|
Removal cerumen impacted (both sides)
|
$28.80 |
$28.80 |
$28.80 |
$163.20
|
|
Removal devitalized tissue non-selective debridement without anesthesia per session
|
$98.24 |
$98.24 |
$98.24 |
$249.60
|
|
Removal duct glbldr calculi
|
$828.80 |
$828.80 |
$828.80 |
$2,771.60
|
|
Remove cva lumen obstruct
|
$410.56 |
$410.56 |
$410.56 |
$490.80
|
|
Remove renal tube w/fluoro
|
$683.84 |
$683.84 |
$683.84 |
$1,141.31
|
|
Remove ureter stent percut
|
$2,050.24 |
$2,050.24 |
$2,050.24 |
$3,612.60
|
|
Renal function panel
|
$22.40 |
$22.40 |
$22.40 |
$113.52
|
|
Repair prosthesis per 15 min
|
$16.00 |
$16.00 |
$16.00 |
$16.50
|
|
Replace duod/jej tube perc
|
$449.92 |
$449.92 |
$449.92 |
$1,354.54
|
|
Replace g/c tube perc
|
$449.92 |
$449.92 |
$449.92 |
$1,341.50
|
|
Replace g-j tube perc
|
$449.92 |
$449.92 |
$449.92 |
$1,498.53
|
|
Replace picvad cath
|
$945.28 |
$945.28 |
$945.28 |
$3,724.63
|
|
Reptilase test
|
$33.92 |
$33.92 |
$33.92 |
$72.00
|
|
Respirator motion mgmt simul
|
$179.20 |
$179.20 |
$179.20 |
$1,197.50
|
|
Resuscitation cardiopulmonary
|
$192.32 |
$192.32 |
$192.32 |
$764.40
|
|
Reticulocyte automated
|
$12.80 |
$12.80 |
$12.80 |
$52.57
|
|
Retifanlimab-dlwr 500 mg/20 ml intravenous solution
|
$16,078.12 |
$16,078.12 |
$16,078.12 |
$23,780.31
|
|
Revasc evasc fpvt angio cplx 1st
|
$2,654.72 |
$2,654.72 |
$2,654.72 |
$10,094.56
|
|
Revasc evasc fpvt angio sf 1st
|
$2,654.72 |
$2,654.72 |
$2,654.72 |
$10,094.56
|
|
Revasc evasc fpvt athrec cplx 1st
|
$8,550.08 |
$8,550.08 |
$8,550.08 |
$29,423.20
|
|
Revasc evasc fpvt athrec sf 1st
|
$8,550.08 |
$8,550.08 |
$8,550.08 |
$25,206.69
|
|
Revasc evasc fpvt st athrec sf 1st
|
$8,550.08 |
$8,550.08 |
$8,550.08 |
$32,513.04
|
|
Revasc evasc fpvt stent cplx 1st
|
$5,384.32 |
$5,384.32 |
$5,384.32 |
$20,474.72
|
|
Revasc evasc fpvt stent sf 1st
|
$5,384.32 |
$5,384.32 |
$5,384.32 |
$20,474.72
|
|
Revasc evasc ivt angio cplx 1st
|
$2,654.72 |
$2,654.72 |
$2,654.72 |
$10,094.56
|
|
Revasc evasc ivt stent cplx 1st
|
$5,384.32 |
$5,384.32 |
$5,384.32 |
$20,474.72
|
|
Revasc evasc ivt stent sf 1st
|
$5,384.32 |
$5,384.32 |
$5,384.32 |
$20,474.72
|
|
Revasc evasc tpvt angio cplx 1st
|
$5,384.32 |
$5,384.32 |
$5,384.32 |
$20,474.72
|
|
Revasc evasc tpvt angio sf 1st
|
$5,384.32 |
$5,384.32 |
$5,384.32 |
$16,491.68
|
|
Revasc evasc tpvt athrec cplx 1st
|
$8,550.08 |
$8,550.08 |
$8,550.08 |
$31,546.50
|
|
Revasc evasc tpvt athrec sf 1st
|
$8,550.08 |
$8,550.08 |
$8,550.08 |
$26,819.25
|
|
Rheumatoid factor quantitative
|
$18.24 |
$18.24 |
$18.24 |
$57.00
|
|
Rho(d) immune globulin 1,500 unit (300 mcg)/2 ml injection syringe
|
$64.00 |
$64.00 |
$64.00 |
$243.11
|
|
Rho d immune globulin inj
|
$64.00 |
$64.00 |
$64.00 |
$217.71
|
|
Ring fx reform 11-13x17mm
|
$210.24 |
$210.24 |
$210.24 |
$1,509.75
|
|
Risankizumab-rzaa 60 mg/ml intravenous solution
|
$11,594.85 |
$11,594.85 |
$11,594.85 |
$30,071.50
|
|
Risperidone microspheres 12.5 mg/2 ml inj
|
$1,407.55 |
$1,407.55 |
$1,407.55 |
$2,429.37
|
|
Rituximab 10 mg/ml concentrate,intravenous
|
$5,123.01 |
$5,123.01 |
$5,123.01 |
$9,301.22
|
|
Rituximab 1,400 mg/11.7 ml (120 mg/ml)-hyaluronidase subcutaneous soln
|
$8,196.75 |
$8,196.75 |
$8,196.75 |
$15,057.18
|
|
Rituximab-abbs 10 mg/ml intravenous solution
|
$4,610.61 |
$4,610.61 |
$4,610.61 |
$5,343.99
|
|
Rituximab-arrx 10 mg/ml intravenous solution
|
$6,661.08 |
$6,661.08 |
$6,661.08 |
$6,287.16
|
|
Rituximab-pvvr 10 mg/ml intravenous solution
|
$6,661.08 |
$6,661.08 |
$6,661.08 |
$5,309.20
|
|
Rmvl ndwellg tun pleural cath
|
$307.52 |
$307.52 |
$307.52 |
$1,156.80
|
|
Romidepsin 10 mg/2 ml intravenous powder for solution
|
$3,192.30 |
$3,192.30 |
$3,192.30 |
$6,333.33
|
|
Romiplostim 125 mcg subcutaneous solution
|
$6,004.65 |
$6,004.65 |
$6,004.65 |
$8,950.11
|
|
Romosozumab-aqqg 105 mg/1.17 ml subcutaneous syringe (wrapper)
|
$1,433.50 |
$1,433.50 |
$1,433.50 |
$4,820.04
|
|
Ropivacaine 0.2 % epidural pca - 1 hour dose limit
|
$136.35 |
$136.35 |
$136.35 |
$188.50
|
|
Rotavirus antibody
|
$42.56 |
$42.56 |
$42.56 |
$125.01
|
|
Rpl non-tun cvc wo sbq prt/pmp
|
$373.44 |
$373.44 |
$373.44 |
$2,173.60
|
|
Rp loclzj tum 2+area 1+d img
|
$256.00 |
$256.00 |
$256.00 |
$1,310.00
|
|
Rpl picc wo subq port/pump incl image guidnc w/s&i
|
$373.44 |
$373.44 |
$373.44 |
$2,173.60
|
|
Rpl tun-cvad w subq port
|
$945.28 |
$945.28 |
$945.28 |
$4,647.04
|
|
Rpl tun cvc wo subq port
|
$945.28 |
$945.28 |
$945.28 |
$3,687.00
|
|
Rsv assay w/optic
|
$36.80 |
$36.80 |
$36.80 |
$79.38
|
|
Rubella antibody igg
|
$19.52 |
$19.52 |
$19.52 |
$77.03
|
|
Rubeola antibody igg
|
$23.04 |
$23.04 |
$23.04 |
$80.00
|
|
Russell viper venom diluted
|
$36.48 |
$36.48 |
$36.48 |
$72.54
|
|
Sacituzumab govitecan-hziy 180 mg intravenous solution
|
$2,740.84 |
$2,740.84 |
$2,740.84 |
$5,174.32
|
|
Sargramostim injection
|
$269.92 |
$269.92 |
$269.92 |
$609.00
|
|
Sarscov coronavirus ag ia
|
$79.04 |
$79.04 |
$79.04 |
$59.25
|
|
Scan duplex abd/pelvis/retroperitoneal complete
|
$117.12 |
$117.12 |
$117.12 |
$983.50
|
|
Scan duplex abd/pelvis/retroperitoneal limited
|
$78.72 |
$78.72 |
$78.72 |
$662.00
|
|
Scan duplex extracranial arteries unilateral/limited study
|
$62.40 |
$62.40 |
$62.40 |
$583.00
|
|
Scan duplex extremity veins unilateral/limited study
|
$139.52 |
$139.52 |
$139.52 |
$721.60
|
|
Scan duplex lower extremity arteries complete bilateral
|
$278.08 |
$278.08 |
$278.08 |
$985.20
|
|
Scan duplex lower extremity arteries unilateral/limited study left
|
$139.52 |
$139.52 |
$139.52 |
$660.00
|
|
Scan duplex upper extremity arteries unilateral/limited study left
|
$139.52 |
$139.52 |
$139.52 |
$595.35
|
|
Sclerotherapy fluid collection pq w/img
|
$406.08 |
$406.08 |
$406.08 |
$2,114.45
|
|
Screening HIV antigen/antibody combination assay
|
$56.96 |
$56.96 |
$56.96 |
$42.30
|
|
Screening Mammogram
|
$74.88 |
$74.88 |
$74.88 |
$312.55
|
|
Screening prostate cancer PSA
|
$59.20 |
$59.20 |
$59.20 |
$100.63
|
|
Screw cortex 2.0 x 10mm
|
$17,585.60 |
$17,585.60 |
$17,585.60 |
$29,055.00
|
|
Sc ther infusion reset pump
|
$35.20 |
$35.20 |
$35.20 |
$140.15
|
|
Sedimentation rate erythrocyte automated
|
$8.64 |
$8.64 |
$8.64 |
$42.00
|
|
Semen analysis presence/motility
|
$38.72 |
$38.72 |
$38.72 |
$71.05
|
|
Set radiation therapy field
|
$136.32 |
$136.32 |
$136.32 |
$762.40
|
|
Set radiation therapy field
|
$183.68 |
$183.68 |
$183.68 |
$1,157.38
|
|
Set radiation therapy field
|
$226.56 |
$226.56 |
$226.56 |
$1,636.36
|
|
Sewho erbs palsey design abd
|
$318.08 |
$318.08 |
$318.08 |
$988.40
|
|
Shoulder MRI (with and without contrast)
|
$868.80 |
$868.80 |
$868.80 |
$2,713.80
|
|
Shoulder MRI (with contrast)
|
$568.64 |
$568.64 |
$568.64 |
$2,448.60
|
|
Shoulder MRI (without contrast)
|
$566.08 |
$566.08 |
$566.08 |
$2,065.05
|
|
Shoulder X-ray
|
$139.84 |
$139.84 |
$139.84 |
$339.50
|
|
Shuntogram nonvascular supervision & interpretation
|
$95.36 |
$95.36 |
$95.36 |
$349.20
|
|
Sialography s&i
|
$120.64 |
$120.64 |
$120.64 |
$499.20
|
|
Sickling rbc
|
$44.16 |
$44.16 |
$44.16 |
$57.92
|
|
Sincalide 5 mcg solution for injection
|
$142.28 |
$142.28 |
$142.28 |
$307.58
|
|
Sinus CT scan (with and without contrast)
|
$553.60 |
$553.60 |
$553.60 |
$1,790.00
|
|
Sinus CT scan (with contrast)
|
$369.60 |
$369.60 |
$369.60 |
$1,527.60
|
|
Sinus CT scan (without contrast)
|
$369.60 |
$369.60 |
$369.60 |
$1,292.04
|
|
Sinus/juglr venogram s&i
|
$1,548.48 |
$1,548.48 |
$1,548.48 |
$2,489.25
|
|
Sirolimus, oral
|
$11.23 |
$11.23 |
$11.23 |
$41.25
|
|
Skin Biopsy
|
$199.36 |
$199.36 |
$199.36 |
$360.34
|
|
Sleep Study (Polysomnography)
|
$903.04 |
$903.04 |
$903.04 |
$3,607.50
|
|
Sleep study unattended
|
$105.92 |
$105.92 |
$105.92 |
$580.87
|
|
Sleeve fing rolyan med
|
$79.04 |
$79.04 |
$79.04 |
$203.58
|
|
Sling suprapubic suburetheral
|
$14,695.20 |
$14,695.20 |
$14,695.20 |
$9,679.96
|
|
Slp pure tone screening
|
$15.04 |
$15.04 |
$15.04 |
$60.48
|
|
Smear fluorescent and/or acid fast stain
|
$15.04 |
$15.04 |
$15.04 |
$64.20
|
|
Smear gram stain
|
$13.76 |
$13.76 |
$13.76 |
$55.25
|
