|
Sodium chloride 0.9 % IV bolus
|
$81.78 |
$81.78 |
$81.78 |
$44.34
|
|
Sodium ferric gluconate complex in sucrose 62.5 mg/5 ml intravenous
|
$346.42 |
$346.42 |
$346.42 |
$77.77
|
|
Sodium thiosulfate 12.5 gram/50 ml (250 mg/ml) intravenous solution
|
$898.13 |
$898.13 |
$898.13 |
$177.52
|
|
Spirometry bronchodilation responsiveness pre/post bronchodilator administration
|
$1,745.56 |
$1,745.56 |
$1,745.56 |
$536.34
|
|
St analysis behavior qualitative voice/resonance
|
$541.86 |
$541.86 |
$541.86 |
$295.10
|
|
St cognitve performance testing healthcare professional each hour
|
$612.67 |
$612.67 |
$612.67 |
$284.65
|
|
St evaluate speech sound production
|
$541.86 |
$541.86 |
$541.86 |
$288.75
|
|
St evaluation motion fluoroscopic swallow function cine/video
|
$1,427.93 |
$1,427.93 |
$1,427.93 |
$373.50
|
|
St evaluation swallow function
|
$1,457.24 |
$1,457.24 |
$1,457.24 |
$311.36
|
|
St treatment speech individual
|
$541.86 |
$541.86 |
$541.86 |
$253.80
|
|
St treatment swallow dysfunction/oral
|
$490.61 |
$490.61 |
$490.61 |
$245.50
|
|
Succinylcholine chloride 20 mg/ml injection solution (wrapper)
|
$167.00 |
$167.00 |
$167.00 |
$50.22
|
|
Sulfamethoxazole 400 mg-trimethoprim 80 mg/5 ml intravenous solution
|
$354.24 |
$354.24 |
$354.24 |
$82.46
|
|
Sulfonylurea screen qn-sendout
|
$345.55 |
$345.55 |
$345.55 |
$152.64
|
|
Sumatriptan 6 mg/0.5 ml subcutaneous solution
|
$1,314.33 |
$1,314.33 |
$1,314.33 |
$123.58
|
|
Susceptibility enzyme detection per enzyme
|
$19.00 |
$19.00 |
$19.00 |
$35.10
|
|
Tamoxifen 10 mg tabs 60 each bottle
|
$42.94 |
$42.94 |
$42.94 |
$14.62
|
|
Tb test cell mediated immunity antigen response enumeration gamma interferon t-cells
|
$58.94 |
$58.94 |
$58.94 |
$194.35
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$517.00 |
$517.00 |
$517.00 |
$175.00
|
|
Tc-99m exametazime diag
|
$847.85 |
$847.85 |
$847.85 |
$2,033.20
|
|
Tc-99m labeled rbc
|
$7,727.21 |
$7,727.21 |
$7,727.21 |
$302.40
|
|
Tc-99m maa
|
$460.68 |
$460.68 |
$460.68 |
$283.41
|
|
Tc-99m mebrofenin
|
$460.68 |
$460.68 |
$460.68 |
$160.58
|
|
Tc-99m medronate
|
$543.07 |
$543.07 |
$543.07 |
$109.50
|
|
Tc-99m mertiatide
|
$3,885.49 |
$3,885.49 |
$3,885.49 |
$756.00
|
|
Tc-99m pentetate dtpa
|
$6,909.12 |
$6,909.12 |
$6,909.12 |
$222.60
|
|
Tc-99m pertechnetate per mci
|
$460.68 |
$460.68 |
$460.68 |
$27.20
|
|
Tc-99m sestamibi p study dose
|
$3,359.93 |
$3,359.93 |
$3,359.93 |
$293.73
|
|
Tc-99m sulfur colloid
|
$686.70 |
$686.70 |
$686.70 |
$239.40
|
|
Tc-99m tetrofosmin p study dose
|
$740.99 |
$740.99 |
$740.99 |
$188.50
|
|
Tc-99m tilmanocept diag
|
$1,300.19 |
$1,300.19 |
$1,300.19 |
$930.54
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$125.72 |
$125.72 |
$125.72 |
$39.18
|
|
Test pathogen(s) for platelets reference
|
$4,249.17 |
$4,249.17 |
$4,249.17 |
$66.00
|
|
Tetanus immune globulin inj
|
$2,546.29 |
$2,546.29 |
$2,546.29 |
$1,228.80
|
|
Theophylline therapeutic drug level
|
$677.96 |
$677.96 |
$677.96 |
$108.00
|
|
Therapy nutrition individual initial f2f w/patient each 15 minutes
|
$102.94 |
$102.94 |
$102.94 |
$57.50
|
|
Therapy nutrition individual reassessment/intervention f2f w/patient each 15 minutes
|
$64.87 |
$64.87 |
$64.87 |
$50.00
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$67.65 |
$67.65 |
$67.65 |
$25.54
|
|
Thyroid imaging
|
$1,805.62 |
$1,805.62 |
$1,805.62 |
$673.01
|
|
Tilt table study
|
$1,998.13 |
$1,998.13 |
$1,998.13 |
$1,495.00
|
|
Tl-201 thallium diag per mci
|
$1,634.42 |
$1,634.42 |
$1,634.42 |
$80.10
|
|
Tomosynthesis breast diagnostic left
|
$110.39 |
$110.39 |
$110.39 |
$74.10
|
|
Tomosynthesis breast screen bilateral
|
$116.97 |
$116.97 |
$116.97 |
$70.89
|
|
Training self management diabetes individual outpatient department per 30 minutes
|
$306.69 |
$306.69 |
$306.69 |
$101.58
|
|
Tranexamic acid 1,000 mg/10 ml (100 mg/ml) intravenous solution
|
$33.00 |
$33.00 |
$33.00 |
$55.69
|
|
Transcatheter bx s&i
|
$5,196.15 |
$5,196.15 |
$5,196.15 |
$1,973.01
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$1,266.74 |
$1,266.74 |
$1,266.74 |
$224.90
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$1,266.74 |
$1,266.74 |
$1,266.74 |
$141.00
|
|
Treatment inhalation pressurized/nonpressurized acute airway obstruction
|
$481.45 |
$481.45 |
$481.45 |
$203.35
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$260.90 |
$260.90 |
$260.90 |
$43.80
|
|
Trichomonas assay w/optic
|
$61.16 |
$61.16 |
$61.16 |
$58.25
|
|
Ultrasound abdomen aorta screening study aaa
|
$1,155.65 |
$1,155.65 |
$1,155.65 |
$394.20
|
|
Ultrasound exam k transpl w/doppler
|
$1,121.99 |
$1,121.99 |
$1,121.99 |
$573.54
|
|
Ultrasound guidance for vascular access
|
$1,623.33 |
$1,623.33 |
$1,623.33 |
$379.36
|
|
Ultrasound guide intraoperative
|
$1,383.18 |
$1,383.18 |
$1,383.18 |
$625.15
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$371.96 |
$371.96 |
$371.96 |
$323.40
|
|
Ultrasound pregnant uterus follow up per fetus
|
$1,264.37 |
$1,264.37 |
$1,264.37 |
$420.80
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$13,103.90 |
$13,103.90 |
$13,103.90 |
$3,039.60
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$11,498.12 |
$11,498.12 |
$11,498.12 |
$2,412.60
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$8,387.70 |
$8,387.70 |
$8,387.70 |
$2,034.41
|
|
Urethrcystgrphy rtrgrde s&i
|
$965.56 |
$965.56 |
$965.56 |
$584.00
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$129.47 |
$129.47 |
$129.47 |
$42.90
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$640.44 |
$640.44 |
$640.44 |
$154.78
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$259.20 |
$259.20 |
$259.20 |
$74.42
|
|
Vaccine influenza (iiv) preservative free antigen content im
|
$683.00 |
$683.00 |
$683.00 |
$143.20
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$179.00 |
$179.00 |
$179.00 |
$47.88
|
|
Vaccine mengingoccocal serogroup b 2 dose im
|
$3,373.03 |
$3,373.03 |
$3,373.03 |
$400.03
|
|
Vaccine mengingoccocal serogroup b 2 or 3 dose im
|
$500.04 |
$500.04 |
$500.04 |
$409.35
|
|
Vaccine menigococcal serogroups a/c/w/y quadrivalent tetanus toxoid(menacwy-tt) im
|
$1,681.95 |
$1,681.95 |
$1,681.95 |
$310.93
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$1,583.97 |
$1,583.97 |
$1,583.97 |
$381.89
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$1,965.39 |
$1,965.39 |
$1,965.39 |
$252.90
|
|
Vaccine pneumonococcal conjugate 15 valent (pcv15) im
|
$2,078.00 |
$2,078.00 |
$2,078.00 |
$385.45
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$681.18 |
$681.18 |
$681.18 |
$563.36
|
|
Vaccine tdap >=7 years im
|
$478.22 |
$478.22 |
$478.22 |
$136.80
|
|
Vaccine td preservative free >= 7 years im
|
$370.92 |
$370.92 |
$370.92 |
$112.10
|
|
Valproate in ns IV syringe 10 mg/ml (pediatric) - cnr
|
$179.45 |
$179.45 |
$179.45 |
$24.12
|
|
Venipuncture >= 3 years diagnostic/therapeutic (not to be used for routine venipuncture)
|
$1,518.45 |
$1,518.45 |
$1,518.45 |
$188.83
|
|
Ventilator each subsequent day
|
$4,938.20 |
$4,938.20 |
$4,938.20 |
$1,148.00
|
|
Ventilator initial day
|
$6,619.50 |
$6,619.50 |
$6,619.50 |
$1,433.60
|
|
Virus isolation addl studies ea
|
$80.80 |
$80.80 |
$80.80 |
$79.34
|
|
Vital capacity test
|
$761.93 |
$761.93 |
$761.93 |
$170.99
|
|
Volume measurement urine timed
|
$14.56 |
$14.56 |
$14.56 |
$21.00
|
|
Voriconazole in ns IV syringe 5 mg/ml (pediatric) - cnr
|
$3,841.47 |
$3,841.47 |
$3,841.47 |
$165.81
|
|
Warde 3400652 smear complex special stain ova/parasites
|
$71.92 |
$71.92 |
$71.92 |
$70.20
|
|
Warde acetylcholine receptor blocking antibody
|
$73.60 |
$73.60 |
$73.60 |
$70.56
|
|
Warde anti-mullerian hormone
|
$243.15 |
$243.15 |
$243.15 |
$80.08
|
|
Warde calculus (stone) infrared
|
$1,028.51 |
$1,028.51 |
$1,028.51 |
$59.52
|
|
Warde neutralization rabies
|
$149.00 |
$149.00 |
$149.00 |
$106.50
|
|
Whole blood or red blood cells frozen/deglycerolized/washed leukocytes reduced each unit
|
$753.87 |
$753.87 |
$753.87 |
$611.55
|
|
Wound therapy negative pressure per session > 50 sq cm
|
$1,827.68 |
$1,827.68 |
$1,827.68 |
$611.25
|
|
Wound therapy negative pressure per session <= 50 sq cm dme
|
$935.30 |
$935.30 |
$935.30 |
$284.40
|
|
Wound therapy negative pressure per session > 50 sq cm dme
|
$1,150.26 |
$1,150.26 |
$1,150.26 |
$431.28
|
|
X-ray abdomen >=3 views
|
$1,191.67 |
$1,191.67 |
$1,191.67 |
$338.25
|
|
X-ray bone age studies
|
$962.18 |
$962.18 |
$962.18 |
$248.85
|
|
X-ray bone survey complete
|
$1,507.71 |
$1,507.71 |
$1,507.71 |
$660.00
|
|
X-ray colon abdominal radiograph(s) & delayed images single contrast study
|
$2,024.06 |
$2,024.06 |
$2,024.06 |
$665.70
|
|
X-ray colon abdominal radiograph(s) & delayed images with glucagon double contrast study
|
$2,094.64 |
$2,094.64 |
$2,094.64 |
$820.15
|
|
X-ray esophogram chest radiograph(s) & delayed images single contrast study
|
$1,223.73 |
$1,223.73 |
$1,223.73 |
$483.50
|
|
X-ray exam entire spi 4/5 vw
|
$1,276.57 |
$1,276.57 |
$1,276.57 |
$436.80
|
|
X-ray hip with pelvis when performed bilateral >= 5 views
|
$1,276.57 |
$1,276.57 |
$1,276.57 |
$496.80
|
