|
Pvb thoracic cont infusion
|
$5,339.00 |
$5,339.00 |
$5,339.00 |
$2,047.68
|
|
Pvb thoracic single inj site
|
$5,339.00 |
$5,339.00 |
$5,339.00 |
$1,189.08
|
|
Pyruvate
|
$15.93 |
$15.93 |
$15.93 |
$65.00
|
|
Pyruvate kinase
|
$10.38 |
$10.38 |
$10.38 |
$65.00
|
|
Quant diff pulm perf and vent w/imaging
|
$559.81 |
$559.81 |
$559.81 |
$1,524.16
|
|
Quant diff pulm perf w/imaging
|
$327.28 |
$327.28 |
$327.28 |
$1,209.44
|
|
Quest t3 uptake
|
$7.12 |
$7.12 |
$7.12 |
$56.10
|
|
Radiation physics consult
|
$344.11 |
$344.11 |
$344.11 |
$574.75
|
|
Radiation therapy dose plan
|
$204.47 |
$204.47 |
$204.47 |
$530.53
|
|
Radiation treatment aid(s)
|
$260.58 |
$260.58 |
$260.58 |
$541.45
|
|
Radiation treatment aid(s)
|
$307.33 |
$307.33 |
$307.33 |
$665.00
|
|
Radiation treatment aid(s)
|
$677.63 |
$677.63 |
$677.63 |
$1,103.09
|
|
Radiation treatment delivery
|
$170.39 |
$170.39 |
$170.39 |
$552.40
|
|
Radiation treatment delivery
|
$595.97 |
$595.97 |
$595.97 |
$909.98
|
|
Radical resection of elbow
|
$5,339.00 |
$5,339.00 |
$5,339.00 |
$7,626.53
|
|
Radic resect abd tumor<5cm 22904
|
$5,339.00 |
$5,339.00 |
$5,339.00 |
$3,386.84
|
|
Radic resect shoulder tumor 5cm/> 23078
|
$5,339.00 |
$5,339.00 |
$5,339.00 |
$4,460.78
|
|
Radiology port images(s)
|
$159.59 |
$159.59 |
$159.59 |
$260.07
|
|
Radiotherapy dose plan imrt
|
$3,392.33 |
$3,392.33 |
$3,392.33 |
$5,996.21
|
|
Radphm lcl tmr plnr bdy sgl day img
|
$790.47 |
$790.47 |
$790.47 |
$2,014.64
|
|
Radphm lcl tmr plnr bdy two day img
|
$1,138.74 |
$1,138.74 |
$1,138.74 |
$2,728.42
|
|
Radphm lcl tomogr sgl area sgl day
|
$869.43 |
$869.43 |
$869.43 |
$2,377.65
|
|
Radphm lcl tumor plr sgl day
|
$479.39 |
$479.39 |
$479.39 |
$1,139.40
|
|
Rad rescj tum dstl/shft hum
|
$5,339.00 |
$5,339.00 |
$5,339.00 |
$7,628.80
|
|
Rad rescj tum shoulder<5 cm
|
$5,339.00 |
$5,339.00 |
$5,339.00 |
$3,994.09
|
|
Rad rescj tum tiss a/e 5 cm+
|
$5,339.00 |
$5,339.00 |
$5,339.00 |
$4,460.78
|
|
Rad rescj tum tiss a/e <5cm
|
$5,339.00 |
$5,339.00 |
$5,339.00 |
$3,986.00
|
|
Rad resec soft tis tum/ft/toe/<3cm 28046
|
$5,339.00 |
$5,339.00 |
$5,339.00 |
$3,386.84
|
|
Rad resect abd tumor 5 cm/>
|
$5,339.00 |
$5,339.00 |
$5,339.00 |
$3,386.84
|
|
Rad resect hand tumor < 3 cm
|
$5,339.00 |
$5,339.00 |
$5,339.00 |
$3,167.89
|
|
Rad resect hand tumor 3 cm/>
|
$5,339.00 |
$5,339.00 |
$5,339.00 |
$3,386.84
|
|
Rad resection tum radial h/n
|
$5,339.00 |
$5,339.00 |
$5,339.00 |
$7,807.24
|
|
Rad resect tumor/neck/ant thor/<5cm21557
|
$5,339.00 |
$5,339.00 |
$5,339.00 |
$3,167.89
|
|
Rapid Strep Test
|
$18.18 |
$18.18 |
$18.18 |
$74.10
|
|
Rbc count only automated
|
$3.32 |
$3.32 |
$3.32 |
$20.00
|
|
Rbc deglycerolized each unit
|
$332.68 |
$332.68 |
$332.68 |
$790.31
|
|
Rbc depletion of harvest
|
$5,339.00 |
$5,339.00 |
$5,339.00 |
$1,673.75
|
|
Rcnst bfrnt sp orb rm&lw fhd
|
$5,339.00 |
$5,339.00 |
$5,339.00 |
$5,741.00
|
|
Rdctj forehead cntrg only
|
$5,339.00 |
$5,339.00 |
$5,339.00 |
$3,837.72
|
|
Rdctj forehead cntrg&prostc
|
$5,339.00 |
$5,339.00 |
$5,339.00 |
$5,339.00
|
|
Rdctj forehead cntrg&setback
|
$5,339.00 |
$5,339.00 |
$5,339.00 |
$6,311.00
|
|
Realignment of tendons
|
$5,339.00 |
$5,339.00 |
$5,339.00 |
$3,591.33
|
|
Rebuild eardrum structures
|
$5,339.00 |
$5,339.00 |
$5,339.00 |
$6,553.49
|
|
Rebuild eardrum structures
|
$5,339.00 |
$5,339.00 |
$5,339.00 |
$6,547.81
|
|
Rebuild eardrum structures
|
$5,339.00 |
$5,339.00 |
$5,339.00 |
$6,771.20
|
|
Rebuild outer ear canal
|
$5,339.00 |
$5,339.00 |
$5,339.00 |
$6,017.08
|
|
Rebuild outer ear canal
|
$5,339.00 |
$5,339.00 |
$5,339.00 |
$6,839.00
|
|
Reconst lwr jaw w/fixation
|
$5,339.00 |
$5,339.00 |
$5,339.00 |
$6,553.49
|
|
Reconst lwr jaw w/graft
|
$5,339.00 |
$5,339.00 |
$5,339.00 |
$6,553.49
|
|
Reconst lwr jaw without fixation
|
$5,339.00 |
$5,339.00 |
$5,339.00 |
$5,419.00
|
|
Reconst lwr jaw without graft
|
$5,339.00 |
$5,339.00 |
$5,339.00 |
$5,339.00
|
|
Reconstr lwr jaw segment
|
$5,339.00 |
$5,339.00 |
$5,339.00 |
$5,339.00
|
|
Reconstr lwr jaw w/advance
|
$5,339.00 |
$5,339.00 |
$5,339.00 |
$6,311.00
|
|
Reconstruct ankle joint
|
$5,339.00 |
$5,339.00 |
$5,339.00 |
$5,741.00
|
|
Reconstruct cleft foot
|
$5,339.00 |
$5,339.00 |
$5,339.00 |
$7,907.11
|
|
Reconstruct cleft palate
|
$5,339.00 |
$5,339.00 |
$5,339.00 |
$5,493.56
|
|
Reconstruct cleft palate
|
$5,339.00 |
$5,339.00 |
$5,339.00 |
$3,837.72
|
|
Reconstruct cleft palate
|
$5,339.00 |
$5,339.00 |
$5,339.00 |
$5,289.89
|
|
Reconstruct cleft palate
|
$5,339.00 |
$5,339.00 |
$5,339.00 |
$5,419.00
|
|
Reconstruct cleft palate
|
$5,339.00 |
$5,339.00 |
$5,339.00 |
$5,339.00
|
|
Reconstruct cleft palate
|
$5,339.00 |
$5,339.00 |
$5,339.00 |
$5,419.00
|
|
Reconstruct elbow joint
|
$5,339.00 |
$5,339.00 |
$5,339.00 |
$5,855.00
|
|
Reconstruct elbow joint
|
$5,339.00 |
$5,339.00 |
$5,339.00 |
$16,139.55
|
|
Reconstruct elbow joint
|
$5,339.00 |
$5,339.00 |
$5,339.00 |
$9,787.28
|
|
Reconstruct elbow lat ligmnt
|
$5,339.00 |
$5,339.00 |
$5,339.00 |
$7,907.11
|
|
Reconstruct elbow med ligmnt
|
$5,339.00 |
$5,339.00 |
$5,339.00 |
$11,365.24
|
|
Reconstruct extra finger
|
$5,339.00 |
$5,339.00 |
$5,339.00 |
$3,534.24
|
|
Reconstruct finger joint
|
$5,339.00 |
$5,339.00 |
$5,339.00 |
$3,839.54
|
|
Reconstruct finger joint
|
$5,339.00 |
$5,339.00 |
$5,339.00 |
$4,017.51
|
|
Reconstruct head of radius
|
$5,339.00 |
$5,339.00 |
$5,339.00 |
$7,300.31
|
|
Reconstruct head of radius
|
$5,339.00 |
$5,339.00 |
$5,339.00 |
$10,629.07
|
|
Reconstruction knee
|
$5,339.00 |
$5,339.00 |
$5,339.00 |
$5,741.00
|
|
Reconstruction knee
|
$5,339.00 |
$5,339.00 |
$5,339.00 |
$8,814.96
|
|
Reconstruction knee
|
$5,339.00 |
$5,339.00 |
$5,339.00 |
$10,629.07
|
|
Reconstruction of anus
|
$5,339.00 |
$5,339.00 |
$5,339.00 |
$3,245.23
|
|
Reconstruction of eyelid
|
$5,339.00 |
$5,339.00 |
$5,339.00 |
$3,590.40
|
|
Reconstruction of eyelid
|
$5,339.00 |
$5,339.00 |
$5,339.00 |
$3,269.14
|
|
Reconstruction of eyelid
|
$5,339.00 |
$5,339.00 |
$5,339.00 |
$4,462.45
|
|
Reconstruction of eyelid
|
$5,339.00 |
$5,339.00 |
$5,339.00 |
$2,760.73
|
|
Reconstruction of jaw
|
$5,339.00 |
$5,339.00 |
$5,339.00 |
$5,339.00
|
|
Reconstruction of jaw
|
$5,339.00 |
$5,339.00 |
$5,339.00 |
$5,289.89
|
|
Reconstruction of jaw
|
$5,339.00 |
$5,339.00 |
$5,339.00 |
$6,465.11
|
|
Reconstruction of jaw
|
$5,339.00 |
$5,339.00 |
$5,339.00 |
$6,553.49
|
|
Reconstruction of jaw joint
|
$5,339.00 |
$5,339.00 |
$5,339.00 |
$6,547.81
|
|
Reconstruction of jaw joint
|
$5,339.00 |
$5,339.00 |
$5,339.00 |
$6,547.81
|
|
Reconstruction of jaw joint
|
$5,339.00 |
$5,339.00 |
$5,339.00 |
$10,157.83
|
|
Reconstruction of lower jaw
|
$5,339.00 |
$5,339.00 |
$5,339.00 |
$6,349.67
|
|
Reconstruction of mouth
|
$5,339.00 |
$5,339.00 |
$5,339.00 |
$5,741.00
|
|
Reconstruction of mouth
|
$5,339.00 |
$5,339.00 |
$5,339.00 |
$6,311.00
|
|
Reconstruction of mouth
|
$5,339.00 |
$5,339.00 |
$5,339.00 |
$6,465.11
|
|
Reconstruction of mouth
|
$5,339.00 |
$5,339.00 |
$5,339.00 |
$6,465.11
|
|
Reconstruction of mouth
|
$5,339.00 |
$5,339.00 |
$5,339.00 |
$6,547.81
|
|
Reconstruction of nail bed
|
$5,339.00 |
$5,339.00 |
$5,339.00 |
$2,164.64
|
|
Reconstruction of nose
|
$5,339.00 |
$5,339.00 |
$5,339.00 |
$5,925.35
|
|
Reconstruction of nose
|
$5,339.00 |
$5,339.00 |
$5,339.00 |
$6,547.81
|
|
Reconstruction of orbit
|
$5,339.00 |
$5,339.00 |
$5,339.00 |
$6,161.60
|
|
Reconstruction of throat
|
$5,339.00 |
$5,339.00 |
$5,339.00 |
$5,741.00
|
|
Reconstruction of urethra
|
$5,339.00 |
$5,339.00 |
$5,339.00 |
$5,626.86
|
|
Reconstruction of urethra
|
$5,339.00 |
$5,339.00 |
$5,339.00 |
$5,631.74
|
|
Reconstruction of urethra
|
$5,339.00 |
$5,339.00 |
$5,339.00 |
$5,339.00
|
