|
Alpha-fetoprotein amniotic
|
$45.60 |
$45.60 |
$45.60 |
$96.20
|
|
Alpha-fetoprotein tumor marker
|
$19.20 |
$19.20 |
$19.20 |
$106.00
|
|
Alprostadil for injection
|
$15.20 |
$15.20 |
$15.20 |
$519.93
|
|
Alteplase 100 mg infusion from pyxis vial
|
$388.82 |
$388.82 |
$388.82 |
$15,857.45
|
|
Alt/sgpt
|
$9.60 |
$9.60 |
$9.60 |
$47.45
|
|
Alys cplx sp/pn npgt w/prgrm
|
$146.40 |
$146.40 |
$146.40 |
$434.00
|
|
Amantadine (symmetrel)-sendout
|
$227.20 |
$227.20 |
$227.20 |
$169.80
|
|
Ambl bp mntr w/sw a/r
|
$268.80 |
$268.80 |
$268.80 |
$310.44
|
|
Amikacin 4 mg/ml intravitreal injection - cnr
|
$1.60 |
$1.60 |
$1.60 |
$39.84
|
|
Aminolevulinic acid delta
|
$40.00 |
$40.00 |
$40.00 |
$85.15
|
|
Aminolevulinic acid hcl top
|
$944.00 |
$944.00 |
$944.00 |
$640.56
|
|
Amiodarone 150 mg/100 ml (1.5 mg/ml) in dextrose, iso-osmotic IV
|
$76.56 |
$76.56 |
$76.56 |
$119.07
|
|
Amiodarone 50 mg/ml intravenous solution
|
$8.73 |
$8.73 |
$8.73 |
$55.86
|
|
Amitriptyline (elavil) -sendout
|
$17.60 |
$17.60 |
$17.60 |
$87.45
|
|
Ammonia
|
$120.00 |
$120.00 |
$120.00 |
$119.70
|
|
Amp f/th 1/2 jt/phalanx w/neurect local flap
|
$1,156.80 |
$1,156.80 |
$1,156.80 |
$3,730.53
|
|
Amphetamine confirm urine -sendout
|
$260.00 |
$260.00 |
$260.00 |
$92.61
|
|
Amphetamines 5 or more
|
$55.20 |
$55.20 |
$55.20 |
$82.96
|
|
Ampicillin 1 gram solution for injection
|
$5.36 |
$5.36 |
$5.36 |
$56.70
|
|
Ampicillin-sulbactam 1.5 gram solution for injection
|
$6.78 |
$6.78 |
$6.78 |
$53.86
|
|
Amp metatarsal w/toe single 28810
|
$716.80 |
$716.80 |
$716.80 |
$4,271.00
|
|
Amputate leg at thigh
|
$1,176.00 |
$1,176.00 |
$1,176.00 |
$2,854.80
|
|
Amputate metacarpal bone 26910
|
$1,291.20 |
$1,291.20 |
$1,291.20 |
$3,821.05
|
|
Amputation follow-up surgery
|
$1,366.40 |
$1,366.40 |
$1,366.40 |
$3,766.40
|
|
Amputation follow-up surgery
|
$6,739.20 |
$6,739.20 |
$6,739.20 |
$3,839.54
|
|
Amputation leg thr tib/fib 27880
|
$9,651.20 |
$9,651.20 |
$9,651.20 |
$2,241.60
|
|
Amputation leg; tib/fib f/u 27886
|
$1,117.60 |
$1,117.60 |
$1,117.60 |
$1,461.89
|
|
Amputation of lower leg
|
$1,038.40 |
$1,038.40 |
$1,038.40 |
$1,417.20
|
|
Amputation thru metatarsal
|
$1,185.60 |
$1,185.60 |
$1,185.60 |
$3,839.54
|
|
Amputation toe interphalangeal joint
|
$5,014.40 |
$5,014.40 |
$5,014.40 |
$3,998.20
|
|
Amputation toe metatarsophalangeal joint
|
$5,014.40 |
$5,014.40 |
$5,014.40 |
$3,839.54
|
|
Amylase
|
$379.20 |
$379.20 |
$379.20 |
$89.04
|
|
Analgesics non-opioid definitive assay 1 or 2 acetaminophen
|
$72.00 |
$72.00 |
$72.00 |
$117.01
|
|
Anal/urinary muscle study
|
$67.20 |
$67.20 |
$67.20 |
$407.00
|
|
Analysis gene f2 20210g>a variant
|
$173.60 |
$173.60 |
$173.60 |
$219.60
|
|
Analysis gene f5 leiden variant
|
$128.80 |
$128.80 |
$128.80 |
$230.40
|
|
Analyze neurostimulator simple w/reprogramming 95971
|
$145.60 |
$145.60 |
$145.60 |
$396.48
|
|
Anaplsma phgcytophlm amp prb
|
$176.00 |
$176.00 |
$176.00 |
$85.80
|
|
Anca screen with reflex to titer -quest
|
$153.60 |
$153.60 |
$153.60 |
$103.20
|
|
An fluoro guide for cvp
|
$142.40 |
$142.40 |
$142.40 |
$515.00
|
|
Angio balloon ctrl dialysis seg add-on
|
$242.40 |
$242.40 |
$242.40 |
$5,341.83
|
|
Angiotensin ii 0.5 mg/ml soln 1 ml vial
|
$4,404.11 |
$4,404.11 |
$4,404.11 |
$3,080.85
|
|
Ankle arthroscopy/surgery
|
$1,138.40 |
$1,138.40 |
$1,138.40 |
$3,839.54
|
|
Ankle arthroscopy/surgery
|
$1,075.20 |
$1,075.20 |
$1,075.20 |
$6,193.84
|
|
Ankle arthroscopy/surgery
|
$780.00 |
$780.00 |
$780.00 |
$3,797.90
|
|
Ankle arthroscopy/surgery
|
$837.60 |
$837.60 |
$837.60 |
$3,839.54
|
|
Ankle arthroscopy/surgery
|
$943.20 |
$943.20 |
$943.20 |
$3,839.54
|
|
Ankle arthroscopy/surgery
|
$1,680.00 |
$1,680.00 |
$1,680.00 |
$7,913.97
|
|
Ankle X-ray
|
$201.60 |
$201.60 |
$201.60 |
$353.60
|
|
Annual alcohol screen 15 min
|
$14.40 |
$14.40 |
$14.40 |
$40.00
|
|
Annual Physical, Established Patient (age 18-39)
|
$161.60 |
$161.60 |
$161.60 |
$141.00
|
|
Annual Physical, Established Patient (age 40-64)
|
$176.80 |
$176.80 |
$176.80 |
$158.76
|
|
Annual Physical, New Patient (age 18-39)
|
$184.80 |
$184.80 |
$184.80 |
$143.25
|
|
Annual Physical, New Patient (age 40-64)
|
$216.80 |
$216.80 |
$216.80 |
$165.10
|
|
Anora (draw only)
|
$30.40 |
$30.40 |
$30.40 |
$33.58
|
|
Anoscopy
|
$136.00 |
$136.00 |
$136.00 |
$1,278.72
|
|
Anoscopy and biopsy
|
$129.60 |
$129.60 |
$129.60 |
$1,395.28
|
|
Anoscopy and dilation 46604
|
$113.60 |
$113.60 |
$113.60 |
$1,621.60
|
|
Anoscopy control bleeding 46614
|
$111.20 |
$111.20 |
$111.20 |
$2,140.60
|
|
Anoscopy remove fb 46608
|
$152.00 |
$152.00 |
$152.00 |
$1,435.00
|
|
Anoscopy remove lesion 46610
|
$139.20 |
$139.20 |
$139.20 |
$3,723.75
|
|
Anoscopy remove lesions w/cautery/snare 46612
|
$169.60 |
$169.60 |
$169.60 |
$3,816.64
|
|
Ant colporrhaphy/rpr cyctocele 57240
|
$2,863.20 |
$2,863.20 |
$2,863.20 |
$5,463.96
|
|
Antibody bacterium, not elsewhere specified
|
$153.60 |
$153.60 |
$153.60 |
$57.81
|
|
Antibody elution rbc reference
|
$151.20 |
$151.20 |
$151.20 |
$175.50
|
|
Antibody identification platelet antibodies heparin-pf4 igg
|
$728.00 |
$728.00 |
$728.00 |
$218.30
|
|
Antibody id rbc panel
|
$72.00 |
$72.00 |
$72.00 |
$274.56
|
|
Antibody influenza virus
|
$28.80 |
$28.80 |
$28.80 |
$53.95
|
|
Antibody screen rbc
|
$17.60 |
$17.60 |
$17.60 |
$100.00
|
|
Antibody tetanus
|
$24.00 |
$24.00 |
$24.00 |
$53.95
|
|
Anticoag mgmt pt warfarin
|
$20.00 |
$20.00 |
$20.00 |
$26.40
|
|
Antigen therapy services
|
$4.80 |
$4.80 |
$4.80 |
$70.07
|
|
Antineutrophil cytoplasmic antibody screen each antibody
|
$256.00 |
$256.00 |
$256.00 |
$37.05
|
|
Antineutrophil cytoplasmic antibody titer each antibody
|
$13.60 |
$13.60 |
$13.60 |
$40.00
|
|
Antinuclear antibodies
|
$19.20 |
$19.20 |
$19.20 |
$89.40
|
|
Antinuclear antibodies titer
|
$24.00 |
$24.00 |
$24.00 |
$77.00
|
|
Antiphosphatidylserine antibody
|
$275.20 |
$275.20 |
$275.20 |
$65.97
|
|
Antistreptolysin o titer
|
$16.80 |
$16.80 |
$16.80 |
$51.45
|
|
Antithrombin iii activity
|
$65.60 |
$65.60 |
$65.60 |
$114.00
|
|
Ant/post colporrhap/enterocele rpr 57265
|
$1,425.60 |
$1,425.60 |
$1,425.60 |
$4,155.20
|
|
Apl(pml-rara) quant - sendout
|
$264.00 |
$264.00 |
$264.00 |
$482.95
|
|
Appendectomy
|
$1,136.80 |
$1,136.80 |
$1,136.80 |
$5,681.93
|
|
Appendectomy add-on 44955
|
$143.20 |
$143.20 |
$143.20 |
$189.55
|
|
Appendectomy/open/rup/w/absc/peri 44960
|
$1,553.60 |
$1,553.60 |
$1,553.60 |
$1,562.44
|
|
Appendix Removal (Laparoscopic)
|
$8,701.60 |
$8,701.60 |
$8,701.60 |
$6,870.89
|
|
App high cost ss f/n/g/h/f >100sq cm 1st 100sq cm
|
$369.60 |
$369.60 |
$369.60 |
$2,114.00
|
|
App high cost ss f/n/g/h/f >100sq cm addl 100sq cm
|
$92.00 |
$92.00 |
$92.00 |
$851.85
|
|
App high cost ss f/n/g/h/f <100sq cm addl <25sq cm
|
$218.40 |
$218.40 |
$218.40 |
$463.65
|
|
App high cost ss t/a/l >100sq cm 1st 100sq cm
|
$321.60 |
$321.60 |
$321.60 |
$3,345.60
|
|
App high cost ss t/a/l >100sq cm addl 100sq cm
|
$73.60 |
$73.60 |
$73.60 |
$1,091.30
|
|
App high cost ss t/a/l <100sq cm addl <25sq cm
|
$28.00 |
$28.00 |
$28.00 |
$498.81
|
|
Application finger splntstatic 29130
|
$204.00 |
$204.00 |
$204.00 |
$208.16
|
|
Application long leg splint 29505
|
$354.40 |
$354.40 |
$354.40 |
$338.25
|
|
Application lower leg splint 29515
|
$354.40 |
$354.40 |
$354.40 |
$330.48
|
|
Application multi layer compression below knee (both sides)
|
$499.20 |
$499.20 |
$499.20 |
$373.20
|
|
Application of cylinder cast 29365
|
$148.00 |
$148.00 |
$148.00 |
$420.00
|
|
Application of forearm cast 29075
|
$428.80 |
$428.80 |
$428.80 |
$339.30
|
|
Application of long arm cast 29065
|
$428.80 |
$428.80 |
$428.80 |
$395.00
|
|
Application of long leg cast 29345
|
$580.80 |
$580.80 |
$580.80 |
$455.00
|
|
Application of paste boot 29580
|
$499.20 |
$499.20 |
$499.20 |
$331.74
|
