|
Ot therapeutic activities direct patient contact each 15 minutes
|
$73.80 |
$73.80 |
$73.80 |
$98.90
|
|
Ot therapeutic procedure >=1 area therapeutic exercise each 15 minutes
|
$121.80 |
$121.80 |
$121.80 |
$97.80
|
|
Ot therapeutic procedure neuromuscular reeducate each 15 minutes
|
$115.20 |
$115.20 |
$115.20 |
$100.65
|
|
Ot training self care/home management direct contact each 15 minutes
|
$73.20 |
$73.20 |
$73.20 |
$93.60
|
|
Oxytocin 10 unit/ml injection solution
|
$3.60 |
$3.60 |
$3.60 |
$50.40
|
|
Pantoprazole in ns IV syringe 0.8 mg/ml (neo/ped) - cnr
|
$11.40 |
$11.40 |
$11.40 |
$27.16
|
|
Parathormone (pth) intact
|
$423.00 |
$423.00 |
$423.00 |
$201.50
|
|
Pelvic CT scan (with contrast)
|
$2,357.40 |
$2,357.40 |
$2,357.40 |
$1,635.62
|
|
Pelvic CT scan (without contrast)
|
$1,700.40 |
$1,700.40 |
$1,700.40 |
$1,366.50
|
|
Pelvic MRI (with and without contrast)
|
$3,205.20 |
$3,205.20 |
$3,205.20 |
$2,870.36
|
|
Pelvic MRI (without contrast)
|
$3,052.20 |
$3,052.20 |
$3,052.20 |
$1,929.85
|
|
Penicillin g potassium in ns IV syringe 100,000 units/ml (neo/ped) - cnr
|
$169.80 |
$169.80 |
$169.80 |
$97.85
|
|
Ph body fluid
|
$112.80 |
$112.80 |
$112.80 |
$40.04
|
|
Phenobarbital in ns IV syringe 10 mg/ml (neonate) - cnr
|
$70.20 |
$70.20 |
$70.20 |
$114.60
|
|
Phenobarbital therapeutic drug level
|
$144.00 |
$144.00 |
$144.00 |
$104.50
|
|
Phenytoin in ns IV syringe 5 mg/ml (neo/ped) - cnr
|
$6.60 |
$6.60 |
$6.60 |
$10.80
|
|
Phenytoin total therapeutic drug level
|
$141.00 |
$141.00 |
$141.00 |
$112.50
|
|
Phosphorus
|
$52.80 |
$52.80 |
$52.80 |
$49.60
|
|
Phosphorus 24 hour urine
|
$54.00 |
$54.00 |
$54.00 |
$41.58
|
|
Phytonadione (vitamin k1) 10 mg/ml injection solution
|
$16.80 |
$16.80 |
$16.80 |
$85.79
|
|
Piperacillin-tazobactam 3.375 gram intravenous solution
|
$26.40 |
$26.40 |
$26.40 |
$83.57
|
|
Poct blood gases ph pco2 po2 arterial calculated o2
|
$311.40 |
$311.40 |
$311.40 |
$187.04
|
|
Potassium 24 hour urine
|
$76.80 |
$76.80 |
$76.80 |
$50.70
|
|
Potassium chloride 10 meq/100ml in sterile water intravenous piggyback
|
$48.00 |
$48.00 |
$48.00 |
$64.09
|
|
Potassium serum/plasma/whole blood
|
$58.20 |
$58.20 |
$58.20 |
$46.00
|
|
Prealbumin
|
$87.60 |
$87.60 |
$87.60 |
$93.60
|
|
Prednisolone sodium phosphate 15 mg/5 ml (3 mg/ml) oral solution
|
$3.60 |
$3.60 |
$3.60 |
$13.80
|
|
Procalcitonin
|
$271.80 |
$271.80 |
$271.80 |
$157.56
|
|
Prochlorperazine edisylate 10 mg/2 ml (5 mg/ml) injection solution
|
$62.40 |
$62.40 |
$62.40 |
$36.33
|
|
Progesterone
|
$151.20 |
$151.20 |
$151.20 |
$113.24
|
|
Prolactin
|
$158.40 |
$158.40 |
$158.40 |
$123.50
|
|
Propofol infusion 10 mg/ml
|
$86.40 |
$86.40 |
$86.40 |
$73.36
|
|
Protamine 10 mg/ml intravenous solution
|
$123.60 |
$123.60 |
$123.60 |
$59.61
|
|
Protein c activity
|
$89.40 |
$89.40 |
$89.40 |
$119.60
|
|
Protein electrophoretic fractionation & quantitation serum
|
$106.20 |
$106.20 |
$106.20 |
$84.00
|
|
Protein s total
|
$51.60 |
$51.60 |
$51.60 |
$77.60
|
|
Protein total 24 hour urine
|
$78.60 |
$78.60 |
$78.60 |
$52.47
|
|
Protein total body fluid
|
$9.00 |
$9.00 |
$9.00 |
$52.00
|
|
Protein total serum plasma whole blood
|
$78.60 |
$78.60 |
$78.60 |
$42.81
|
|
Prothrombin complex kcentra
|
$9.00 |
$9.00 |
$9.00 |
$7.55
|
|
PSA (Prostate) Test
|
$184.20 |
$184.20 |
$184.20 |
$107.50
|
|
Pt application of modality >=1 area electrical stimulation each 15 minutes
|
$98.40 |
$98.40 |
$98.40 |
$87.45
|
|
Pt application of modality >=1 area iontophoresis each 15 minutes
|
$101.40 |
$101.40 |
$101.40 |
$102.00
|
|
Pt application of modality >=1 area ultrasound each 15 minutes
|
$132.60 |
$132.60 |
$132.60 |
$79.76
|
|
Pt application of modality traction mechanical
|
$150.00 |
$150.00 |
$150.00 |
$87.00
|
|
Pt evaluation high complexity patient/family
|
$179.40 |
$179.40 |
$179.40 |
$289.50
|
|
Pt evaluation low complexity patient/family
|
$179.40 |
$179.40 |
$179.40 |
$222.24
|
|
Pt evaluation moderate complexity patient/family
|
$179.40 |
$179.40 |
$179.40 |
$249.26
|
|
Pt re-evaluation patient/family
|
$82.20 |
$82.20 |
$82.20 |
$152.40
|
|
Pt therapeutic procedure >=1 area gait training each 15 minutes
|
$82.20 |
$82.20 |
$82.20 |
$87.10
|
|
Pt wheelchair management each 15 minutes
|
$73.20 |
$73.20 |
$73.20 |
$86.53
|
|
Quest t3 uptake
|
$95.40 |
$95.40 |
$95.40 |
$55.00
|
|
Rabies ig ht&sol human im/sc
|
$13,679.40 |
$13,679.40 |
$13,679.40 |
$2,997.00
|
|
Rapid Strep Test
|
$52.80 |
$52.80 |
$52.80 |
$74.25
|
|
Regadenoson 0.4 mg/5 ml intravenous syringe
|
$811.20 |
$811.20 |
$811.20 |
$378.22
|
|
Remdesivir 100 mg intravenous powder for solution
|
$1,909.80 |
$1,909.80 |
$1,909.80 |
$1,524.70
|
|
Renal function panel
|
$152.40 |
$152.40 |
$152.40 |
$113.52
|
|
Reticulocyte automated
|
$26.40 |
$26.40 |
$26.40 |
$53.00
|
|
Rheumatoid factor qualitative
|
$30.60 |
$30.60 |
$30.60 |
$57.20
|
|
Rheumatoid factor quantitative
|
$171.60 |
$171.60 |
$171.60 |
$56.55
|
|
Rho(d) immune globulin 1,500 unit (300 mcg)/2 ml injection syringe
|
$289.80 |
$289.80 |
$289.80 |
$247.55
|
|
Rho d immune globulin inj
|
$394.20 |
$394.20 |
$394.20 |
$224.10
|
|
Risankizumab-rzaa 60 mg/ml intravenous solution
|
$36,988.20 |
$36,988.20 |
$36,988.20 |
$30,071.50
|
|
Rituximab 10 mg/ml concentrate,intravenous
|
$15,661.80 |
$15,661.80 |
$15,661.80 |
$9,301.22
|
|
Rituximab-arrx 10 mg/ml intravenous solution
|
$13,159.20 |
$13,159.20 |
$13,159.20 |
$6,287.16
|
|
Rubella antibody igg
|
$87.00 |
$87.00 |
$87.00 |
$76.86
|
|
Rubeola antibody igg
|
$209.40 |
$209.40 |
$209.40 |
$80.00
|
|
Russell viper venom diluted
|
$213.60 |
$213.60 |
$213.60 |
$68.64
|
|
Screening colorectal cancer fecal occult blood immunoassay 1-3 simultaneous determinations
|
$37.80 |
$37.80 |
$37.80 |
$57.60
|
|
Screening Mammogram
|
$380.40 |
$380.40 |
$380.40 |
$310.20
|
|
Sedimentation rate erythrocyte automated
|
$48.00 |
$48.00 |
$48.00 |
$44.20
|
|
Shoulder MRI (with and without contrast)
|
$2,851.80 |
$2,851.80 |
$2,851.80 |
$2,743.02
|
|
Shoulder MRI (without contrast)
|
$3,073.20 |
$3,073.20 |
$3,073.20 |
$2,110.00
|
|
Sickling rbc
|
$67.20 |
$67.20 |
$67.20 |
$54.00
|
|
Sincalide 5 mcg solution for injection
|
$545.40 |
$545.40 |
$545.40 |
$309.14
|
|
Sinus CT scan (with contrast)
|
$2,067.60 |
$2,067.60 |
$2,067.60 |
$1,562.50
|
|
Sinus CT scan (without contrast)
|
$1,595.40 |
$1,595.40 |
$1,595.40 |
$1,281.80
|
|
Smear fluorescent and/or acid fast stain
|
$147.00 |
$147.00 |
$147.00 |
$64.35
|
|
Smear gram stain
|
$12.00 |
$12.00 |
$12.00 |
$55.35
|
|
Sodium 24 hour urine
|
$76.80 |
$76.80 |
$76.80 |
$48.60
|
|
Sodium chloride 0.9 % IV bolus
|
$18.60 |
$18.60 |
$18.60 |
$44.34
|
|
Sodium serum/plasma/whole blood
|
$63.60 |
$63.60 |
$63.60 |
$45.00
|
|
Succinylcholine chloride 20 mg/ml injection solution (wrapper)
|
$64.80 |
$64.80 |
$64.80 |
$50.22
|
|
Sumatriptan 6 mg/0.5 ml subcutaneous solution
|
$247.20 |
$247.20 |
$247.20 |
$123.58
|
|
Susceptibility agar dilution per agent
|
$47.40 |
$47.40 |
$47.40 |
$42.70
|
|
Susceptibility mic per plate
|
$183.00 |
$183.00 |
$183.00 |
$104.00
|
|
Syphilis test non-treponemal antibody quantitative rpr
|
$33.60 |
$33.60 |
$33.60 |
$40.11
|
|
T3 (triiodothyronine) free
|
$251.40 |
$251.40 |
$251.40 |
$99.20
|
|
T3 (triiodothyronine) total
|
$144.00 |
$144.00 |
$144.00 |
$93.52
|
|
T4 (thyroxine) free
|
$135.00 |
$135.00 |
$135.00 |
$85.20
|
|
T4 (thyroxine) total
|
$189.00 |
$189.00 |
$189.00 |
$67.80
|
|
Tacrolimus 1 mg capsule, immediate-release
|
$9.60 |
$9.60 |
$9.60 |
$10.03
|
|
Tacrolimus therapeutic drug level
|
$93.00 |
$93.00 |
$93.00 |
$120.60
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$132.60 |
$132.60 |
$132.60 |
$175.00
|
|
Tc-99m labeled rbc
|
$3.60 |
$3.60 |
$3.60 |
$302.40
|
|
Tc-99m maa
|
$103.20 |
$103.20 |
$103.20 |
$283.41
|
|
Tc-99m mebrofenin
|
$121.80 |
$121.80 |
$121.80 |
$160.58
|
|
Tc-99m medronate
|
$103.20 |
$103.20 |
$103.20 |
$109.50
|
|
Tc-99m pentetate dtpa
|
$103.20 |
$103.20 |
$103.20 |
$222.60
|
|
Tc-99m pertechnetate per mci
|
$3.00 |
$3.00 |
$3.00 |
$27.20
|
