|
Adenovirus antibody,serum - quest
|
$19.00 |
$39.50 |
$109.50 |
|
|
Adenovirus assay w/optic
|
$44.00 |
$44.00 |
$44.00 |
|
|
Adh-sendout
|
$31.00 |
$31.00 |
$233.05 |
|
|
Adj gastric band via subq port
|
$943.50 |
$1,042.50 |
$8,176.00 |
|
|
Adjmt/revj ext fixj sys anes
|
$4,400.67 |
$4,400.67 |
$17,825.00 |
|
|
Adj tis trans/see area/10.1-30sqcm 14041
|
$730.00 |
$2,371.50 |
$20,783.50 |
|
|
Adjustment gastric band
|
$114.50 |
$122.50 |
$137.00 |
|
|
Admelog u-100 insulin lispro 100 unit/ml subcutaneous solution
|
$1.20 |
$26.84 |
$587.52 |
|
|
Admin ecg contrast agent
|
$29.50 |
$37.00 |
$59.20 |
|
|
Administration chemotherapy IV infusion each additional hour
|
$69.00 |
$215.50 |
$2,112.00 |
|
|
Administration chemotherapy IV infusion each addl sequential infusion diff substance/drug >1 hr
|
$45.50 |
$187.00 |
$1,008.00 |
|
|
Administration chemotherapy IV infusion up to 1 hour single/initial substance/drug
|
$316.50 |
$680.50 |
$1,442.50 |
|
|
Administration chemotherapy IV push single/initial substance/drug
|
$169.00 |
$316.50 |
$504.50 |
|
|
Administration chemotherapy subcutaneous/im anti neoplastic hormonal
|
$40.00 |
$130.40 |
$273.00 |
|
|
Administration chemotherapy subcutaneous/im anti neoplastic non hormonal
|
$84.50 |
$163.00 |
$273.00 |
|
|
Administration immunization 1 vaccine
|
$39.00 |
$69.00 |
$181.50 |
|
|
Administration immunization each additional component
|
$10.50 |
$25.00 |
$637.50 |
|
|
Administration immunization each additional vaccine
|
$23.50 |
$43.00 |
$337.00 |
|
|
Administration immunization first component each vaccine
|
$13.00 |
$24.00 |
$670.00 |
|
|
Administration immunization intranasal/oral route 1 vaccine
|
$26.50 |
$37.00 |
$69.00 |
|
|
Administration immunization intranasal/oral route each additional vaccine
|
$10.50 |
$13.50 |
$59.50 |
|
|
Administration rsv monoclonal ab seasonal dose im w/counseling
|
$39.00 |
$76.50 |
$186.50 |
|
|
Administration vaccine hepatitis b
|
$9.00 |
$40.80 |
$87.00 |
|
|
Administration vaccine influenza virus
|
$16.00 |
$32.50 |
$87.00 |
|
|
Administration vaccine pneumococcal
|
$9.00 |
$32.50 |
$132.50 |
|
|
Administration vaccine rsv monoclonal ab seasonal dose im
|
$32.50 |
$78.50 |
$186.50 |
|
|
Ado-trastuzumab emtansine 100 mg intravenous solution
|
$12,578.12 |
$15,093.74 |
$39,306.70 |
|
|
Adrenal cortex & medulla img
|
$1,156.50 |
$1,156.50 |
$1,156.50 |
|
|
Adrenalin epinephrine inject
|
$4.28 |
$88.88 |
$271.80 |
|
|
Advance care planning each additional 30 min 99498
|
$72.00 |
$77.00 |
$128.00 |
|
|
Aep hearing status deter i&r
|
$136.00 |
$241.50 |
$383.00 |
|
|
Aep neurodiagnostic i&r
|
$330.50 |
$350.50 |
$582.50 |
|
|
Aep thrshld est mlt freq i&r
|
$330.50 |
$350.50 |
$898.67 |
|
|
_afb id by dna probe rflx ast
|
$54.00 |
$75.50 |
$1,050.00 |
|
|
#afb mycobacteria suscep. #1
|
$24.00 |
$24.00 |
$26.00 |
|
|
_afb org id by sequencing rflx ast-sendout
|
$186.50 |
$472.00 |
$743.00 |
|
|
Aflibercept injection
|
$847.00 |
$2,185.50 |
$8,742.00 |
|
|
Afo molded to patient plasti
|
$954.00 |
$974.50 |
$1,077.50 |
|
|
Afo sing bar clasp attach sh
|
$188.50 |
$194.00 |
$199.50 |
|
|
Afo sing solid stirrup calf
|
$713.00 |
$728.50 |
$805.50 |
|
|
Afo tibial fracture rigid
|
$38.50 |
$38.50 |
$38.50 |
|
|
Afo, walk boot type, cus fab
|
$244.00 |
$244.00 |
$251.00 |
|
|
After cataract laser surgery
|
$296.00 |
$632.00 |
$1,449.00 |
|
|
Agalsidase beta 35 mg intravenous solution
|
$46,964.82 |
$46,964.82 |
$46,964.82 |
|
|
Air conduction bilat
|
$23.50 |
$121.00 |
$193.60 |
|
|
Air injection into abdomen 49400
|
$68.50 |
$82.00 |
$91.50 |
|
|
Airway resistance by impulse oscillometry 94728
|
$212.00 |
$226.50 |
$1,162.00 |
|
|
Albumin body fluid quantitative each specimen
|
$5.40 |
$28.00 |
$113.50 |
|
|
Albumin (human), 25%, 50ml
|
$52.50 |
$294.00 |
$922.50 |
|
|
Albumin (human), 5%, 250 ml
|
$92.25 |
$144.00 |
$1,845.00 |
|
|
Albumin (microalbumin) 24 hour urine quantitative
|
$17.50 |
$33.00 |
$105.00 |
|
|
Albumin serum plasma or whole blood
|
$11.20 |
$30.50 |
$100.20 |
|
|
Albuterol comp unit
|
$0.39 |
$0.39 |
$0.39 |
|
|
Albuterol ipratrop non-comp
|
$1.00 |
$1.00 |
$1.60 |
|
|
Alcohol (ethanol) any specimen except urine/breath
|
$28.00 |
$44.80 |
$131.00 |
|
|
Alcohol/subs interv 15-30mn
|
$28.00 |
$36.00 |
$57.60 |
|
|
Alcohol/subs interv >30 min
|
$201.00 |
$201.00 |
$201.00 |
|
|
Alginate dressing <=16 sq in
|
$76.00 |
$76.00 |
$78.00 |
|
|
Alginate drsg >16 <=48 sq in
|
$93.50 |
$93.50 |
$93.50 |
|
|
Alkaline phosphatase
|
$18.00 |
$34.00 |
$87.00 |
|
|
Allergen alpha lactalbumin ige
|
$13.00 |
$61.00 |
$1,600.00 |
|
|
Allergen egg white ige
|
$10.20 |
$143.00 |
$7,030.00 |
|
|
Allergen specific ige qual multi scrn ea
|
$13.61 |
$13.61 |
$26.40 |
|
|
Allergy injections; 2 or more 95117
|
$12.50 |
$32.50 |
$135.00 |
|
|
Allergy injection; single 95115
|
$10.00 |
$38.40 |
$58.00 |
|
|
Allergy Skin Testing
|
$3.50 |
$6.40 |
$1,092.00 |
|
|
Allg patch or app # of tests 95044
|
$4.00 |
$738.00 |
$1,890.00 |
|
|
Allgrft implnt knee w/scope
|
$13,841.50 |
$13,841.50 |
$13,841.50 |
|
|
Allograft allowrap 4x4cm dry 16sqcm
|
$635.04 |
$635.04 |
$4,737.17 |
|
|
Allograft amnioexcel plus 17mm disk
|
$119.50 |
$143.50 |
$8,760.00 |
|
|
Allograft amniotic activebarrier 200 2x2cm-q4100-cost per sheet
|
$0.01 |
$0.01 |
$11,345.00 |
|
|
Allograft dermis 20x25x1mm decell w/matracell arthroflex
|
$85.00 |
$1,785.35 |
$4,201.00 |
|
|
Allograft ecm allopatch hd dehydr thick 0.8-1.7mmx2x5cm-cost per sq cm
|
$44.00 |
$46.00 |
$8,240.97 |
|
|
Allograft epieffect 2x3cm-q4186-cost per sq cm
|
$219.00 |
$222.50 |
$1,313.47 |
|
|
Allograft graftjacket 2x12cm-q4107-cost per sq cm
|
$119.50 |
$143.50 |
$3,457.75 |
|
|
Allograft membrn amnio 1x2cm hu ambriodry
|
$650.50 |
$668.50 |
$2,555.25 |
|
|
Allograft umbil cord+amniotic membrane-q4148-cost per sq cm
|
$261.00 |
$265.50 |
$318.00 |
|
|
Allograft umbilical epicord 15 sq cm-q4187-cost per sq cm
|
$380.73 |
$380.73 |
$380.73 |
|
|
All tstg perq&iq drugs/biol
|
$50.00 |
$59.50 |
$272.50 |
|
|
All tstg perq&iq w/venoms
|
$177.50 |
$177.50 |
$177.50 |
|
|
Alpha-1-proteinase inhibitor (human) 1,000 mg (+/-) IV solution
|
$3.60 |
$3,047.76 |
$3,697.65 |
|
|
Alpha-fetoprotein afp-l3 frac & total
|
$37.80 |
$116.50 |
$568.50 |
|
|
Alpha-fetoprotein amniotic
|
$28.50 |
$28.50 |
$174.50 |
|
|
Alpha-fetoprotein tumor marker
|
$19.20 |
$91.50 |
$184.20 |
|
|
Alprostadil for injection
|
$9.50 |
$14.00 |
$328.46 |
|
|
Alteplase 100 mg infusion from pyxis vial
|
$128.00 |
$364.53 |
$32,310.00 |
|
|
Alt/sgpt
|
$9.60 |
$34.00 |
$135.60 |
|
|
Aluminum - quest
|
$25.00 |
$25.00 |
$162.00 |
|
|
Alveoloplasty each quadrant
|
$3,636.63 |
$3,636.63 |
$3,636.63 |
|
|
Alys cplx sp/pn npgt w/prgrm
|
$77.50 |
$140.00 |
$4,353.67 |
|
|
Amantadine (symmetrel)-sendout
|
$129.00 |
$142.00 |
$227.20 |
|
|
Ambl bp mntr w/software
|
$155.50 |
$155.50 |
$155.50 |
|
|
Ambl bp mntr w/sw a/r
|
$168.00 |
$268.80 |
$379.50 |
|
|
Amikacin 4 mg/ml intravitreal injection - cnr
|
$1.00 |
$1.50 |
$53.02 |
|
|
Amino acids quant 2-5
|
$87.50 |
$104.00 |
$216.00 |
|
|
Aminocaproic acid 5 g/250 ml 0.9% nacl IV - cnr
|
$9.23 |
$9.23 |
$9.23 |
|
|
Aminolevulinic acid delta
|
$23.00 |
$84.00 |
$214.50 |
|
|
Aminolevulinic acid hcl top
|
$590.00 |
$885.00 |
$944.00 |
|
|
Aminophylline 25 mg/ml intravenous solution (wrapper)
|
$1.02 |
$9.67 |
$24.00 |
|
|
Amiodarone 150 mg/100 ml (1.5 mg/ml) in dextrose, iso-osmotic IV
|
$31.80 |
$120.00 |
$180.00 |
|
