|
Alcohol (ethanol) any specimen except urine/breath
|
$44.50 |
$44.50 |
$44.50 |
$93.60
|
|
Alcohol/subs interv 15-30mn
|
$36.00 |
$36.00 |
$36.00 |
$51.52
|
|
Alkaline phosphatase
|
$26.00 |
$26.00 |
$26.00 |
$46.40
|
|
Allergen alpha lactalbumin ige
|
$180.00 |
$180.00 |
$180.00 |
$48.00
|
|
Allergen egg white ige
|
$189.50 |
$189.50 |
$189.50 |
$38.00
|
|
Allergy injections; 2 or more 95117
|
$45.00 |
$45.00 |
$45.00 |
$43.75
|
|
Allergy injection; single 95115
|
$45.00 |
$45.00 |
$45.00 |
$42.75
|
|
Allergy Skin Testing
|
$3.50 |
$3.50 |
$3.50 |
$47.44
|
|
Allograft amnioexcel plus 17mm disk
|
$119.50 |
$119.50 |
$119.50 |
$2,250.00
|
|
Allograft amniotic activebarrier 200 2x2cm-q4100-cost per sheet
|
$0.01 |
$0.01 |
$0.01 |
$9,018.12
|
|
Allograft graftjacket 2x12cm-q4107-cost per sq cm
|
$119.50 |
$119.50 |
$119.50 |
$4,677.40
|
|
All tstg perq&iq drugs/biol
|
$59.50 |
$59.50 |
$59.50 |
$64.80
|
|
Alpha-fetoprotein amniotic
|
$28.50 |
$28.50 |
$28.50 |
$96.20
|
|
Alpha-fetoprotein tumor marker
|
$74.50 |
$74.50 |
$74.50 |
$106.00
|
|
Alprostadil for injection
|
$9.50 |
$9.50 |
$9.50 |
$519.93
|
|
Alteplase 100 mg infusion from pyxis vial
|
$255.12 |
$255.12 |
$255.12 |
$15,857.45
|
|
Alt/sgpt
|
$26.00 |
$26.00 |
$26.00 |
$47.45
|
|
Alys cplx sp/pn npgt w/prgrm
|
$121.50 |
$121.50 |
$121.50 |
$434.00
|
|
Amantadine (symmetrel)-sendout
|
$142.00 |
$142.00 |
$142.00 |
$169.80
|
|
Amikacin 4 mg/ml intravitreal injection - cnr
|
$1.00 |
$1.00 |
$1.00 |
$39.84
|
|
Aminolevulinic acid hcl top
|
$590.00 |
$590.00 |
$590.00 |
$640.56
|
|
Aminophylline 25 mg/ml intravenous solution (wrapper)
|
$4.30 |
$4.30 |
$4.30 |
$45.02
|
|
Amiodarone 150 mg/100 ml (1.5 mg/ml) in dextrose, iso-osmotic IV
|
$95.40 |
$95.40 |
$95.40 |
$119.07
|
|
Amiodarone 50 mg/ml intravenous solution
|
$1.04 |
$1.04 |
$1.04 |
$55.86
|
|
Amitriptyline (elavil) -sendout
|
$20.00 |
$20.00 |
$20.00 |
$87.45
|
|
Amivantamab-vmjw 50 mg/ml intravenous solution
|
$21,878.10 |
$21,878.10 |
$21,878.10 |
$7,994.03
|
|
Ammonia
|
$35.50 |
$35.50 |
$35.50 |
$119.70
|
|
Amp f/th 1/2 jt/phalanx w/neurect local flap
|
$723.00 |
$723.00 |
$723.00 |
$3,730.53
|
|
Amphetamine confirm urine -sendout
|
$20.00 |
$20.00 |
$20.00 |
$92.61
|
|
Amphetamines 5 or more
|
$57.00 |
$57.00 |
$57.00 |
$82.96
|
|
Ampicillin 1 gram solution for injection
|
$3.58 |
$3.58 |
$3.58 |
$56.70
|
|
Ampicillin-sulbactam 1.5 gram solution for injection
|
$4.78 |
$4.78 |
$4.78 |
$53.86
|
|
Amp metatarsal w/toe single 28810
|
$448.00 |
$448.00 |
$448.00 |
$4,271.00
|
|
Amputate leg at thigh
|
$735.00 |
$735.00 |
$735.00 |
$2,854.80
|
|
Amputate metacarpal bone 26910
|
$807.00 |
$807.00 |
$807.00 |
$3,821.05
|
|
Amputation follow-up surgery
|
$854.00 |
$854.00 |
$854.00 |
$3,766.40
|
|
Amputation follow-up surgery
|
$642.50 |
$642.50 |
$642.50 |
$3,839.54
|
|
Amputation leg thr tib/fib 27880
|
$972.50 |
$972.50 |
$972.50 |
$2,241.60
|
|
Amputation leg; tib/fib f/u 27886
|
$698.50 |
$698.50 |
$698.50 |
$1,461.89
|
|
Amputation of lower leg
|
$649.00 |
$649.00 |
$649.00 |
$1,417.20
|
|
Amputation thru metatarsal
|
$777.00 |
$777.00 |
$777.00 |
$3,839.54
|
|
Amputation toe interphalangeal joint
|
$2,640.00 |
$2,640.00 |
$2,640.00 |
$3,998.20
|
|
Amputation toe metatarsophalangeal joint
|
$2,288.00 |
$2,288.00 |
$2,288.00 |
$3,839.54
|
|
Amylase
|
$237.00 |
$237.00 |
$237.00 |
$89.04
|
|
Analgesics non-opioid definitive assay 1 or 2 acetaminophen
|
$45.00 |
$45.00 |
$45.00 |
$117.01
|
|
Anal/urinary muscle study
|
$71.50 |
$71.50 |
$71.50 |
$407.00
|
|
Analysis gene f2 20210g>a variant
|
$100.50 |
$100.50 |
$100.50 |
$219.60
|
|
Analysis gene f5 leiden variant
|
$100.50 |
$100.50 |
$100.50 |
$230.40
|
|
Analyze neurostimulator simple w/reprogramming 95971
|
$91.00 |
$91.00 |
$91.00 |
$396.48
|
|
Anaplsma phgcytophlm amp prb
|
$110.00 |
$110.00 |
$110.00 |
$85.80
|
|
Anca screen with reflex to titer -quest
|
$99.00 |
$99.00 |
$99.00 |
$103.20
|
|
An cholangiogram percutaneous compl
|
$2,916.00 |
$2,916.00 |
$2,916.00 |
$2,626.65
|
|
An fluoro guide for cvp
|
$349.00 |
$349.00 |
$349.00 |
$515.00
|
|
Angio balloon ctrl dialysis seg add-on
|
$151.50 |
$151.50 |
$151.50 |
$5,341.83
|
|
Angioplasty/iliac/init ves/unilat 37220
|
$424.00 |
$424.00 |
$424.00 |
$10,173.90
|
|
Angiotensin ii 0.5 mg/ml soln 1 ml vial
|
$11.50 |
$11.50 |
$11.50 |
$3,080.85
|
|
Ankle arthroscopy/surgery
|
$711.50 |
$711.50 |
$711.50 |
$3,839.54
|
|
Ankle arthroscopy/surgery
|
$672.00 |
$672.00 |
$672.00 |
$6,193.84
|
|
Ankle arthroscopy/surgery
|
$487.50 |
$487.50 |
$487.50 |
$3,797.90
|
|
Ankle arthroscopy/surgery
|
$523.50 |
$523.50 |
$523.50 |
$3,839.54
|
|
Ankle arthroscopy/surgery
|
$589.50 |
$589.50 |
$589.50 |
$3,839.54
|
|
Ankle arthroscopy/surgery
|
$1,050.00 |
$1,050.00 |
$1,050.00 |
$7,913.97
|
|
Ankle X-ray
|
$376.00 |
$376.00 |
$376.00 |
$353.60
|
|
Annual alcohol screen 15 min
|
$9.00 |
$9.00 |
$9.00 |
$40.00
|
|
Annual Physical, Established Patient (age 18-39)
|
$200.00 |
$200.00 |
$200.00 |
$141.00
|
|
Annual Physical, Established Patient (age 40-64)
|
$230.00 |
$230.00 |
$230.00 |
$158.76
|
|
Annual Physical, New Patient (age 18-39)
|
$170.50 |
$170.50 |
$170.50 |
$143.25
|
|
Annual Physical, New Patient (age 40-64)
|
$175.00 |
$175.00 |
$175.00 |
$165.10
|
|
Anora (draw only)
|
$12.50 |
$12.50 |
$12.50 |
$33.58
|
|
Anoscopy
|
$85.00 |
$85.00 |
$85.00 |
$1,278.72
|
|
Anoscopy and biopsy
|
$83.00 |
$83.00 |
$83.00 |
$1,395.28
|
|
Anoscopy and dilation 46604
|
$71.00 |
$71.00 |
$71.00 |
$1,621.60
|
|
Anoscopy control bleeding 46614
|
$69.50 |
$69.50 |
$69.50 |
$2,140.60
|
|
Anoscopy remove fb 46608
|
$95.00 |
$95.00 |
$95.00 |
$1,435.00
|
|
Anoscopy remove lesion 46610
|
$87.00 |
$87.00 |
$87.00 |
$3,723.75
|
|
Anoscopy remove lesions w/cautery/snare 46612
|
$106.00 |
$106.00 |
$106.00 |
$3,816.64
|
|
Ant colporrhaphy/rpr cyctocele 57240
|
$643.50 |
$643.50 |
$643.50 |
$5,463.96
|
|
Antibody bacterium, not elsewhere specified
|
$32.00 |
$32.00 |
$32.00 |
$57.81
|
|
Antibody elution rbc reference
|
$90.00 |
$90.00 |
$90.00 |
$175.50
|
|
Antibody identification platelet antibodies heparin-pf4 igg
|
$455.00 |
$455.00 |
$455.00 |
$218.30
|
|
Antibody id rbc panel
|
$384.00 |
$384.00 |
$384.00 |
$274.56
|
|
Antibody screen rbc
|
$41.00 |
$41.00 |
$41.00 |
$100.00
|
|
Antibody tetanus
|
$15.00 |
$15.00 |
$15.00 |
$53.95
|
|
Anticoag mgmt pt warfarin
|
$12.50 |
$12.50 |
$12.50 |
$26.40
|
|
Antigen therapy services
|
$96.00 |
$96.00 |
$96.00 |
$70.07
|
|
Antineutrophil cytoplasmic antibody screen each antibody
|
$10.00 |
$10.00 |
$10.00 |
$37.05
|
|
Antineutrophil cytoplasmic antibody titer each antibody
|
$43.50 |
$43.50 |
$43.50 |
$40.00
|
|
Antinuclear antibodies
|
$67.50 |
$67.50 |
$67.50 |
$89.40
|
|
Antinuclear antibodies titer
|
$47.00 |
$47.00 |
$47.00 |
$77.00
|
|
Antistreptolysin o titer
|
$5.00 |
$5.00 |
$5.00 |
$51.45
|
|
Antithrombin iii activity
|
$48.00 |
$48.00 |
$48.00 |
$114.00
|
|
Ant/post colporrhap/enterocele rpr 57265
|
$891.00 |
$891.00 |
$891.00 |
$4,155.20
|
|
Apl(pml-rara) quant - sendout
|
$165.00 |
$165.00 |
$165.00 |
$482.95
|
|
Appendectomy
|
$9,919.00 |
$9,919.00 |
$9,919.00 |
$5,681.93
|
|
Appendectomy add-on 44955
|
$89.50 |
$89.50 |
$89.50 |
$189.55
|
|
Appendectomy/open/rup/w/absc/peri 44960
|
$989.50 |
$989.50 |
$989.50 |
$1,562.44
|
|
Appendix Removal (Laparoscopic)
|
$9,646.00 |
$9,646.00 |
$9,646.00 |
$6,870.89
|
|
App high cost ss f/n/g/h/f >100sq cm 1st 100sq cm
|
$231.00 |
$231.00 |
$231.00 |
$2,114.00
|
|
App high cost ss f/n/g/h/f >100sq cm addl 100sq cm
|
$57.50 |
$57.50 |
$57.50 |
$851.85
|
|
App high cost ss f/n/g/h/f <100sq cm addl <25sq cm
|
$130.00 |
$130.00 |
$130.00 |
$463.65
|
