|
St treatment speech individual
|
$83.44 |
$83.44 |
$83.44 |
$246.87
|
|
St treatment swallow dysfunction/oral
|
$113.68 |
$113.68 |
$113.68 |
$221.00
|
|
System pacing micra av
|
$13,720.00 |
$13,720.00 |
$13,720.00 |
$22,146.00
|
|
System pcmkr dual chamber leadless micra av2 intrdcr cath
|
$4,480.00 |
$4,480.00 |
$4,480.00 |
$11,441.25
|
|
Tc-99m exametazime diag
|
$577.36 |
$577.36 |
$577.36 |
$2,236.65
|
|
Tc-99m medronate
|
$54.32 |
$54.32 |
$54.32 |
$120.35
|
|
Tc-99m sestamibi p study dose
|
$192.08 |
$192.08 |
$192.08 |
$221.60
|
|
Tc-99m tetrofosmin p study dose
|
$192.08 |
$192.08 |
$192.08 |
$198.05
|
|
Ther/proph/diag inj ia
|
$99.68 |
$99.68 |
$99.68 |
$247.33
|
|
Tigecycline injection
|
$1.34 |
$1.34 |
$1.34 |
$7.44
|
|
Tissue surgimend prs meshed 20 cm x 10 cm - cost per 0.5cm
|
$13,052.48 |
$13,052.48 |
$13,052.48 |
$6,727.80
|
|
Tray bonemarrw oncontrol 102mm
|
$172.48 |
$172.48 |
$172.48 |
$1,094.25
|
|
Treatment inhalation pressurized/nonpressurized acute airway obstruction
|
$133.28 |
$133.28 |
$133.28 |
$197.60
|
|
Tte w or without contr, cont ecg
|
$1,237.04 |
$1,237.04 |
$1,237.04 |
$1,613.95
|
|
Unsched dialysis esrd pt hos
|
$855.68 |
$855.68 |
$855.68 |
$980.20
|
|
Urethrcystgrphy rtrgrde s&i
|
$222.32 |
$222.32 |
$222.32 |
$554.28
|
|
Ventilator each subsequent day
|
$1,305.92 |
$1,305.92 |
$1,305.92 |
$1,138.50
|
|
Ventilator initial day
|
$1,305.92 |
$1,305.92 |
$1,305.92 |
$1,331.00
|
|
Vincristine 1 mg/ml intravenous solution
|
$18.62 |
$18.62 |
$18.62 |
$52.02
|
|
Visit established high 40-54 minutes/level 5
|
$82.32 |
$82.32 |
$82.32 |
$186.60
|
|
Warde amino acids 6 or more quantitative each specimen
|
$103.90 |
$103.90 |
$103.90 |
$177.60
|
|
Warde cobalt heavy metal quantitative each nes
|
$38.43 |
$38.43 |
$38.43 |
$126.08
|
|
Warde infectious agent nucleic acid genotype hepatitis c
|
$293.44 |
$293.44 |
$293.44 |
$672.75
|
|
Wrist X-ray
|
$231.28 |
$231.28 |
$231.28 |
$311.20
|
|
X-ray abdomen 1 view
|
$112.00 |
$112.00 |
$112.00 |
$243.00
|
|
X-ray abdomen 2 views
|
$161.84 |
$161.84 |
$161.84 |
$281.50
|
|
X-ray abdomen >=3 views
|
$176.40 |
$176.40 |
$176.40 |
$309.38
|
|
X-ray abdomen complete acute series including spine erect and/or decubitus single view chest
|
$133.28 |
$133.28 |
$133.28 |
$359.84
|
|
X-ray acromioclavicular joints without or w/weighted distraction bilateral
|
$132.16 |
$132.16 |
$132.16 |
$246.42
|
|
X-ray ankle 2 views (both sides)
|
$152.88 |
$152.88 |
$152.88 |
$240.00
|
|
X-ray bone age studies
|
$114.80 |
$114.80 |
$114.80 |
$227.08
|
|
X-ray bone survey complete
|
$150.08 |
$150.08 |
$150.08 |
$569.03
|
|
X-ray cervical spine 2-3 views
|
$180.32 |
$180.32 |
$180.32 |
$308.40
|
|
X-ray cervical spine 4-5 views
|
$231.84 |
$231.84 |
$231.84 |
$439.14
|
|
X-ray cervical spine >= 6 views
|
$238.00 |
$238.00 |
$238.00 |
$479.05
|
|
X-ray clavicle complete (both sides)
|
$128.24 |
$128.24 |
$128.24 |
$277.00
|
|
X-ray colon abdominal radiograph(s) & delayed images single contrast study
|
$366.80 |
$366.80 |
$366.80 |
$594.68
|
|
X-ray colon abdominal radiograph(s) & delayed images with glucagon double contrast study
|
$359.52 |
$359.52 |
$359.52 |
$785.86
|
|
X-ray elbow 2 views (both sides)
|
$148.40 |
$148.40 |
$148.40 |
$281.40
|
|
X-ray elbow >= 3 views (both sides)
|
$220.08 |
$220.08 |
$220.08 |
$325.88
|
|
X-ray esophogram chest radiograph(s) & delayed images single contrast study
|
$192.64 |
$192.64 |
$192.64 |
$434.76
|
|
X-ray exam of arm infant
|
$118.16 |
$118.16 |
$118.16 |
$238.26
|
|
X-ray exam of eye sockets
|
$222.88 |
$222.88 |
$222.88 |
$321.48
|
|
X-ray exam of femur 1
|
$109.76 |
$109.76 |
$109.76 |
$194.40
|
|
X-ray exam thorac spine4/>vw
|
$231.84 |
$231.84 |
$231.84 |
$365.00
|
|
X-ray eye detection foreign body (both sides)
|
$128.24 |
$128.24 |
$128.24 |
$227.80
|
|
X-ray facial bones complete > 3 views
|
$238.00 |
$238.00 |
$238.00 |
$337.95
|
|
X-ray femur >=2 views (both sides)
|
$192.64 |
$192.64 |
$192.64 |
$290.44
|
|
X-ray finger(s) >= 2 views (both sides)
|
$78.96 |
$78.96 |
$78.96 |
$233.55
|
|
X-ray foot 2 views (both sides)
|
$131.04 |
$131.04 |
$131.04 |
$270.40
|
|
X-ray forearm 2 views (both sides)
|
$102.48 |
$102.48 |
$102.48 |
$317.62
|
|
X-ray hand 2 views (both sides)
|
$95.76 |
$95.76 |
$95.76 |
$270.00
|
|
X-ray heel/calcaneus > 2 views (both sides)
|
$152.88 |
$152.88 |
$152.88 |
$243.10
|
|
X-ray hip uni w/wo pelvis min 4 views
|
$342.16 |
$342.16 |
$342.16 |
$300.00
|
|
X-ray hip with pelvis when performed bilateral 2 views
|
$269.92 |
$269.92 |
$269.92 |
$313.45
|
|
X-ray hip with pelvis when performed bilateral 3-4 views
|
$342.16 |
$342.16 |
$342.16 |
$376.80
|
|
X-ray hip with pelvis when performed bilateral >= 5 views
|
$359.52 |
$359.52 |
$359.52 |
$477.10
|
|
X-ray hip with pelvis when performed unilateral 1 view left
|
$140.56 |
$140.56 |
$140.56 |
$187.20
|
|
X-ray humerus >= 2 views left
|
$155.68 |
$155.68 |
$155.68 |
$285.00
|
|
X-ray knee 1-2 views (both sides)
|
$173.60 |
$173.60 |
$173.60 |
$271.70
|
|
X-ray knee 3 views (both sides)
|
$184.24 |
$184.24 |
$184.24 |
$319.24
|
|
X-ray knee ap standing bilateral
|
$139.44 |
$139.44 |
$139.44 |
$243.09
|
|
X-ray lower extremities infant > 2 views (both sides)
|
$171.92 |
$171.92 |
$171.92 |
$227.92
|
|
X-ray lumbosacral spine >= 4 views
|
$268.80 |
$268.80 |
$268.80 |
$475.04
|
|
X-ray lumbosacral spine complete including bending views >= 6 views
|
$211.68 |
$211.68 |
$211.68 |
$513.63
|
|
X-ray mandible complete > 4 views
|
$232.96 |
$232.96 |
$232.96 |
$323.70
|
|
X-ray nasal bones complete > 3 views
|
$148.40 |
$148.40 |
$148.40 |
$260.52
|
|
X-ray neck soft tissue
|
$126.56 |
$126.56 |
$126.56 |
$221.10
|
|
X-ray nose to rectum for foreign body child
|
$42.00 |
$42.00 |
$42.00 |
$201.00
|
|
X-ray pelvis 1-2 views
|
$98.56 |
$98.56 |
$98.56 |
$242.58
|
|
X-ray pelvis complete > 3 views
|
$177.52 |
$177.52 |
$177.52 |
$299.46
|
|
X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation
|
$288.40 |
$288.40 |
$288.40 |
$663.18
|
|
X-ray ribs 2 views left
|
$127.68 |
$127.68 |
$127.68 |
$281.45
|
|
X-ray ribs 3 views bilateral
|
$201.60 |
$201.60 |
$201.60 |
$361.20
|
|
X-ray ribs w/posterior anterior chest 3 views left
|
$142.80 |
$142.80 |
$142.80 |
$327.21
|
|
X-ray ribs w/posterior anterior chest > 4 views bilateral
|
$159.60 |
$159.60 |
$159.60 |
$466.80
|
|
X-ray sacroiliac joints >= 3 views
|
$114.80 |
$114.80 |
$114.80 |
$270.40
|
|
X-ray sacrum/coccyx >= 2 views
|
$124.88 |
$124.88 |
$124.88 |
$260.65
|
|
X-ray scapula complete (both sides)
|
$114.80 |
$114.80 |
$114.80 |
$264.80
|
|
X-ray shoulder 1 view (both sides)
|
$137.20 |
$137.20 |
$137.20 |
$242.00
|
|
X-ray sinuses paranasal complete > 3 views
|
$238.00 |
$238.00 |
$238.00 |
$324.53
|
|
X-ray skull < 4 views
|
$187.04 |
$187.04 |
$187.04 |
$277.54
|
|
X-ray skull > 4 views complete
|
$255.36 |
$255.36 |
$255.36 |
$404.30
|
|
X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study
|
$238.00 |
$238.00 |
$238.00 |
$511.38
|
|
X-ray spine single view
|
$63.28 |
$63.28 |
$63.28 |
$225.00
|
|
X-ray sternoclavicular joint(s) > 3 views
|
$132.16 |
$132.16 |
$132.16 |
$236.88
|
|
X-ray sternum > 2 views
|
$114.80 |
$114.80 |
$114.80 |
$230.00
|
|
X-ray surgical specimen
|
$283.36 |
$283.36 |
$283.36 |
$457.47
|
|
X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study
|
$160.16 |
$160.16 |
$160.16 |
$463.00
|
|
X-ray temporomandibular joint open/closed mouth bilateral
|
$106.96 |
$106.96 |
$106.96 |
$276.00
|
|
X-ray thoracic spine 2 views
|
$129.92 |
$129.92 |
$129.92 |
$286.65
|
|
X-ray thoracic spine 3 views
|
$185.92 |
$185.92 |
$185.92 |
$343.00
|
|
X-ray thoracolumbar spine >=2 views
|
$81.20 |
$81.20 |
$81.20 |
$269.10
|
|
X-ray tibia/fibula 2 views (both sides)
|
$152.88 |
$152.88 |
$152.88 |
$306.47
|
|
X-ray toe(s) > 2 views (both sides)
|
$72.24 |
$72.24 |
$72.24 |
$225.00
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images double contrast
|
$370.72 |
$370.72 |
$370.72 |
$590.20
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images single contrast study
|
$370.72 |
$370.72 |
$370.72 |
$497.93
|
|
X-ray wrist 2 views (both sides)
|
$146.16 |
$146.16 |
$146.16 |
$268.49
|