|
Albumin serum plasma or whole blood
|
$25.50 |
$25.50 |
$25.50 |
$40.80
|
|
Albuterol comp unit
|
$0.39 |
$0.39 |
$0.39 |
$0.80
|
|
Albuterol ipratrop non-comp
|
$1.00 |
$1.00 |
$1.00 |
$5.40
|
|
Alcohol (ethanol) any specimen except urine/breath
|
$131.00 |
$131.00 |
$131.00 |
$93.60
|
|
Alcohol/subs interv 15-30mn
|
$33.50 |
$33.50 |
$33.50 |
$51.52
|
|
Alginate dressing <=16 sq in
|
$78.00 |
$78.00 |
$78.00 |
$18.20
|
|
Alkaline phosphatase
|
$26.00 |
$26.00 |
$26.00 |
$46.40
|
|
Allergen alpha lactalbumin ige
|
$1,600.00 |
$1,600.00 |
$1,600.00 |
$48.00
|
|
Allergen egg white ige
|
$143.00 |
$143.00 |
$143.00 |
$38.00
|
|
Allergy injections; 2 or more 95117
|
$31.00 |
$31.00 |
$31.00 |
$43.75
|
|
Allergy injection; single 95115
|
$31.00 |
$31.00 |
$31.00 |
$42.75
|
|
Allergy Skin Testing
|
$21.00 |
$21.00 |
$21.00 |
$47.44
|
|
Allgrft implnt knee w/scope
|
$13,841.50 |
$13,841.50 |
$13,841.50 |
$6,411.60
|
|
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
|
$1,785.35 |
$1,785.35 |
$1,785.35 |
$6,414.50
|
|
Allograft graftjacket 2x12cm-q4107-cost per sq cm
|
$143.50 |
$143.50 |
$143.50 |
$4,677.40
|
|
All tstg perq&iq drugs/biol
|
$63.50 |
$63.50 |
$63.50 |
$64.80
|
|
Alpha-1-proteinase inhibitor (human) 1,000 mg (+/-) IV solution
|
$3,697.65 |
$3,697.65 |
$3,697.65 |
$12.50
|
|
Alpha-fetoprotein amniotic
|
$28.50 |
$28.50 |
$28.50 |
$96.20
|
|
Alpha-fetoprotein tumor marker
|
$85.00 |
$85.00 |
$85.00 |
$106.00
|
|
Alprostadil for injection
|
$14.00 |
$14.00 |
$14.00 |
$519.93
|
|
Alteplase 100 mg infusion from pyxis vial
|
$729.05 |
$729.05 |
$729.05 |
$15,857.45
|
|
Alt/sgpt
|
$26.50 |
$26.50 |
$26.50 |
$47.45
|
|
Aluminum - quest
|
$131.50 |
$131.50 |
$131.50 |
$83.05
|
|
Alys cplx sp/pn npgt w/prgrm
|
$141.50 |
$141.50 |
$141.50 |
$434.00
|
|
Amantadine (symmetrel)-sendout
|
$142.00 |
$142.00 |
$142.00 |
$169.80
|
|
Ambl bp mntr w/sw a/r
|
$297.00 |
$297.00 |
$297.00 |
$310.44
|
|
Amikacin 4 mg/ml intravitreal injection - cnr
|
$1.50 |
$1.50 |
$1.50 |
$39.84
|
|
Amino acids quant 2-5
|
$87.50 |
$87.50 |
$87.50 |
$104.00
|
|
Aminolevulinic acid delta
|
$84.00 |
$84.00 |
$84.00 |
$85.15
|
|
Aminolevulinic acid hcl top
|
$885.00 |
$885.00 |
$885.00 |
$640.56
|
|
Amiodarone 150 mg/100 ml (1.5 mg/ml) in dextrose, iso-osmotic IV
|
$180.00 |
$180.00 |
$180.00 |
$119.07
|
|
Amiodarone 50 mg/ml intravenous solution
|
$4.10 |
$4.10 |
$4.10 |
$55.86
|
|
Amitriptyline (elavil) -sendout
|
$103.00 |
$103.00 |
$103.00 |
$87.45
|
|
Ammonia
|
$77.50 |
$77.50 |
$77.50 |
$119.70
|
|
Amp f/th 1/2 jt/phalanx w/neurect local flap
|
$3,607.34 |
$3,607.34 |
$3,607.34 |
$3,730.53
|
|
Amphetamine confirm urine -sendout
|
$21.50 |
$21.50 |
$21.50 |
$92.61
|
|
Amphetamines 5 or more
|
$103.00 |
$103.00 |
$103.00 |
$82.96
|
|
Ampicillin 1 gram solution for injection
|
$49.84 |
$49.84 |
$49.84 |
$56.70
|
|
Ampicillin-sulbactam 1.5 gram solution for injection
|
$7.17 |
$7.17 |
$7.17 |
$53.86
|
|
Amp metatarsal w/toe single 28810
|
$4,271.00 |
$4,271.00 |
$4,271.00 |
$4,271.00
|
|
Amputation thru metatarsal
|
$5,938.00 |
$5,938.00 |
$5,938.00 |
$3,839.54
|
|
Amputation toe interphalangeal joint
|
$5,440.50 |
$5,440.50 |
$5,440.50 |
$3,998.20
|
|
Amputation toe metatarsophalangeal joint
|
$4,803.00 |
$4,803.00 |
$4,803.00 |
$3,839.54
|
|
Amylase
|
$237.00 |
$237.00 |
$237.00 |
$89.04
|
|
Ana ds-dna
|
$62.50 |
$62.50 |
$62.50 |
$56.50
|
|
Analgesics non-opioid 3-5
|
$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
|
|
Analysis gene f2 20210g>a variant
|
$263.00 |
$263.00 |
$263.00 |
$219.60
|
|
Analysis gene f5 leiden variant
|
$328.00 |
$328.00 |
$328.00 |
$230.40
|
|
Analyze neurostimulator simple w/reprogramming 95971
|
$89.00 |
$89.00 |
$89.00 |
$396.48
|
|
Anaplsma phgcytophlm amp prb
|
$110.00 |
$110.00 |
$110.00 |
$85.80
|
|
Anca screen with reflex to titer -quest
|
$78.00 |
$78.00 |
$78.00 |
$103.20
|
|
An cholangiogram percutaneous compl
|
$5,953.50 |
$5,953.50 |
$5,953.50 |
$2,626.65
|
|
An fluoro guide for cvp
|
$368.00 |
$368.00 |
$368.00 |
$515.00
|
|
Angiotensin ii 0.5 mg/ml soln 1 ml vial
|
$10,983.60 |
$10,983.60 |
$10,983.60 |
$3,080.85
|
|
Angio trnslmnl balloon same artery ini
|
$12,114.00 |
$12,114.00 |
$12,114.00 |
$9,074.63
|
|
Ankle X-ray
|
$388.00 |
$388.00 |
$388.00 |
$353.60
|
|
Anl sp inf pmp w/mdreprg&fil
|
$337.50 |
$337.50 |
$337.50 |
$627.94
|
|
Annual alcohol screen 15 min
|
$34.50 |
$34.50 |
$34.50 |
$40.00
|
|
Annual Physical, Established Patient (age 18-39)
|
$91.50 |
$91.50 |
$91.50 |
$141.00
|
|
Annual Physical, Established Patient (age 40-64)
|
$99.00 |
$99.00 |
$99.00 |
$158.76
|
|
Annual Physical, New Patient (age 18-39)
|
$100.00 |
$100.00 |
$100.00 |
$143.25
|
|
Annual Physical, New Patient (age 40-64)
|
$121.00 |
$121.00 |
$121.00 |
$165.10
|
|
Ant colporrhaphy/rpr cyctocele 57240
|
$2,766.33 |
$2,766.33 |
$2,766.33 |
$5,463.96
|
|
Antibody bacterium, not elsewhere specified
|
$264.00 |
$264.00 |
$264.00 |
$57.81
|
|
Antibody elution rbc reference
|
$223.50 |
$223.50 |
$223.50 |
$175.50
|
|
Antibody htlv-i
|
$43.00 |
$43.00 |
$43.00 |
$49.53
|
|
Antibody identification platelet antibodies heparin-pf4 igg
|
$455.00 |
$455.00 |
$455.00 |
$218.30
|
|
Antibody id rbc panel
|
$1,042.50 |
$1,042.50 |
$1,042.50 |
$274.56
|
|
Antibody influenza virus
|
$70.00 |
$70.00 |
$70.00 |
$53.95
|
|
Antibody lymphocytic choriomeningitis
|
$37.20 |
$37.20 |
$37.20 |
$48.57
|
|
Antibody screen rbc
|
$57.25 |
$57.25 |
$57.25 |
$100.00
|
|
Antibody tetanus
|
$76.50 |
$76.50 |
$76.50 |
$53.95
|
|
Antidepressant not specified
|
$5.50 |
$5.50 |
$5.50 |
$61.80
|
|
Antidepressants class 3-5
|
$5.00 |
$5.00 |
$5.00 |
$59.46
|
|
Antiepileptics nos 4-6
|
$5.00 |
$5.00 |
$5.00 |
$16.24
|
|
Antigen therapy services
|
$51.00 |
$51.00 |
$51.00 |
$73.84
|
|
Antigen therapy services
|
$51.00 |
$51.00 |
$51.00 |
$83.72
|
|
Antigen therapy services
|
$75.50 |
$75.50 |
$75.50 |
$101.40
|
|
Antigen therapy services
|
$75.50 |
$75.50 |
$75.50 |
$96.72
|
|
Antigen therapy services
|
$75.50 |
$75.50 |
$75.50 |
$130.00
|
|
Antigen therapy services
|
$120.00 |
$120.00 |
$120.00 |
$70.07
|
|
Antihemophilic factor-vwf 250 unit-600 unit intravenous solution
|
$6,372.00 |
$6,372.00 |
$6,372.00 |
$6.10
|
|
Anti mog serum - sendout
|
$462.50 |
$462.50 |
$462.50 |
$159.00
|
|
Antineutrophil cytoplasmic antibody screen each antibody
|
$40.00 |
$40.00 |
$40.00 |
$37.05
|
|
Antineutrophil cytoplasmic antibody titer each antibody
|
$40.00 |
$40.00 |
$40.00 |
$40.00
|
|
Antinuclear antibodies
|
$70.00 |
$70.00 |
$70.00 |
$89.40
|
|
Antinuclear antibodies titer
|
$40.00 |
$40.00 |
$40.00 |
$77.00
|
|
Antiphosphatidylserine antibody
|
$57.50 |
$57.50 |
$57.50 |
$65.97
|
|
Antipsychotics nos 1-3
|
$295.00 |
$295.00 |
$295.00 |
$142.42
|
|
Antipsychotics nos 7/more
|
$5.00 |
$5.00 |
$5.00 |
$16.24
|
|
Antistreptolysin o titer
|
$37.50 |
$37.50 |
$37.50 |
$51.45
|
|
Antithrombin iii activity
|
$38.00 |
$38.00 |
$38.00 |
$114.00
|
|
Apl(pml-rara) quant - sendout
|
$741.00 |
$741.00 |
$741.00 |
$482.95
|
|
Appendix Removal (Laparoscopic)
|
$8,840.50 |
$8,840.50 |
$8,840.50 |
$6,870.89
|
|
App high cost ss f/n/g/h/f <100sq cm addl <25sq cm
|
$585.17 |
$585.17 |
$585.17 |
$463.65
|
|
App high cost ss t/a/l >100sq cm 1st 100sq cm
|
$2,591.50 |
$2,591.50 |
$2,591.50 |
$3,345.60
|
|
App high cost ss t/a/l >100sq cm addl 100sq cm
|
$1,295.75 |
$1,295.75 |
$1,295.75 |
$1,091.30
|
