|
Pt application of modality >=1 area electrical stimulation each 15 minutes
|
$451.50 |
$451.50 |
$451.50 |
$92.43
|
|
Pt evaluation high complexity patient/family
|
$838.25 |
$838.25 |
$838.25 |
$299.40
|
|
Pt evaluation low complexity patient/family
|
$502.50 |
$502.50 |
$502.50 |
$226.80
|
|
Pt evaluation moderate complexity patient/family
|
$669.50 |
$669.50 |
$669.50 |
$264.00
|
|
Pt re-evaluation patient/family
|
$450.00 |
$450.00 |
$450.00 |
$159.75
|
|
Pulmonary vent imaging
|
$933.75 |
$933.75 |
$933.75 |
$845.28
|
|
Pyruvate
|
$67.00 |
$67.00 |
$67.00 |
$65.00
|
|
Radiation physics consult
|
$356.75 |
$356.75 |
$356.75 |
$594.60
|
|
Radiation therapy dose plan
|
$724.00 |
$724.00 |
$724.00 |
$530.53
|
|
Radiotherapy dose plan imrt
|
$6,246.00 |
$6,246.00 |
$6,246.00 |
$5,996.21
|
|
Radphm lcl tmr plnr bdy sgl day img
|
$9,942.50 |
$9,942.50 |
$9,942.50 |
$2,014.64
|
|
Radphm lcl tmr plnr bdy two day img
|
$18,904.25 |
$18,904.25 |
$18,904.25 |
$2,728.42
|
|
Radphm lcl tomogr sgl area sgl day
|
$5,764.75 |
$5,764.75 |
$5,764.75 |
$2,379.29
|
|
Radphm lcl tumor plr sgl day
|
$3,095.25 |
$3,095.25 |
$3,095.25 |
$1,120.50
|
|
Rbc count only automated
|
$14.00 |
$14.00 |
$14.00 |
$19.50
|
|
Regadenoson 0.4 mg/5 ml intravenous syringe
|
$933.00 |
$933.00 |
$933.00 |
$683.18
|
|
Remdesivir 100 mg intravenous powder for solution
|
$2,098.25 |
$2,098.25 |
$2,098.25 |
$1,872.00
|
|
#resp virpnl dfa-adenovirus
|
$75.75 |
$75.75 |
$75.75 |
$45.80
|
|
#resp virpnl dfa-parainfluenza
|
$76.00 |
$76.00 |
$76.00 |
$35.20
|
|
Reticulocyte automated
|
$26.75 |
$26.75 |
$26.75 |
$54.60
|
|
Reticulocyte direct measurement automated
|
$25.75 |
$25.75 |
$25.75 |
$33.57
|
|
Rheumatoid factor quantitative
|
$26.50 |
$26.50 |
$26.50 |
$58.50
|
|
Rho(d) immune globulin 1,500 unit (300 mcg)/2 ml injection syringe
|
$1,070.00 |
$1,070.00 |
$1,070.00 |
$255.26
|
|
Ropivacaine 0.2 % epidural pca - 1 hour dose limit
|
$51.00 |
$51.00 |
$51.00 |
$218.00
|
|
Russell viper venom diluted
|
$63.75 |
$63.75 |
$63.75 |
$73.03
|
|
Screening HIV antigen/antibody combination assay
|
$217.25 |
$217.25 |
$217.25 |
$26.49
|
|
Screening Mammogram
|
$555.75 |
$555.75 |
$555.75 |
$297.50
|
|
Sedimentation rate erythrocyte automated
|
$601.00 |
$601.00 |
$601.00 |
$44.20
|
|
Semen analysis w/count
|
$458.00 |
$458.00 |
$458.00 |
$56.44
|
|
Sincalide 5 mcg solution for injection
|
$684.00 |
$684.00 |
$684.00 |
$412.96
|
|
Smear nasal eosinophil
|
$110.75 |
$110.75 |
$110.75 |
$50.00
|
|
Sodium chloride 0.9 % intravenous solution
|
$297.00 |
$297.00 |
$297.00 |
$46.43
|
|
Sodium chloride 0.9 % IV bolus
|
$229.00 |
$229.00 |
$229.00 |
$49.63
|
|
Sodium ferric gluconate complex in sucrose 62.5 mg/5 ml intravenous
|
$88.00 |
$88.00 |
$88.00 |
$104.98
|
|
Sodium thiosulfate 12.5 gram/50 ml (250 mg/ml) intravenous solution
|
$374.50 |
$374.50 |
$374.50 |
$243.88
|
|
Specimen fat stain
|
$19.00 |
$19.00 |
$19.00 |
$32.76
|
|
St evaluate speech sound production
|
$1,842.00 |
$1,842.00 |
$1,842.00 |
$310.20
|
|
St evaluate speech sound production comprehensive/expressive
|
$1,842.00 |
$1,842.00 |
$1,842.00 |
$393.00
|
|
St evaluation motion fluoroscopic swallow function cine/video
|
$2,028.25 |
$2,028.25 |
$2,028.25 |
$408.60
|
|
St evaluation swallow function
|
$680.75 |
$680.75 |
$680.75 |
$336.60
|
|
Strep b assay w/optic
|
$18.25 |
$18.25 |
$18.25 |
$32.00
|
|
St treatment speech individual
|
$715.25 |
$715.25 |
$715.25 |
$256.55
|
|
St treatment swallow dysfunction/oral
|
$407.50 |
$407.50 |
$407.50 |
$260.00
|
|
Succinylcholine chloride 20 mg/ml injection solution (wrapper)
|
$8.00 |
$8.00 |
$8.00 |
$49.13
|
|
Sugars single quant
|
$53.25 |
$53.25 |
$53.25 |
$53.25
|
|
Sumatriptan 6 mg/0.5 ml subcutaneous solution
|
$1,049.50 |
$1,049.50 |
$1,049.50 |
$111.46
|
|
Surgical pathology level 1 gross examination only
|
$141.25 |
$141.25 |
$141.25 |
$93.00
|
|
Surgical pathology level 2 gross & microscopic examination
|
$141.25 |
$141.25 |
$141.25 |
$150.80
|
|
Surgical pathology level 3 gross & microscopic examination
|
$198.00 |
$198.00 |
$198.00 |
$198.90
|
|
Surgical pathology level 4 gross & microscopic examination
|
$198.00 |
$198.00 |
$198.00 |
$256.80
|
|
Surgical pathology level 5 gross & microscopic examination
|
$916.25 |
$916.25 |
$916.25 |
$495.42
|
|
Surgical pathology level 6 gross & microscopic examination
|
$2,262.00 |
$2,262.00 |
$2,262.00 |
$795.70
|
|
Susceptibility enzyme detection per enzyme
|
$22.00 |
$22.00 |
$22.00 |
$35.10
|
|
Suscept studies macrobroth dilution ea
|
$30.75 |
$30.75 |
$30.75 |
$51.50
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$56.50 |
$56.50 |
$56.50 |
$166.46
|
|
Tc-99m exame autol wbc diag per dose
|
$6,412.00 |
$6,412.00 |
$6,412.00 |
$2,393.40
|
|
Tc-99m exametazime diag
|
$17,362.50 |
$17,362.50 |
$17,362.50 |
$2,166.26
|
|
Tc-99m labeled rbc
|
$1,360.75 |
$1,360.75 |
$1,360.75 |
$322.20
|
|
Tc-99m maa
|
$1,388.75 |
$1,388.75 |
$1,388.75 |
$312.06
|
|
Tc-99m mebrofenin
|
$411.00 |
$411.00 |
$411.00 |
$169.53
|
|
Tc-99m medronate
|
$3,098.50 |
$3,098.50 |
$3,098.50 |
$122.46
|
|
Tc-99m mertiatide
|
$1,835.00 |
$1,835.00 |
$1,835.00 |
$757.25
|
|
Tc-99m oxidronate
|
$240.50 |
$240.50 |
$240.50 |
$124.23
|
|
Tc-99m pentetate dtpa
|
$1,075.00 |
$1,075.00 |
$1,075.00 |
$240.46
|
|
Tc-99m pentetate dtpa aerosol
|
$363.25 |
$363.25 |
$363.25 |
$244.02
|
|
Tc-99m pertechnetate per mci
|
$14.00 |
$14.00 |
$14.00 |
$28.08
|
|
Tc-99m sestamibi p study dose
|
$3,391.75 |
$3,391.75 |
$3,391.75 |
$221.60
|
|
Tc-99m succimer (dmsa)
|
$2,873.75 |
$2,873.75 |
$2,873.75 |
$1,578.33
|
|
Tc-99m sulfur colloid
|
$744.50 |
$744.50 |
$744.50 |
$245.70
|
|
Tc-99m tetrofosmin p study dose
|
$3,803.25 |
$3,803.25 |
$3,803.25 |
$198.05
|
|
T cells absolute cd4/cd8 including ratio
|
$34.75 |
$34.75 |
$34.75 |
$185.28
|
|
T cells absolute cd 4 count
|
$124.00 |
$124.00 |
$124.00 |
$120.25
|
|
T cells total count
|
$174.75 |
$174.75 |
$174.75 |
$121.90
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$26,435.00 |
$26,435.00 |
$26,435.00 |
$17,652.73
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$96.00 |
$96.00 |
$96.00 |
$44.76
|
|
Test urine for porphyrins
|
$6.00 |
$6.00 |
$6.00 |
$27.30
|
|
Tetanus immune globulin inj
|
$173.00 |
$173.00 |
$173.00 |
$1,368.00
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$47.00 |
$47.00 |
$47.00 |
$36.78
|
|
Thrombin time
|
$28.75 |
$28.75 |
$28.75 |
$48.75
|
|
Thyroglobulin antibody
|
$129.00 |
$129.00 |
$129.00 |
$84.00
|
|
Thyroid uptake measurement
|
$4,280.25 |
$4,280.25 |
$4,280.25 |
$606.43
|
|
Thyroxine binding globulin (tbg)
|
$13.25 |
$13.25 |
$13.25 |
$63.05
|
|
Tigecycline injection
|
$223.00 |
$223.00 |
$223.00 |
$317.36
|
|
Tl-201 thallium diag per mci
|
$1,364.25 |
$1,364.25 |
$1,364.25 |
$77.22
|
|
Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr
|
$88.00 |
$88.00 |
$88.00 |
$131.70
|
|
Tobramycin non-comp unit
|
$403.00 |
$403.00 |
$403.00 |
$117.27
|
|
Tocilizumab 162 mg/0.9 ml subcutaneous pen injector
|
$4,780.50 |
$4,780.50 |
$4,780.50 |
$5,434.99
|
|
Tomosynthesis breast diagnostic left
|
$667.00 |
$667.00 |
$667.00 |
$63.00
|
|
Tomosynthesis breast screen bilateral
|
$182.75 |
$182.75 |
$182.75 |
$73.45
|
|
Tranexamic acid 1,000 mg/10 ml (100 mg/ml) intravenous solution
|
$305.49 |
$305.49 |
$305.49 |
$84.15
|
|
Transferrin
|
$3.50 |
$3.50 |
$3.50 |
$84.54
|
|
Trastuzumab 150 mg intravenous solution
|
$182.00 |
$182.00 |
$182.00 |
$2,629.80
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$148.75 |
$148.75 |
$148.75 |
$241.24
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$1,970.75 |
$1,970.75 |
$1,970.75 |
$155.00
|
|
Trichinella antibody
|
$105.50 |
$105.50 |
$105.50 |
$72.80
|
|
Trichomonas assay w/optic
|
$69.50 |
$69.50 |
$69.50 |
$66.00
|
|
Ultrasound pregnant uterus transvaginal
|
$464.25 |
$464.25 |
$464.25 |
$484.52
|
|
Unlisted neurological dx px
|
$675.00 |
$675.00 |
$675.00 |
$185.15
|
|
Urea nitrogen 24 hour urine
|
$25.75 |
$25.75 |
$25.75 |
$50.70
|
|
Vaccine dtap < 7 years im
|
$110.00 |
$110.00 |
$110.00 |
$86.28
|
