|
Mpl gene analysis common variants
|
$746.40 |
$746.40 |
$746.40 |
$399.85
|
|
MRI lower extremity other than joint without contrast (both sides)
|
$3,052.20 |
$3,052.20 |
$3,052.20 |
$2,110.00
|
|
MRI upper extremity other than joint without contrast (both sides)
|
$2,306.40 |
$2,306.40 |
$2,306.40 |
$2,020.80
|
|
Myeloperoxidase ab multi step qualitative/semiquantitative
|
$104.40 |
$104.40 |
$104.40 |
$131.07
|
|
Naloxone 0.4 mg/ml injection (wrapper)
|
$110.40 |
$110.40 |
$110.40 |
$70.87
|
|
Natriuretic peptide
|
$230.40 |
$230.40 |
$230.40 |
$176.15
|
|
Neck (Cervical Spine) CT scan (without contrast)
|
$2,537.40 |
$2,537.40 |
$2,537.40 |
$1,513.95
|
|
Neck (Cervical Spine) MRI (without contrast)
|
$3,052.20 |
$3,052.20 |
$3,052.20 |
$2,054.72
|
|
Nicardipine 25 mg/10 ml intravenous solution
|
$103.20 |
$103.20 |
$103.20 |
$264.31
|
|
Nushield 1 square cm
|
$817.69 |
$817.69 |
$817.69 |
$937.50
|
|
Octreotide acetate 100 mcg/ml injection (wrapper)
|
$332.40 |
$332.40 |
$332.40 |
$90.00
|
|
Ondansetron 8 mg disintegrating tablet
|
$4.80 |
$4.80 |
$4.80 |
$8.40
|
|
Ondansetron hcl (pf) 2 mg/ml injection (wrapper)
|
$1.20 |
$1.20 |
$1.20 |
$22.62
|
|
Orphenadrine citrate 30 mg/ml injection solution
|
$53.40 |
$53.40 |
$53.40 |
$50.63
|
|
Ot evaluation high complexity patient/family
|
$272.40 |
$272.40 |
$272.40 |
$292.80
|
|
Ot evaluation low complexity patient/family
|
$272.40 |
$272.40 |
$272.40 |
$226.80
|
|
Ot evaluation moderate complexity patient/family
|
$272.40 |
$272.40 |
$272.40 |
$263.50
|
|
Ot management orthotic(s)/prosthetic subsequent encounter each 15 minutes
|
$141.00 |
$141.00 |
$141.00 |
$98.62
|
|
Ot management/training orthotic(s) upper/lower extremities and/or trunk each 15 minutes
|
$141.00 |
$141.00 |
$141.00 |
$104.50
|
|
Ot manual therpy techniques >=1 region each 15 minutes
|
$208.20 |
$208.20 |
$208.20 |
$105.00
|
|
Ot re-evaluation patient/family
|
$213.00 |
$213.00 |
$213.00 |
$160.80
|
|
Ot therapeutic activities direct patient contact each 15 minutes
|
$164.40 |
$164.40 |
$164.40 |
$98.90
|
|
Ot therapeutic procedure >=1 area therapeutic exercise each 15 minutes
|
$174.60 |
$174.60 |
$174.60 |
$97.80
|
|
Ot therapeutic procedure neuromuscular reeducate each 15 minutes
|
$152.40 |
$152.40 |
$152.40 |
$100.65
|
|
Ot training self care/home management direct contact each 15 minutes
|
$161.40 |
$161.40 |
$161.40 |
$93.60
|
|
Paliperidone 117 mg/0.75 ml inj
|
$8,341.20 |
$8,341.20 |
$8,341.20 |
$6,272.41
|
|
Pantoprazole in ns IV syringe 0.8 mg/ml (neo/ped) - cnr
|
$11.40 |
$11.40 |
$11.40 |
$27.16
|
|
Pelvic CT scan (with and without contrast)
|
$2,918.40 |
$2,918.40 |
$2,918.40 |
$1,899.75
|
|
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
|
|
Peng benzathine/procaine inj
|
$37.20 |
$37.20 |
$37.20 |
$338.23
|
|
Penicillin g benzathine 1,200,000 unit/2 ml intramuscular syringe
|
$1,013.40 |
$1,013.40 |
$1,013.40 |
$826.47
|
|
Ph body fluid
|
$158.40 |
$158.40 |
$158.40 |
$40.04
|
|
Phenytoin in ns IV syringe 5 mg/ml (neo/ped) - cnr
|
$6.60 |
$6.60 |
$6.60 |
$10.80
|
|
Phytonadione (vitamin k1) 10 mg/ml injection solution
|
$16.80 |
$16.80 |
$16.80 |
$85.79
|
|
Piperacillin-tazobactam 3.375 gram intravenous solution
|
$31.20 |
$31.20 |
$31.20 |
$83.57
|
|
Potassium chloride 10 meq/100ml in sterile water intravenous piggyback
|
$15.90 |
$15.90 |
$15.90 |
$64.09
|
|
Potassium serum/plasma/whole blood
|
$19.20 |
$19.20 |
$19.20 |
$46.00
|
|
Pr discharge day management hospital ip/obs > 30 min on encounter date
|
$118.80 |
$118.80 |
$118.80 |
$189.80
|
|
Prednisolone sodium phosphate 15 mg/5 ml (3 mg/ml) oral solution
|
$11.40 |
$11.40 |
$11.40 |
$13.80
|
|
Prochlorperazine edisylate 10 mg/2 ml (5 mg/ml) injection solution
|
$62.40 |
$62.40 |
$62.40 |
$36.33
|
|
Propofol infusion 10 mg/ml
|
$86.40 |
$86.40 |
$86.40 |
$73.36
|
|
Prothrombin complex kcentra
|
$9.00 |
$9.00 |
$9.00 |
$7.55
|
|
Pt application of modality >=1 area electrical stimulation each 15 minutes
|
$164.40 |
$164.40 |
$164.40 |
$87.45
|
|
Pt application of modality >=1 area iontophoresis each 15 minutes
|
$186.60 |
$186.60 |
$186.60 |
$102.00
|
|
Pt application of modality >=1 area ultrasound each 15 minutes
|
$181.20 |
$181.20 |
$181.20 |
$79.76
|
|
Pt application of modality traction mechanical
|
$200.40 |
$200.40 |
$200.40 |
$87.00
|
|
Pt evaluation high complexity patient/family
|
$223.80 |
$223.80 |
$223.80 |
$289.50
|
|
Pt evaluation low complexity patient/family
|
$223.80 |
$223.80 |
$223.80 |
$222.24
|
|
Pt evaluation moderate complexity patient/family
|
$223.80 |
$223.80 |
$223.80 |
$249.26
|
|
Pt re-evaluation patient/family
|
$148.80 |
$148.80 |
$148.80 |
$152.40
|
|
Pt therapeutic procedure >=1 area gait training each 15 minutes
|
$141.00 |
$141.00 |
$141.00 |
$87.10
|
|
Pt wheelchair management each 15 minutes
|
$141.00 |
$141.00 |
$141.00 |
$86.53
|
|
Rabies ig ht&sol human im/sc
|
$13,679.40 |
$13,679.40 |
$13,679.40 |
$2,997.00
|
|
Rapid Strep Test
|
$63.60 |
$63.60 |
$63.60 |
$74.25
|
|
Remdesivir 100 mg intravenous powder for solution
|
$1,909.80 |
$1,909.80 |
$1,909.80 |
$1,524.70
|
|
Renal function panel
|
$235.20 |
$235.20 |
$235.20 |
$113.52
|
|
Screening colorectal cancer fecal occult blood immunoassay 1-3 simultaneous determinations
|
$37.80 |
$37.80 |
$37.80 |
$57.60
|
|
Screening Mammogram
|
$229.20 |
$229.20 |
$229.20 |
$310.20
|
|
Shoulder MRI (without contrast)
|
$3,205.20 |
$3,205.20 |
$3,205.20 |
$2,110.00
|
|
Sincalide 5 mcg solution for injection
|
$545.40 |
$545.40 |
$545.40 |
$309.14
|
|
Sinus CT scan (with contrast)
|
$1,999.80 |
$1,999.80 |
$1,999.80 |
$1,562.50
|
|
Sinus CT scan (without contrast)
|
$1,587.60 |
$1,587.60 |
$1,587.60 |
$1,281.80
|
|
Sodium serum/plasma/whole blood
|
$89.40 |
$89.40 |
$89.40 |
$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
|
|
Tacrolimus 1 mg capsule, immediate-release
|
$9.60 |
$9.60 |
$9.60 |
$10.03
|
|
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
|
|
Tc-99m sulfur colloid
|
$103.20 |
$103.20 |
$103.20 |
$239.40
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$21,126.00 |
$21,126.00 |
$21,126.00 |
$15,600.75
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$17.40 |
$17.40 |
$17.40 |
$25.54
|
|
Thyroid (TSH) Test
|
$64.20 |
$64.20 |
$64.20 |
$112.00
|
|
Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr
|
$12.00 |
$12.00 |
$12.00 |
$152.80
|
|
Tomosynthesis breast diagnostic left
|
$40.20 |
$40.20 |
$40.20 |
$74.10
|
|
Treponema pallidum antibody
|
$192.60 |
$192.60 |
$192.60 |
$70.85
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$31.80 |
$31.80 |
$31.80 |
$43.80
|
|
Triglycerides
|
$95.40 |
$95.40 |
$95.40 |
$57.85
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$3,010.20 |
$3,010.20 |
$3,010.20 |
$2,034.41
|
|
Urea nitrogen
|
$73.80 |
$73.80 |
$73.80 |
$39.90
|
|
Uric acid blood
|
$67.80 |
$67.80 |
$67.80 |
$49.32
|
|
Urinalysis (without microscopy)
|
$34.20 |
$34.20 |
$34.20 |
$35.91
|
|
Vaccine covid-19 pfizer tris-sucrose >=12yrs 30mcg/0.3ml im
|
$589.50 |
$589.50 |
$589.50 |
$239.85
|
|
Vaccine influenza inactivated adjuvant im
|
$250.80 |
$250.80 |
$250.80 |
$109.50
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$54.90 |
$54.90 |
$54.90 |
$47.88
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im
|
$69.00 |
$69.00 |
$69.00 |
$31.91
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$451.80 |
$451.80 |
$451.80 |
$252.90
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$991.20 |
$991.20 |
$991.20 |
$563.36
|
|
Vaccine rabies im
|
$1,326.00 |
$1,326.00 |
$1,326.00 |
$858.95
|
|
Vaccine tdap >=7 years im
|
$173.40 |
$173.40 |
$173.40 |
$136.80
|
|
Vaccine td preservative free >= 7 years im
|
$105.60 |
$105.60 |
$105.60 |
$112.10
|
|
Vancomycin 1,000 mg intravenous injection
|
$94.20 |
$94.20 |
$94.20 |
$246.70
|
|
Vancomycin 750 mg intravenous solution
|
$82.20 |
$82.20 |
$82.20 |
$90.33
|
|
Vasopressin 20 unit/ml intravenous solution
|
$325.80 |
$325.80 |
$325.80 |
$342.98
|
|
Warde 1015200 kappa light chain free
|
$108.00 |
$108.00 |
$108.00 |
$64.28
|
|
Warde actin (smooth muscle) antibody each
|
$15.00 |
$15.00 |
$15.00 |
$40.20
|