|
Abdominal CT scan (with and without contrast)
|
$3,990.92 |
$3,990.92 |
$3,990.92 |
$2,009.80
|
|
Abdominal CT scan (with contrast)
|
$3,254.59 |
$3,254.59 |
$3,254.59 |
$1,683.63
|
|
Abdominal MRI (with and without contrast)
|
$6,956.58 |
$6,956.58 |
$6,956.58 |
$2,933.60
|
|
Abdominal paracentesis w/image guidance
|
$3,562.88 |
$3,562.88 |
$3,562.88 |
$1,688.29
|
|
Abdominal Ultrasound (complete)
|
$1,201.46 |
$1,201.46 |
$1,201.46 |
$785.25
|
|
Abdominal Ultrasound (limited)
|
$1,081.53 |
$1,081.53 |
$1,081.53 |
$604.43
|
|
Ablation of upper extremity nerves rf
|
$1,426.83 |
$1,426.83 |
$1,426.83 |
$825.60
|
|
Acetaminophen 10 mg/ml soln 100 ml glass cont
|
$303.75 |
$303.75 |
$303.75 |
$89.91
|
|
Acetaminophen level
|
$302.10 |
$302.10 |
$302.10 |
$117.01
|
|
Acetazolamide 500 mg solution for injection
|
$140.28 |
$140.28 |
$140.28 |
$137.80
|
|
Acetylcysteine 200 mg/ml (20 %) intravenous solution
|
$66.67 |
$66.67 |
$66.67 |
$306.22
|
|
Acute hepatitis panel
|
$703.51 |
$703.51 |
$703.51 |
$284.70
|
|
Acyclovir 5 mg/ml in ns IV syringe (neo/ped) - cnr
|
$36.83 |
$36.83 |
$36.83 |
$64.45
|
|
Adenosine 3 mg/250 ml bag for osm
|
$419.15 |
$419.15 |
$419.15 |
$217.04
|
|
Admelog u-100 insulin lispro 100 unit/ml subcutaneous solution
|
$32.08 |
$32.08 |
$32.08 |
$158.18
|
|
Administration chemotherapy IV push single/initial substance/drug
|
$1,071.61 |
$1,071.61 |
$1,071.61 |
$444.49
|
|
Administration chemotherapy subcutaneous/im anti neoplastic non hormonal
|
$518.05 |
$518.05 |
$518.05 |
$267.43
|
|
Administration immunization 1 vaccine
|
$126.46 |
$126.46 |
$126.46 |
$70.00
|
|
Administration immunization each additional vaccine
|
$134.53 |
$134.53 |
$134.53 |
$46.23
|
|
Administration vaccine influenza virus
|
$312.99 |
$312.99 |
$312.99 |
$49.40
|
|
Albumin (human), 25%, 50ml
|
$453.41 |
$453.41 |
$453.41 |
$277.87
|
|
Albumin, human 25 % intravenous solution
|
$301.06 |
$301.06 |
$301.06 |
$488.08
|
|
Albumin (human), 5%, 250 ml
|
$478.85 |
$478.85 |
$478.85 |
$292.50
|
|
Albumin (microalbumin) 24 hour urine quantitative
|
$194.38 |
$194.38 |
$194.38 |
$58.00
|
|
Albumin serum plasma or whole blood
|
$150.18 |
$150.18 |
$150.18 |
$43.45
|
|
Albuterol ipratrop non-comp
|
$71.48 |
$71.48 |
$71.48 |
$9.93
|
|
Albuterol non-comp unit
|
$16.25 |
$16.25 |
$16.25 |
$9.43
|
|
Alcohol (ethanol) any specimen except urine/breath
|
$336.83 |
$336.83 |
$336.83 |
$94.90
|
|
Alkaline phosphatase
|
$197.61 |
$197.61 |
$197.61 |
$46.50
|
|
Allergen alpha lactalbumin ige
|
$227.34 |
$227.34 |
$227.34 |
$56.35
|
|
Allergen egg white ige
|
$64.02 |
$64.02 |
$64.02 |
$39.78
|
|
Alpha-fetoprotein tumor marker
|
$271.79 |
$271.79 |
$271.79 |
$103.60
|
|
Alteplase 100 mg infusion from pyxis vial
|
$421.20 |
$421.20 |
$421.20 |
$9,600.63
|
|
Alt/sgpt
|
$85.90 |
$85.90 |
$85.90 |
$49.00
|
|
Aminophylline 25 mg/ml intravenous solution (wrapper)
|
$31.44 |
$31.44 |
$31.44 |
$43.72
|
|
Amiodarone 150 mg/100 ml (1.5 mg/ml) in dextrose, iso-osmotic IV
|
$1,434.07 |
$1,434.07 |
$1,434.07 |
$174.72
|
|
Amiodarone 50 mg/ml intravenous solution
|
$47.44 |
$47.44 |
$47.44 |
$50.85
|
|
Amivantamab-vmjw 50 mg/ml intravenous solution
|
$30,131.94 |
$30,131.94 |
$30,131.94 |
$15,167.75
|
|
Ammonia
|
$222.90 |
$222.90 |
$222.90 |
$123.48
|
|
Amphetamines 5 or more
|
$385.99 |
$385.99 |
$385.99 |
$93.60
|
|
Ampicillin 1 gram solution for injection
|
$213.59 |
$213.59 |
$213.59 |
$68.44
|
|
Ampicillin-sulbactam 1.5 gram solution for injection
|
$442.71 |
$442.71 |
$442.71 |
$57.38
|
|
Amylase
|
$228.48 |
$228.48 |
$228.48 |
$93.00
|
|
Analgesics non-opioid definitive assay 1 or 2 acetaminophen
|
$249.13 |
$249.13 |
$249.13 |
$117.01
|
|
Analysis gene f2 20210g>a variant
|
$805.71 |
$805.71 |
$805.71 |
$219.13
|
|
Analysis gene f5 leiden variant
|
$899.90 |
$899.90 |
$899.90 |
$226.60
|
|
Anaplsma phgcytophlm amp prb
|
$184.50 |
$184.50 |
$184.50 |
$95.45
|
|
Anca screen with reflex to titer -quest
|
$171.45 |
$171.45 |
$171.45 |
$103.20
|
|
Angiotensin ii 0.5 mg/ml soln 1 ml vial
|
$14,669.95 |
$14,669.95 |
$14,669.95 |
$6,048.00
|
|
Ankle X-ray
|
$474.26 |
$474.26 |
$474.26 |
$350.85
|
|
Antibody id rbc panel
|
$471.02 |
$471.02 |
$471.02 |
$291.75
|
|
Antibody screen rbc
|
$227.63 |
$227.63 |
$227.63 |
$105.00
|
|
Antidepressant not specified
|
$188.32 |
$188.32 |
$188.32 |
$89.50
|
|
Antineutrophil cytoplasmic antibody screen each antibody
|
$190.70 |
$190.70 |
$190.70 |
$50.88
|
|
Antinuclear antibodies
|
$245.03 |
$245.03 |
$245.03 |
$91.70
|
|
Antinuclear antibodies titer
|
$273.68 |
$273.68 |
$273.68 |
$80.25
|
|
Antiphosphatidylserine antibody
|
$162.06 |
$162.06 |
$162.06 |
$74.20
|
|
Antistreptolysin o titer
|
$391.74 |
$391.74 |
$391.74 |
$57.85
|
|
Antithrombin iii activity
|
$523.11 |
$523.11 |
$523.11 |
$106.85
|
|
Application long leg splint 29505
|
$1,798.42 |
$1,798.42 |
$1,798.42 |
$370.00
|
|
Application lower leg splint 29515
|
$1,064.78 |
$1,064.78 |
$1,064.78 |
$365.60
|
|
Application of forearm cast 29075
|
$1,578.53 |
$1,578.53 |
$1,578.53 |
$386.10
|
|
Apply hand/wrist cast 29085
|
$924.21 |
$924.21 |
$924.21 |
$275.80
|
|
Apply intrcav radiat compl
|
$9,218.31 |
$9,218.31 |
$9,218.31 |
$1,717.51
|
|
Apply intrcav radiat interm
|
$7,013.06 |
$7,013.06 |
$7,013.06 |
$1,521.98
|
|
Apply intrcav radiat simple
|
$7,013.06 |
$7,013.06 |
$7,013.06 |
$1,001.00
|
|
Apply short leg castambul type 29425
|
$1,790.41 |
$1,790.41 |
$1,790.41 |
$460.92
|
|
Aprepitant 130 mg/18 ml (7.2 mg/ml) intravenous emulsion
|
$457.14 |
$457.14 |
$457.14 |
$943.40
|
|
Arsenic trioxide 2 mg/ml intravenous solution
|
$772.22 |
$772.22 |
$772.22 |
$1,301.04
|
|
Arthrocentesis/aspiration/inj major joint/bursa without Ultrasound guidance (both sides)
|
$852.03 |
$852.03 |
$852.03 |
$715.37
|
|
Assay dir meas fr estradiol
|
$30.81 |
$30.81 |
$30.81 |
$75.11
|
|
Assay of salicylate
|
$157.22 |
$157.22 |
$157.22 |
$104.00
|
|
Assess aphasia/interp/rpt/per hr 96105
|
$529.91 |
$529.91 |
$529.91 |
$312.00
|
|
Ast/sgot
|
$83.96 |
$83.96 |
$83.96 |
$46.20
|
|
Atezolizumab 60 mg/ml intravenous solution (wrapper)
|
$29,545.00 |
$29,545.00 |
$29,545.00 |
$31,198.64
|
|
Atropine 0.1 mg/ml injection syringe
|
$46.69 |
$46.69 |
$46.69 |
$43.85
|
|
Avulsion nail plate partial/complete simple single nail plate
|
$653.78 |
$653.78 |
$653.78 |
$356.00
|
|
Azacitidine injection
|
$424.31 |
$424.31 |
$424.31 |
$1,042.91
|
|
Azithromycin 500 mg intravenous solution
|
$178.66 |
$178.66 |
$178.66 |
$55.63
|
|
Bacterial meningitis antigen
|
$141.55 |
$141.55 |
$141.55 |
$66.76
|
|
Bacterial vaginosis pcr
|
$776.79 |
$776.79 |
$776.79 |
$284.00
|
|
Bendamustine 25 mg/ml intravenous solution (bendeka)
|
$8,607.23 |
$8,607.23 |
$8,607.23 |
$6,471.19
|
|
#_benzodiazconfur
|
$112.49 |
$112.49 |
$112.49 |
$100.75
|
|
Benztropine 1 mg/ml injection solution
|
$61.69 |
$61.69 |
$61.69 |
$116.84
|
|
Beta 2 glycoprotein 1 antibody iga
|
$149.91 |
$149.91 |
$149.91 |
$92.82
|
|
Betamethasone acetate and sodium phos 6 mg/ml suspension for injection
|
$55.07 |
$55.07 |
$55.07 |
$70.37
|
|
Bevacizumab 25 mg/ml intravenous solution
|
$8,993.76 |
$8,993.76 |
$8,993.76 |
$5,250.00
|
|
Bevacizumab-awwb 25 mg/ml intravenous solution
|
$1,927.64 |
$1,927.64 |
$1,927.64 |
$4,868.42
|
|
Bevacizumab injection
|
$1,738.78 |
$1,738.78 |
$1,738.78 |
$697.32
|
|
Bilirubin direct
|
$181.79 |
$181.79 |
$181.79 |
$49.31
|
|
Bilirubin total
|
$181.79 |
$181.79 |
$181.79 |
$51.50
|
|
Block tap inj(s) w/wo img bi
|
$2,291.29 |
$2,291.29 |
$2,291.29 |
$1,413.50
|
|
Block tap inj(s) w/wo img uni
|
$1,527.54 |
$1,527.54 |
$1,527.54 |
$1,053.00
|
|
Blood Clotting (PT/INR) Test
|
$132.78 |
$132.78 |
$132.78 |
$52.46
|
|
Blood Clotting (PTT) Test
|
$140.70 |
$140.70 |
$140.70 |
$73.15
|
|
Blood Count (CBC) Test
|
$224.51 |
$224.51 |
$224.51 |
$74.34
|
|
Blood Count (CBC) Test (without differential)
|
$189.69 |
$189.69 |
$189.69 |
$62.15
|
|
Blood Culture Test
|
$384.36 |
$384.36 |
$384.36 |
$145.60
|
|
Blood draw capillary 36416
|
$33.48 |
$33.48 |
$33.48 |
$22.40
|
|
Blood occult fecal hemoglobin immunoassay qualitative 1-3 simultaneous determinations diagnostic
|
$258.01 |
$258.01 |
$258.01 |
$57.60
|
