|
Alcohol/subs interv 15-30mn
|
$35.50 |
$35.50 |
$35.50 |
$51.52
|
|
Alginate dressing <=16 sq in
|
$76.00 |
$76.00 |
$76.00 |
$18.20
|
|
Alkaline phosphatase
|
$47.00 |
$47.00 |
$47.00 |
$46.40
|
|
Allergen alpha lactalbumin ige
|
$28.25 |
$28.25 |
$28.25 |
$48.00
|
|
Allergen egg white ige
|
$150.00 |
$150.00 |
$150.00 |
$38.00
|
|
Allergy injections; 2 or more 95117
|
$57.00 |
$57.00 |
$57.00 |
$43.75
|
|
Allergy injection; single 95115
|
$41.50 |
$41.50 |
$41.50 |
$42.75
|
|
Allograft amnioexcel plus 17mm disk
|
$143.50 |
$143.50 |
$143.50 |
$2,250.00
|
|
Allograft amniotic activebarrier 200 2x2cm-q4100-cost per sheet
|
$0.01 |
$0.01 |
$0.01 |
$9,018.12
|
|
Allograft dermis 20x25x1mm decell w/matracell arthroflex
|
$129.00 |
$129.00 |
$129.00 |
$6,414.50
|
|
Allograft ecm allopatch hd dehydr thick 0.8-1.7mmx2x5cm-cost per sq cm
|
$46.00 |
$46.00 |
$46.00 |
$23,373.60
|
|
Allograft epieffect 2x3cm-q4186-cost per sq cm
|
$229.50 |
$229.50 |
$229.50 |
$874.65
|
|
Allograft graftjacket 2x12cm-q4107-cost per sq cm
|
$151.50 |
$151.50 |
$151.50 |
$4,677.40
|
|
Allograft membrn amnio 1x2cm hu ambriodry
|
$719.50 |
$719.50 |
$719.50 |
$4,725.00
|
|
Allograft umbil cord+amniotic membrane-q4148-cost per sq cm
|
$273.00 |
$273.00 |
$273.00 |
$4,561.83
|
|
All tstg perq&iq drugs/biol
|
$53.50 |
$53.50 |
$53.50 |
$64.80
|
|
Alpha-fetoprotein amniotic
|
$28.50 |
$28.50 |
$28.50 |
$96.20
|
|
Alpha-fetoprotein tumor marker
|
$136.00 |
$136.00 |
$136.00 |
$106.00
|
|
Alprostadil for injection
|
$14.00 |
$14.00 |
$14.00 |
$519.93
|
|
Alteplase 100 mg infusion from pyxis vial
|
$364.53 |
$364.53 |
$364.53 |
$15,857.45
|
|
Alt/sgpt
|
$47.50 |
$47.50 |
$47.50 |
$47.45
|
|
Aluminum - quest
|
$25.00 |
$25.00 |
$25.00 |
$83.05
|
|
Alys cplx sp/pn npgt w/prgrm
|
$124.50 |
$124.50 |
$124.50 |
$434.00
|
|
Amantadine (symmetrel)-sendout
|
$142.00 |
$142.00 |
$142.00 |
$169.80
|
|
Amikacin 4 mg/ml intravitreal injection - cnr
|
$1.50 |
$1.50 |
$1.50 |
$39.84
|
|
Aminolevulinic acid delta
|
$23.00 |
$23.00 |
$23.00 |
$85.15
|
|
Aminolevulinic acid hcl top
|
$885.00 |
$885.00 |
$885.00 |
$640.56
|
|
Aminophylline 25 mg/ml intravenous solution (wrapper)
|
$9.67 |
$9.67 |
$9.67 |
$45.02
|
|
Amiodarone 150 mg/100 ml (1.5 mg/ml) in dextrose, iso-osmotic IV
|
$41.40 |
$41.40 |
$41.40 |
$119.07
|
|
Amiodarone 50 mg/ml intravenous solution
|
$27.83 |
$27.83 |
$27.83 |
$55.86
|
|
Amitriptyline (elavil) -sendout
|
$62.00 |
$62.00 |
$62.00 |
$87.45
|
|
Ammonia
|
$132.50 |
$132.50 |
$132.50 |
$119.70
|
|
Amniocentesisdiagnostic 59000
|
$923.50 |
$923.50 |
$923.50 |
$942.60
|
|
Amp f/th 1/2 jt/phalanx w/neurect local flap
|
$3,907.50 |
$3,907.50 |
$3,907.50 |
$3,730.53
|
|
Amphetamine confirm urine -sendout
|
$32.00 |
$32.00 |
$32.00 |
$92.61
|
|
Amphetamines 5 or more
|
$29.50 |
$29.50 |
$29.50 |
$82.96
|
|
Ampicillin 1 gram solution for injection
|
$14.58 |
$14.58 |
$14.58 |
$56.70
|
|
Ampicillin-sulbactam 1.5 gram solution for injection
|
$7.86 |
$7.86 |
$7.86 |
$53.86
|
|
Amp metatarsal w/toe single 28810
|
$3,981.50 |
$3,981.50 |
$3,981.50 |
$4,271.00
|
|
Amputation toe interphalangeal joint
|
$3,986.50 |
$3,986.50 |
$3,986.50 |
$3,998.20
|
|
Amputation toe metatarsophalangeal joint
|
$6,473.00 |
$6,473.00 |
$6,473.00 |
$3,839.54
|
|
Amylase
|
$237.00 |
$237.00 |
$237.00 |
$89.04
|
|
Ana ds-dna
|
$58.50 |
$58.50 |
$58.50 |
$56.50
|
|
Analgesics non-opioid 3-5
|
$5.00 |
$5.00 |
$5.00 |
$16.24
|
|
Analgesics non-opioid 6/more
|
$5.00 |
$5.00 |
$5.00 |
$16.24
|
|
Analgesics non-opioid definitive assay 1 or 2 acetaminophen
|
$45.00 |
$45.00 |
$45.00 |
$117.01
|
|
Anal/urinary muscle study
|
$282.00 |
$282.00 |
$282.00 |
$576.00
|
|
Analysis gene f2 20210g>a variant
|
$689.00 |
$689.00 |
$689.00 |
$219.60
|
|
Analysis gene f5 leiden variant
|
$915.00 |
$915.00 |
$915.00 |
$230.40
|
|
Analyze neurostimulator simple w/reprogramming 95971
|
$124.50 |
$124.50 |
$124.50 |
$396.48
|
|
Anaplsma phgcytophlm amp prb
|
$115.50 |
$115.50 |
$115.50 |
$85.80
|
|
Anca screen with reflex to titer -quest
|
$99.00 |
$99.00 |
$99.00 |
$103.20
|
|
An cholangiogram percutaneous compl
|
$3,255.00 |
$3,255.00 |
$3,255.00 |
$2,626.65
|
|
An fluoro guide for cvp
|
$197.50 |
$197.50 |
$197.50 |
$515.00
|
|
Angiotensin ii 0.5 mg/ml soln 1 ml vial
|
$186.00 |
$186.00 |
$186.00 |
$3,080.85
|
|
Ankle X-ray
|
$329.50 |
$329.50 |
$329.50 |
$353.60
|
|
Annual alcohol screen 15 min
|
$47.50 |
$47.50 |
$47.50 |
$40.00
|
|
Annual Physical, Established Patient (age 18-39)
|
$131.00 |
$131.00 |
$131.00 |
$141.00
|
|
Annual Physical, Established Patient (age 40-64)
|
$151.50 |
$151.50 |
$151.50 |
$158.76
|
|
Annual Physical, New Patient (age 18-39)
|
$151.50 |
$151.50 |
$151.50 |
$143.25
|
|
Annual Physical, New Patient (age 40-64)
|
$170.50 |
$170.50 |
$170.50 |
$165.10
|
|
Anterior thoracic extension
|
$556.00 |
$556.00 |
$556.00 |
$496.80
|
|
Antibody bacterium, not elsewhere specified
|
$696.00 |
$696.00 |
$696.00 |
$57.81
|
|
Antibody elution rbc reference
|
$203.00 |
$203.00 |
$203.00 |
$175.50
|
|
Antibody htlv/hiv confirm test
|
$168.00 |
$168.00 |
$168.00 |
$130.00
|
|
Antibody identification platelet antibodies heparin-pf4 igg
|
$455.00 |
$455.00 |
$455.00 |
$218.30
|
|
Antibody id rbc panel
|
$338.00 |
$338.00 |
$338.00 |
$274.56
|
|
Antibody influenza virus
|
$216.00 |
$216.00 |
$216.00 |
$53.95
|
|
Antibody lymphocytic choriomeningitis
|
$25.50 |
$25.50 |
$25.50 |
$48.57
|
|
Antibody screen rbc
|
$57.50 |
$57.50 |
$57.50 |
$100.00
|
|
Antibody tetanus
|
$15.00 |
$15.00 |
$15.00 |
$53.95
|
|
Anticoag mgmt pt warfarin
|
$18.00 |
$18.00 |
$18.00 |
$26.40
|
|
Antidepressant not specified
|
$5.00 |
$5.00 |
$5.00 |
$61.80
|
|
Antidepressants class 3-5
|
$5.00 |
$5.00 |
$5.00 |
$59.46
|
|
Antidepressants class 6/more
|
$5.00 |
$5.00 |
$5.00 |
$29.21
|
|
Antiepileptics nos 4-6
|
$5.00 |
$5.00 |
$5.00 |
$16.24
|
|
Antiepileptics nos 7/more
|
$5.00 |
$5.00 |
$5.00 |
$16.24
|
|
Antigen therapy services
|
$54.00 |
$54.00 |
$54.00 |
$73.84
|
|
Antigen therapy services
|
$54.00 |
$54.00 |
$54.00 |
$83.72
|
|
Antigen therapy services
|
$79.50 |
$79.50 |
$79.50 |
$101.40
|
|
Antigen therapy services
|
$79.50 |
$79.50 |
$79.50 |
$96.72
|
|
Antigen therapy services
|
$79.50 |
$79.50 |
$79.50 |
$130.00
|
|
Antigen therapy services
|
$6.00 |
$6.00 |
$6.00 |
$70.07
|
|
Anti mog serum - sendout
|
$785.00 |
$785.00 |
$785.00 |
$159.00
|
|
Antineutrophil cytoplasmic antibody screen each antibody
|
$24.00 |
$24.00 |
$24.00 |
$37.05
|
|
Antineutrophil cytoplasmic antibody titer each antibody
|
$68.00 |
$68.00 |
$68.00 |
$40.00
|
|
Antinuclear antibodies
|
$68.50 |
$68.50 |
$68.50 |
$89.40
|
|
Antinuclear antibodies titer
|
$46.00 |
$46.00 |
$46.00 |
$77.00
|
|
Antipsychotics nos 7/more
|
$5.00 |
$5.00 |
$5.00 |
$16.24
|
|
Antistreptolysin o screen
|
$33.50 |
$33.50 |
$33.50 |
$62.00
|
|
Antistreptolysin o titer
|
$41.00 |
$41.00 |
$41.00 |
$51.45
|
|
Antithrombin iii activity
|
$306.00 |
$306.00 |
$306.00 |
$114.00
|
|
Apl(pml-rara) quant - sendout
|
$165.00 |
$165.00 |
$165.00 |
$482.95
|
|
Appendix Removal (Laparoscopic)
|
$15,977.00 |
$15,977.00 |
$15,977.00 |
$6,870.89
|
|
App high cost ss f/n/g/h/f >100sq cm 1st 100sq cm
|
$2,161.00 |
$2,161.00 |
$2,161.00 |
$2,114.00
|
|
App high cost ss f/n/g/h/f <100sq cm addl <25sq cm
|
$1,432.00 |
$1,432.00 |
$1,432.00 |
$463.65
|
|
App high cost ss t/a/l >100sq cm 1st 100sq cm
|
$398.00 |
$398.00 |
$398.00 |
$3,345.60
|
|
App high cost ss t/a/l >100sq cm addl 100sq cm
|
$259.00 |
$259.00 |
$259.00 |
$1,091.30
|
|
App high cost ss t/a/l <100sq cm addl <25sq cm
|
$398.00 |
$398.00 |
$398.00 |
$498.81
|
|
Application clubfoot cast
|
$191.50 |
$191.50 |
$191.50 |
$297.33
|
