|
Allergy injections; 2 or more 95117
|
$32.50 |
$32.50 |
$32.50 |
$43.75
|
|
Allergy injection; single 95115
|
$27.50 |
$27.50 |
$27.50 |
$42.75
|
|
Allergy Skin Testing
|
$1,092.00 |
$1,092.00 |
$1,092.00 |
$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
|
$513.50 |
$513.50 |
$513.50 |
$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
|
$62.00 |
$62.00 |
$62.00 |
$64.80
|
|
Alpha-1-proteinase inhibitor (human) 1,000 mg (+/-) IV solution
|
$3,047.76 |
$3,047.76 |
$3,047.76 |
$12.50
|
|
Alpha-fetoprotein amniotic
|
$28.50 |
$28.50 |
$28.50 |
$96.20
|
|
Alpha-fetoprotein tumor marker
|
$62.50 |
$62.50 |
$62.50 |
$106.00
|
|
Alprostadil for injection
|
$9.50 |
$9.50 |
$9.50 |
$519.93
|
|
Alteplase 100 mg infusion from pyxis vial
|
$128.00 |
$128.00 |
$128.00 |
$15,857.45
|
|
Alt/sgpt
|
$30.50 |
$30.50 |
$30.50 |
$47.45
|
|
Alys cplx sp/pn npgt w/prgrm
|
$129.50 |
$129.50 |
$129.50 |
$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
|
|
Amiodarone 150 mg/100 ml (1.5 mg/ml) in dextrose, iso-osmotic IV
|
$47.85 |
$47.85 |
$47.85 |
$119.07
|
|
Amiodarone 50 mg/ml intravenous solution
|
$9.61 |
$9.61 |
$9.61 |
$55.86
|
|
Amitriptyline (elavil) -sendout
|
$11.00 |
$11.00 |
$11.00 |
$87.45
|
|
Ammonia
|
$65.50 |
$65.50 |
$65.50 |
$119.70
|
|
Amp f/th 1/2 jt/phalanx w/neurect local flap
|
$726.50 |
$726.50 |
$726.50 |
$3,730.53
|
|
Amphetamine confirm urine -sendout
|
$172.09 |
$172.09 |
$172.09 |
$92.61
|
|
Amphetamines 5 or more
|
$172.10 |
$172.10 |
$172.10 |
$82.96
|
|
Ampicillin 1 gram solution for injection
|
$3.35 |
$3.35 |
$3.35 |
$56.70
|
|
Ampicillin-sulbactam 1.5 gram solution for injection
|
$5.60 |
$5.60 |
$5.60 |
$53.86
|
|
Amp metatarsal w/toe single 28810
|
$2,534.50 |
$2,534.50 |
$2,534.50 |
$4,271.00
|
|
Amputate leg at thigh
|
$721.00 |
$721.00 |
$721.00 |
$2,854.80
|
|
Amputate metacarpal bone 26910
|
$780.00 |
$780.00 |
$780.00 |
$3,821.05
|
|
Amputation follow-up surgery
|
$853.50 |
$853.50 |
$853.50 |
$3,766.40
|
|
Amputation follow-up surgery
|
$642.50 |
$642.50 |
$642.50 |
$3,839.54
|
|
Amputation leg thr tib/fib 27880
|
$1,010.50 |
$1,010.50 |
$1,010.50 |
$2,241.60
|
|
Amputation leg; tib/fib f/u 27886
|
$721.50 |
$721.50 |
$721.50 |
$1,461.89
|
|
Amputation of lower leg
|
$663.50 |
$663.50 |
$663.50 |
$1,417.20
|
|
Amputation thru metatarsal
|
$777.00 |
$777.00 |
$777.00 |
$3,839.54
|
|
Amputation toe interphalangeal joint
|
$191.50 |
$191.50 |
$191.50 |
$3,998.20
|
|
Amputation toe metatarsophalangeal joint
|
$2,387.50 |
$2,387.50 |
$2,387.50 |
$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
|
$38.00 |
$38.00 |
$38.00 |
$407.00
|
|
Analysis gene f2 20210g>a variant
|
$457.00 |
$457.00 |
$457.00 |
$219.60
|
|
Analysis gene f5 leiden variant
|
$356.50 |
$356.50 |
$356.50 |
$230.40
|
|
Analyze neurostimulator simple w/reprogramming 95971
|
$150.50 |
$150.50 |
$150.50 |
$396.48
|
|
Anaplsma phgcytophlm amp prb
|
$201.06 |
$201.06 |
$201.06 |
$85.80
|
|
Anca screen with reflex to titer -quest
|
$99.00 |
$99.00 |
$99.00 |
$103.20
|
|
An fluoro guide for cvp
|
$366.00 |
$366.00 |
$366.00 |
$515.00
|
|
Angio balloon ctrl dialysis seg add-on
|
$154.00 |
$154.00 |
$154.00 |
$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
|
$4,128.86 |
$4,128.86 |
$4,128.86 |
$3,080.85
|
|
Ankle arthroscopy/surgery
|
$737.50 |
$737.50 |
$737.50 |
$3,839.54
|
|
Ankle arthroscopy/surgery
|
$672.00 |
$672.00 |
$672.00 |
$6,193.84
|
|
Ankle arthroscopy/surgery
|
$482.00 |
$482.00 |
$482.00 |
$3,797.90
|
|
Ankle arthroscopy/surgery
|
$543.50 |
$543.50 |
$543.50 |
$3,839.54
|
|
Ankle arthroscopy/surgery
|
$613.00 |
$613.00 |
$613.00 |
$3,839.54
|
|
Ankle arthroscopy/surgery
|
$1,107.00 |
$1,107.00 |
$1,107.00 |
$7,913.97
|
|
Ankle X-ray
|
$180.50 |
$180.50 |
$180.50 |
$353.60
|
|
Annual alcohol screen 15 min
|
$9.50 |
$9.50 |
$9.50 |
$40.00
|
|
Annual Physical, Established Patient (age 18-39)
|
$126.00 |
$126.00 |
$126.00 |
$141.00
|
|
Annual Physical, Established Patient (age 40-64)
|
$146.50 |
$146.50 |
$146.50 |
$158.76
|
|
Annual Physical, New Patient (age 18-39)
|
$146.50 |
$146.50 |
$146.50 |
$143.25
|
|
Annual Physical, New Patient (age 40-64)
|
$164.50 |
$164.50 |
$164.50 |
$165.10
|
|
Anora (draw only)
|
$9.00 |
$9.00 |
$9.00 |
$33.58
|
|
Anoscopy
|
$84.00 |
$84.00 |
$84.00 |
$1,278.72
|
|
Anoscopy and biopsy
|
$79.50 |
$79.50 |
$79.50 |
$1,395.28
|
|
Anoscopy and dilation 46604
|
$72.50 |
$72.50 |
$72.50 |
$1,621.60
|
|
Anoscopy control bleeding 46614
|
$70.50 |
$70.50 |
$70.50 |
$2,140.60
|
|
Anoscopy remove fb 46608
|
$91.00 |
$91.00 |
$91.00 |
$1,435.00
|
|
Anoscopy remove lesion 46610
|
$84.50 |
$84.50 |
$84.50 |
$3,723.75
|
|
Anoscopy remove lesions w/cautery/snare 46612
|
$102.50 |
$102.50 |
$102.50 |
$3,816.64
|
|
Ant colporrhaphy/rpr cyctocele 57240
|
$5,339.50 |
$5,339.50 |
$5,339.50 |
$5,463.96
|
|
Antibody bacterium, not elsewhere specified
|
$378.00 |
$378.00 |
$378.00 |
$57.81
|
|
Antibody elution rbc reference
|
$77.00 |
$77.00 |
$77.00 |
$175.50
|
|
Antibody identification platelet antibodies heparin-pf4 igg
|
$455.00 |
$455.00 |
$455.00 |
$218.30
|
|
Antibody id rbc panel
|
$107.50 |
$107.50 |
$107.50 |
$274.56
|
|
Antibody screen rbc
|
$48.50 |
$48.50 |
$48.50 |
$100.00
|
|
Antibody tetanus
|
$22.50 |
$22.50 |
$22.50 |
$53.95
|
|
Anticoag mgmt pt warfarin
|
$11.50 |
$11.50 |
$11.50 |
$26.40
|
|
Antigen therapy services
|
$125.00 |
$125.00 |
$125.00 |
$70.07
|
|
Antineutrophil cytoplasmic antibody screen each antibody
|
$10.00 |
$10.00 |
$10.00 |
$37.05
|
|
Antineutrophil cytoplasmic antibody titer each antibody
|
$178.00 |
$178.00 |
$178.00 |
$40.00
|
|
Antinuclear antibodies
|
$60.00 |
$60.00 |
$60.00 |
$89.40
|
|
Antinuclear antibodies titer
|
$56.00 |
$56.00 |
$56.00 |
$77.00
|
|
Antistreptolysin o titer
|
$5.00 |
$5.00 |
$5.00 |
$51.45
|
|
Antithrombin iii activity
|
$50.00 |
$50.00 |
$50.00 |
$114.00
|
|
Ant/post colporrhap/enterocele rpr 57265
|
$917.50 |
$917.50 |
$917.50 |
$4,155.20
|
|
Appendectomy
|
$691.50 |
$691.50 |
$691.50 |
$5,681.93
|
|
Appendectomy add-on 44955
|
$89.50 |
$89.50 |
$89.50 |
$189.55
|
|
Appendectomy/open/rup/w/absc/peri 44960
|
$945.00 |
$945.00 |
$945.00 |
$1,562.44
|
|
Appendix Removal (Laparoscopic)
|
$7,121.50 |
$7,121.50 |
$7,121.50 |
$6,870.89
|
|
App high cost ss f/n/g/h/f >100sq cm 1st 100sq cm
|
$246.50 |
$246.50 |
$246.50 |
$2,114.00
|
|
App high cost ss f/n/g/h/f >100sq cm addl 100sq cm
|
$62.00 |
$62.00 |
$62.00 |
$851.85
|
|
App high cost ss f/n/g/h/f <100sq cm addl <25sq cm
|
$763.50 |
$763.50 |
$763.50 |
$463.65
|
|
App high cost ss t/a/l >100sq cm 1st 100sq cm
|
$216.50 |
$216.50 |
$216.50 |
$3,345.60
|
|
App high cost ss t/a/l >100sq cm addl 100sq cm
|
$49.50 |
$49.50 |
$49.50 |
$1,091.30
|
|
App high cost ss t/a/l <100sq cm addl <25sq cm
|
$682.50 |
$682.50 |
$682.50 |
$498.81
|
|
Application finger splntstatic 29130
|
$144.50 |
$144.50 |
$144.50 |
$208.16
|
|
Application long leg splint 29505
|
$350.50 |
$350.50 |
$350.50 |
$338.25
|
|
Application lower leg splint 29515
|
$350.50 |
$350.50 |
$350.50 |
$330.48
|
|
Application multi layer compression below knee (both sides)
|
$353.50 |
$353.50 |
$353.50 |
$373.20
|
|
Application of cylinder cast 29365
|
$91.50 |
$91.50 |
$91.50 |
$420.00
|
