sendout
|
$40.40 |
$40.40 |
$40.40 |
$84.56
|
|
Amivantamab-vmjw 50 mg/ml intravenous solution
|
$44.87 |
$44.87 |
$6,503.73 |
$8,666.76
|
|
Ammonia
|
$36.40 |
$36.40 |
$72.87 |
$119.00
|
|
Amniocentesisdiagnostic 59000
|
$367.89 |
$849.60 |
$849.60 |
$923.50
|
|
Amniocentesis therapeutic
|
$575.35 |
$856.80 |
$856.80 |
$791.05
|
|
Amniotic fluid scan
|
$19.60 |
$19.60 |
$62.50 |
$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
|
|
Amphotericin b in d5w IV syringe 0.1 mg/ml (neo/ped) - cnr
|
$307.68 |
$307.68 |
$144,107.88 |
$117.75
|
|
Amphotericin b lipid complex
|
$3,626.92 |
$3,626.92 |
$3,626.92 |
$226.80
|
|
Amphotericin b liposomal in d5w IV syringe 1 mg/ml (neo/ped) - cnr
|
$64.28 |
$75.06 |
$3,633.84 |
$519.03
|
|
Ampicillin 1 gram solution for injection
|
$32.66 |
$40.82 |
$564.40 |
$58.35
|
|
Ampicillin-sulbactam 1.5 gram solution for injection
|
$64.94 |
$74.26 |
$607.85 |
$54.57
|
|
Amplification real-time pcr dna markers infectious disease bacterial vaginosis and vaginitis
|
$181.50 |
$181.50 |
$181.50 |
$262.99
|
|
Amylase
|
$16.00 |
$16.00 |
$51.88 |
$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 |
$104.19 |
$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 |
$200.70 |
$221.52
|
|
Analysis gene f5 leiden variant
|
$86.00 |
$86.00 |
$188.66 |
$237.60
|
