|
Ostomy clamp, replacement
|
$15.00 |
$15.00 |
$15.00 |
$4.66
|
|
Ost pch drain for barrier fl
|
$67.50 |
$67.50 |
$67.50 |
$11.45
|
|
Ot evaluation high complexity patient/family
|
$539.12 |
$539.12 |
$539.12 |
$292.80
|
|
Ot evaluation low complexity patient/family
|
$504.50 |
$504.50 |
$504.50 |
$226.80
|
|
Ot evaluation moderate complexity patient/family
|
$521.81 |
$521.81 |
$521.81 |
$263.50
|
|
Ot re-evaluation patient/family
|
$400.00 |
$400.00 |
$400.00 |
$160.80
|
|
Oxytocin 10 unit/ml injection solution
|
$256.06 |
$256.06 |
$256.06 |
$50.40
|
|
Palonosetron hcl
|
$3,525.04 |
$3,525.04 |
$3,525.04 |
$154.78
|
|
Pantoprazole in ns IV syringe 0.8 mg/ml (neo/ped) - cnr
|
$318.81 |
$318.81 |
$318.81 |
$27.16
|
|
Parathormone (pth) intact
|
$150.89 |
$150.89 |
$150.89 |
$201.50
|
|
Parathyroid planar imaging
|
$5,464.47 |
$5,464.47 |
$5,464.47 |
$1,073.82
|
|
Paricalcitol
|
$23.17 |
$23.17 |
$23.17 |
$47.15
|
|
Particle matristem matrix 1000mg micron-q4118-cost per mg
|
$40.00 |
$40.00 |
$40.00 |
$4,706.31
|
|
Passy muir valve metal trach
|
$1,094.00 |
$1,094.00 |
$1,094.00 |
$275.75
|
|
Pelvic MRI (with and without contrast)
|
$20,352.11 |
$20,352.11 |
$20,352.11 |
$2,870.36
|
|
Pelvic MRI (with contrast)
|
$17,770.59 |
$17,770.59 |
$17,770.59 |
$2,210.00
|
|
Pelvic MRI (without contrast)
|
$16,928.08 |
$16,928.08 |
$16,928.08 |
$1,929.85
|
|
Penicillin g potassium in ns IV syringe 100,000 units/ml (neo/ped) - cnr
|
$471.06 |
$471.06 |
$471.06 |
$97.85
|
|
Pentamidine 300 mg solution for injection
|
$234.48 |
$234.48 |
$234.48 |
$453.61
|
|
Pentamidine non-comp unit
|
$1,929.42 |
$1,929.42 |
$1,929.42 |
$279.76
|
|
Perflutren lipid microspheres 1.1 mg/ml intravenous suspension
|
$396.66 |
$396.66 |
$396.66 |
$335.79
|
|
Ph body fluid
|
$206.06 |
$206.06 |
$206.06 |
$40.04
|
|
Phenobarbital therapeutic drug level
|
$388.40 |
$388.40 |
$388.40 |
$104.50
|
|
Phentolaine mesylate inj
|
$2,231.79 |
$2,231.79 |
$2,231.79 |
$1,028.40
|
|
Phenytoin total therapeutic drug level
|
$1,149.94 |
$1,149.94 |
$1,149.94 |
$112.50
|
|
Phosphorus 24 hour urine
|
$751.73 |
$751.73 |
$751.73 |
$41.58
|
|
Platelet aggregation each agent teg
|
$647.43 |
$647.43 |
$647.43 |
$136.80
|
|
Platelet automated
|
$649.67 |
$649.67 |
$649.67 |
$45.00
|
|
Potassium 24 hour urine
|
$597.30 |
$597.30 |
$597.30 |
$50.70
|
|
Potassium serum/plasma/whole blood
|
$568.64 |
$568.64 |
$568.64 |
$46.00
|
|
Pouch ostmy flat lk n 2.5in roll premier 1pc trnsp
|
$119.00 |
$119.00 |
$119.00 |
$6.16
|
|
Pouch uros new (both sides) 2.75in clr
|
$100.50 |
$100.50 |
$100.50 |
$15.80
|
|
Pralidoxime 1 gram solution for injection
|
$782.06 |
$782.06 |
$782.06 |
$267.69
|
|
Prealbumin
|
$492.52 |
$492.52 |
$492.52 |
$93.60
|
|
Pretreatment serum by diff red cell adsorption patient rbc/known phenotype each adsorption ref
|
$112.00 |
$112.00 |
$112.00 |
$147.84
|
|
Pretreat rbc absorption reference
|
$340.94 |
$340.94 |
$340.94 |
$139.00
|
|
Pretreat rbc density gradient separation reference
|
$368.86 |
$368.86 |
$368.86 |
$182.31
|
|
Pretreat rbc w chem/drugs reference
|
$112.45 |
$112.45 |
$112.45 |
$106.15
|
|
Pretreat rbc w enzyme reference
|
$33.52 |
$33.52 |
$33.52 |
$164.99
|
|
Procainamide 100 mg/ml injection (wrapper)
|
$237.95 |
$237.95 |
$237.95 |
$655.08
|
|
Prochlorperazine edisylate 10 mg/2 ml (5 mg/ml) injection solution
|
$223.71 |
$223.71 |
$223.71 |
$36.33
|
|
Progesterone
|
$1,798.97 |
$1,798.97 |
$1,798.97 |
$113.24
|
|
Prolactin
|
$1,768.94 |
$1,768.94 |
$1,768.94 |
$123.50
|
|
Propranolol in ns IV syringe 0.1 mg/ml (neo/ped) - cnr
|
$256.71 |
$256.71 |
$256.71 |
$30.26
|
|
Protein c activity
|
$1,371.38 |
$1,371.38 |
$1,371.38 |
$119.60
|
|
Protein electrophoretic fractionation & quantitation serum
|
$1,250.54 |
$1,250.54 |
$1,250.54 |
$84.00
|
|
Protein s total
|
$1,115.69 |
$1,115.69 |
$1,115.69 |
$77.60
|
|
Protein total 24 hour urine
|
$273.11 |
$273.11 |
$273.11 |
$52.47
|
|
Protein total serum plasma whole blood
|
$273.11 |
$273.11 |
$273.11 |
$42.81
|
|
Prothrombin time substitution plasma fractions each
|
$176.72 |
$176.72 |
$176.72 |
$40.30
|
|
PSA (Prostate) Test
|
$764.00 |
$764.00 |
$764.00 |
$107.50
|
|
Pt evaluation high complexity patient/family
|
$394.64 |
$394.64 |
$394.64 |
$289.50
|
|
Pt evaluation low complexity patient/family
|
$360.06 |
$360.06 |
$360.06 |
$222.24
|
|
Pt evaluation moderate complexity patient/family
|
$377.36 |
$377.36 |
$377.36 |
$249.26
|
|
Pt re-evaluation patient/family
|
$360.06 |
$360.06 |
$360.06 |
$152.40
|
|
Rabies ig ht&sol human im/sc
|
$2,087.25 |
$2,087.25 |
$2,087.25 |
$2,997.00
|
|
Rbc count only automated
|
$441.55 |
$441.55 |
$441.55 |
$20.00
|
|
Regadenoson 0.4 mg/5 ml intravenous syringe
|
$2,198.38 |
$2,198.38 |
$2,198.38 |
$378.22
|
|
Remdesivir 100 mg intravenous powder for solution
|
$1,988.73 |
$1,988.73 |
$1,988.73 |
$1,524.70
|
|
Renal function panel
|
$2,075.62 |
$2,075.62 |
$2,075.62 |
$113.52
|
|
Reticulocyte direct measurement automated
|
$15.60 |
$15.60 |
$15.60 |
$35.84
|
|
Rheumatoid factor quantitative
|
$600.12 |
$600.12 |
$600.12 |
$56.55
|
|
Rho(d) immune globulin 1,500 unit (300 mcg)/2 ml injection syringe
|
$1,387.30 |
$1,387.30 |
$1,387.30 |
$247.55
|
|
Rifampin in ns IV syringe 3 mg/ml (neo/ped) - cnr
|
$396.58 |
$396.58 |
$396.58 |
$459.00
|
|
Romosozumab-aqqg 105 mg/1.17 ml subcutaneous syringe (wrapper)
|
$3,769.04 |
$3,769.04 |
$3,769.04 |
$4,820.04
|
|
Rubella antibody igg
|
$655.28 |
$655.28 |
$655.28 |
$76.86
|
|
Rubeola antibody igg
|
$1,211.40 |
$1,211.40 |
$1,211.40 |
$80.00
|
|
Russell viper venom diluted
|
$614.75 |
$614.75 |
$614.75 |
$68.64
|
|
Sargramostim injection
|
$381.55 |
$381.55 |
$381.55 |
$552.52
|
|
Screening Mammogram
|
$676.05 |
$676.05 |
$676.05 |
$310.20
|
|
Screening prostate cancer PSA
|
$1,200.24 |
$1,200.24 |
$1,200.24 |
$98.28
|
|
Sedimentation rate erythrocyte automated
|
$633.62 |
$633.62 |
$633.62 |
$44.20
|
|
Sickling rbc
|
$50.29 |
$50.29 |
$50.29 |
$54.00
|
|
Sincalide 5 mcg solution for injection
|
$354.14 |
$354.14 |
$354.14 |
$309.14
|
|
Smear special stain inclusion bodies/parasites
|
$500.89 |
$500.89 |
$500.89 |
$68.85
|
|
Sodium 24 hour urine
|
$649.67 |
$649.67 |
$649.67 |
$48.60
|
|
Sodium chloride 0.9 % intravenous solution
|
$100.36 |
$100.36 |
$100.36 |
$48.00
|
|
Sodium chloride 0.9 % IV bolus
|
$23.50 |
$23.50 |
$23.50 |
$44.34
|
|
Sodium ferric gluconate complex in sucrose 62.5 mg/5 ml intravenous
|
$256.01 |
$256.01 |
$256.01 |
$77.77
|
|
Sodium serum/plasma/whole blood
|
$567.27 |
$567.27 |
$567.27 |
$45.00
|
|
Sodium thiosulfate 12.5 gram/50 ml (250 mg/ml) intravenous solution
|
$269.58 |
$269.58 |
$269.58 |
$177.52
|
|
St evaluate speech sound production comprehensive/expressive
|
$1,093.85 |
$1,093.85 |
$1,093.85 |
$376.84
|
|
St evaluation swallow function
|
$950.43 |
$950.43 |
$950.43 |
$311.36
|
|
St treatment speech individual
|
$387.27 |
$387.27 |
$387.27 |
$253.80
|
|
St treatment swallow dysfunction/oral
|
$407.18 |
$407.18 |
$407.18 |
$245.50
|
|
Succinylcholine chloride 20 mg/ml injection solution (wrapper)
|
$57.78 |
$57.78 |
$57.78 |
$50.22
|
|
Sulfamethoxazole 400 mg-trimethoprim 80 mg/5 ml intravenous solution
|
$106.40 |
$106.40 |
$106.40 |
$82.46
|
|
Surgical pathology level 1 gross examination only
|
$479.91 |
$479.91 |
$479.91 |
$80.60
|
|
Surgical pathology level 2 gross & microscopic examination
|
$1,142.22 |
$1,142.22 |
$1,142.22 |
$146.30
|
|
Surgical pathology level 3 gross & microscopic examination
|
$2,706.51 |
$2,706.51 |
$2,706.51 |
$184.50
|
|
Surgical pathology level 4 gross & microscopic examination
|
$3,603.54 |
$3,603.54 |
$3,603.54 |
$250.20
|
|
Surgical pathology level 5 gross & microscopic examination
|
$4,807.33 |
$4,807.33 |
$4,807.33 |
$489.00
|
|
Surgical pathology level 6 gross & microscopic examination
|
$6,007.58 |
$6,007.58 |
$6,007.58 |
$730.20
|
|
Susceptibility enzyme detection per enzyme
|
$450.61 |
$450.61 |
$450.61 |
$35.10
|
|
Suscept studies macrobroth dilution ea
|
$18.59 |
$18.59 |
$18.59 |
$59.28
|
|
T3 (triiodothyronine) free
|
$309.46 |
$309.46 |
$309.46 |
$99.20
|
|
T3 (triiodothyronine) total
|
$1,346.27 |
$1,346.27 |
$1,346.27 |
$93.52
|
|
T4 (thyroxine) free
|
$1,167.39 |
$1,167.39 |
$1,167.39 |
$85.20
|
|
T4 (thyroxine) total
|
$803.40 |
$803.40 |
$803.40 |
$67.80
|
|
Tacrolimus therapeutic drug level
|
$2,214.67 |
$2,214.67 |
$2,214.67 |
$120.60
|