|
Protein total serum plasma whole blood
|
$501.00 |
$501.00 |
$501.00 |
$42.81
|
|
PSA (Prostate) Test
|
$608.00 |
$608.00 |
$608.00 |
$107.50
|
|
Pt application of modality >=1 area electrical stimulation each 15 minutes
|
$570.70 |
$570.70 |
$570.70 |
$87.45
|
|
Pt application of modality >=1 area ultrasound each 15 minutes
|
$391.46 |
$391.46 |
$391.46 |
$79.76
|
|
Pt application of modality traction mechanical
|
$508.91 |
$508.91 |
$508.91 |
$87.00
|
|
Pt evaluation high complexity patient/family
|
$502.76 |
$502.76 |
$502.76 |
$289.50
|
|
Pt evaluation low complexity patient/family
|
$464.63 |
$464.63 |
$464.63 |
$222.24
|
|
Pt evaluation moderate complexity patient/family
|
$483.68 |
$483.68 |
$483.68 |
$249.26
|
|
Pt re-evaluation patient/family
|
$307.96 |
$307.96 |
$307.96 |
$152.40
|
|
Pt repositioning canalith procedure(s) per day
|
$432.68 |
$432.68 |
$432.68 |
$115.35
|
|
Pt stimulation electrial unattended >= 1 area other than wound care part of therapy plan
|
$407.95 |
$407.95 |
$407.95 |
$79.20
|
|
Pt therapeutic procedure >=1 area massage each 15 minutes
|
$513.04 |
$513.04 |
$513.04 |
$79.00
|
|
Pyridoxine hcl 100 mg
|
$95.61 |
$95.61 |
$95.61 |
$48.70
|
|
Quant diff pulm perf and vent w/imaging
|
$2,088.80 |
$2,088.80 |
$2,088.80 |
$1,538.60
|
|
Quant diff pulm perf w/imaging
|
$1,381.69 |
$1,381.69 |
$1,381.69 |
$1,199.16
|
|
Rabies ig ht&sol human im/sc
|
$4,339.40 |
$4,339.40 |
$4,339.40 |
$2,997.00
|
|
Radiation physics consult
|
$2,410.94 |
$2,410.94 |
$2,410.94 |
$602.12
|
|
Radiation therapy dose plan
|
$1,805.30 |
$1,805.30 |
$1,805.30 |
$514.05
|
|
Radiation treatment aid(s)
|
$1,805.30 |
$1,805.30 |
$1,805.30 |
$526.80
|
|
Radiation treatment aid(s)
|
$4,950.03 |
$4,950.03 |
$4,950.03 |
$1,075.03
|
|
Radiation treatment delivery
|
$6,543.39 |
$6,543.39 |
$6,543.39 |
$552.40
|
|
Radiation treatment delivery
|
$3,009.60 |
$3,009.60 |
$3,009.60 |
$911.04
|
|
Radiology port images(s)
|
$1,013.26 |
$1,013.26 |
$1,013.26 |
$259.70
|
|
Radiotherapy dose plan imrt
|
$8,858.87 |
$8,858.87 |
$8,858.87 |
$5,718.50
|
|
Radphm lcl tmr plnr bdy two day img
|
$12,974.02 |
$12,974.02 |
$12,974.02 |
$2,658.60
|
|
Radphm lcl tomogr sgl area sgl day
|
$5,972.10 |
$5,972.10 |
$5,972.10 |
$2,242.80
|
|
Rbc count only automated
|
$176.00 |
$176.00 |
$176.00 |
$20.00
|
|
Rbc deglycerolized each unit
|
$1,977.00 |
$1,977.00 |
$1,977.00 |
$767.00
|
|
Red blood cells each unit
|
$462.81 |
$462.81 |
$462.81 |
$382.50
|
|
Red blood cells leukocytes reduced each unit
|
$499.00 |
$499.00 |
$499.00 |
$422.84
|
|
Red blood cells washed each unit
|
$700.00 |
$700.00 |
$700.00 |
$559.00
|
|
Regadenoson 0.4 mg/5 ml intravenous syringe
|
$3,074.91 |
$3,074.91 |
$3,074.91 |
$378.22
|
|
Remdesivir 100 mg intravenous powder for solution
|
$2,806.82 |
$2,806.82 |
$2,806.82 |
$1,524.70
|
|
Respirator motion mgmt simul
|
$3,773.41 |
$3,773.41 |
$3,773.41 |
$1,189.20
|
|
Resuscitation delivery/birthing room
|
$3,688.49 |
$3,688.49 |
$3,688.49 |
$774.37
|
|
Reticulocyte direct measurement automated
|
$388.36 |
$388.36 |
$388.36 |
$35.84
|
|
Rheumatoid factor quantitative
|
$162.00 |
$162.00 |
$162.00 |
$56.55
|
|
Rho(d) immune globulin 1,500 unit (300 mcg)/2 ml injection syringe
|
$740.97 |
$740.97 |
$740.97 |
$247.55
|
|
Rifampin in ns IV syringe 3 mg/ml (neo/ped) - cnr
|
$3,028.00 |
$3,028.00 |
$3,028.00 |
$459.00
|
|
Russell viper venom diluted
|
$711.00 |
$711.00 |
$711.00 |
$68.64
|
|
Screening prostate cancer PSA
|
$608.81 |
$608.81 |
$608.81 |
$98.28
|
|
Set radiation therapy field
|
$3,603.63 |
$3,603.63 |
$3,603.63 |
$731.50
|
|
Set radiation therapy field
|
$7,796.64 |
$7,796.64 |
$7,796.64 |
$1,590.00
|
|
Sickling rbc
|
$85.00 |
$85.00 |
$85.00 |
$54.00
|
|
Sildenafil citrate, 25 mg
|
$89.96 |
$89.96 |
$89.96 |
$182.99
|
|
Sincalide 5 mcg solution for injection
|
$1,032.65 |
$1,032.65 |
$1,032.65 |
$309.14
|
|
Sinus/juglr venogram s&i
|
$4,820.74 |
$4,820.74 |
$4,820.74 |
$2,517.48
|
|
Skeletal muscle relaxant 1/2
|
$138.60 |
$138.60 |
$138.60 |
$80.08
|
|
Skyla, 13.5 mg
|
$4,943.39 |
$4,943.39 |
$4,943.39 |
$1,643.47
|
|
Sleep Study (Polysomnography)
|
$11,846.61 |
$11,846.61 |
$11,846.61 |
$3,659.20
|
|
Sleep study unattended
|
$567.91 |
$567.91 |
$567.91 |
$576.54
|
|
Smear special stain inclusion bodies/parasites
|
$283.00 |
$283.00 |
$283.00 |
$68.85
|
|
Sodium 24 hour urine
|
$203.00 |
$203.00 |
$203.00 |
$48.60
|
|
Sodium chloride 0.9 % intravenous solution
|
$427.30 |
$427.30 |
$427.30 |
$48.00
|
|
Sodium chloride 0.9 % IV bolus
|
$342.73 |
$342.73 |
$342.73 |
$44.34
|
|
Sodium ferric gluconate complex in sucrose 62.5 mg/5 ml intravenous
|
$187.09 |
$187.09 |
$187.09 |
$77.77
|
|
Sodium thiosulfate 12.5 gram/50 ml (250 mg/ml) intravenous solution
|
$518.94 |
$518.94 |
$518.94 |
$177.52
|
|
Special physics consult
|
$4,810.29 |
$4,810.29 |
$4,810.29 |
$702.24
|
|
Special radiation dosimetry
|
$1,327.28 |
$1,327.28 |
$1,327.28 |
$392.50
|
|
Special radiation treatment
|
$6,000.64 |
$6,000.64 |
$6,000.64 |
$1,932.96
|
|
Special teletx port plan
|
$6,000.64 |
$6,000.64 |
$6,000.64 |
$1,050.06
|
|
Specific gravity body fluid
|
$44.00 |
$44.00 |
$44.00 |
$21.55
|
|
Spirometry bronchodilation responsiveness pre/post bronchodilator administration
|
$1,905.98 |
$1,905.98 |
$1,905.98 |
$536.34
|
|
Srs linear based
|
$35,047.03 |
$35,047.03 |
$35,047.03 |
$14,124.25
|
|
St analysis behavior qualitative voice/resonance
|
$852.99 |
$852.99 |
$852.99 |
$295.10
|
|
St evaluate speech sound production
|
$877.73 |
$877.73 |
$877.73 |
$288.75
|
|
St evaluate speech sound production comprehensive/expressive
|
$1,071.40 |
$1,071.40 |
$1,071.40 |
$376.84
|
|
St evaluation motion fluoroscopic swallow function cine/video
|
$1,425.82 |
$1,425.82 |
$1,425.82 |
$373.50
|
|
St evaluation swallow function
|
$852.99 |
$852.99 |
$852.99 |
$311.36
|
|
St treatment speech individual
|
$632.52 |
$632.52 |
$632.52 |
$253.80
|
|
St treatment swallow dysfunction/oral
|
$632.52 |
$632.52 |
$632.52 |
$245.50
|
|
Succinylcholine chloride 20 mg/ml injection solution (wrapper)
|
$20.58 |
$20.58 |
$20.58 |
$50.22
|
|
Sulfamethoxazole 400 mg-trimethoprim 80 mg/5 ml intravenous solution
|
$182.27 |
$182.27 |
$182.27 |
$82.46
|
|
Sumatriptan 6 mg/0.5 ml subcutaneous solution
|
$1,655.15 |
$1,655.15 |
$1,655.15 |
$123.58
|
|
Surgical pathology level 1 gross examination only
|
$71.38 |
$71.38 |
$71.38 |
$80.60
|
|
Surgical pathology level 2 gross & microscopic examination
|
$144.84 |
$144.84 |
$144.84 |
$146.30
|
|
Surgical pathology level 3 gross & microscopic examination
|
$149.02 |
$149.02 |
$149.02 |
$184.50
|
|
Surgical pathology level 4 gross & microscopic examination
|
$114.00 |
$114.00 |
$114.00 |
$250.20
|
|
Surgical pathology level 5 gross & microscopic examination
|
$451.34 |
$451.34 |
$451.34 |
$489.00
|
|
Surgical pathology level 6 gross & microscopic examination
|
$627.69 |
$627.69 |
$627.69 |
$730.20
|
|
Susceptibility enzyme detection per enzyme
|
$86.40 |
$86.40 |
$86.40 |
$35.10
|
|
Suscept studies macrobroth dilution ea
|
$1,318.00 |
$1,318.00 |
$1,318.00 |
$59.28
|
|
Svc venogram s&i
|
$70.00 |
$70.00 |
$70.00 |
$1,934.62
|
|
T3 (triiodothyronine) free
|
$136.00 |
$136.00 |
$136.00 |
$99.20
|
|
T3 (triiodothyronine) total
|
$176.00 |
$176.00 |
$176.00 |
$93.52
|
|
T4 (thyroxine) total
|
$556.00 |
$556.00 |
$556.00 |
$67.80
|
|
Tacrolimus therapeutic drug level
|
$214.00 |
$214.00 |
$214.00 |
$120.60
|
|
Tamoxifen 10 mg tabs 60 each bottle
|
$38.32 |
$38.32 |
$38.32 |
$14.62
|
|
Target gsa panel hmtlmph neop
|
$4,983.00 |
$4,983.00 |
$4,983.00 |
$2,160.00
|
|
Tb test cell mediated immunity antigen response enumeration gamma interferon t-cells
|
$60.47 |
$60.47 |
$60.47 |
$194.35
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$352.00 |
$352.00 |
$352.00 |
$175.00
|
|
Tc-99m exametazime diag
|
$8,569.33 |
$8,569.33 |
$8,569.33 |
$2,033.20
|
|
Tc-99m labeled rbc
|
$302.73 |
$302.73 |
$302.73 |
$302.40
|
|
Tc-99m maa
|
$1,541.72 |
$1,541.72 |
$1,541.72 |
$283.41
|
|
Tc-99m mebrofenin
|
$1,541.72 |
$1,541.72 |
$1,541.72 |
$160.58
|
|
Tc-99m medronate
|
$1,541.72 |
$1,541.72 |
$1,541.72 |
$109.50
|
|
Tc-99m mertiatide
|
$1,275.77 |
$1,275.77 |
$1,275.77 |
$756.00
|
|
Tc-99m oxidronate
|
$184.38 |
$184.38 |
$184.38 |
$105.30
|
|
Tc-99m pentetate dtpa aerosol
|
$3,527.79 |
$3,527.79 |
$3,527.79 |
$181.37
|
|
Tc-99m pertechnetate per mci
|
$164.33 |
$164.33 |
$164.33 |
$27.20
|
