|
Revasc evasc fpvt angio sf 1st
|
$2,405.84 |
$2,405.84 |
$2,405.84 |
$10,094.56
|
|
Revasc evasc fpvt athrec cplx 1st
|
$15,497.02 |
$15,497.02 |
$15,497.02 |
$29,423.20
|
|
Revasc evasc fpvt athrec sf 1st
|
$15,497.02 |
$15,497.02 |
$15,497.02 |
$25,206.69
|
|
Revasc evasc fpvt st athrec sf 1st
|
$7,748.51 |
$7,748.51 |
$7,748.51 |
$32,513.04
|
|
Revasc evasc fpvt stent cplx 1st
|
$4,879.54 |
$4,879.54 |
$4,879.54 |
$20,474.72
|
|
Revasc evasc fpvt stent sf 1st
|
$4,879.54 |
$4,879.54 |
$4,879.54 |
$20,474.72
|
|
Revasc evasc ivt angio cplx 1st
|
$4,811.68 |
$4,811.68 |
$4,811.68 |
$10,094.56
|
|
Revasc evasc ivt stent cplx 1st
|
$9,759.08 |
$9,759.08 |
$9,759.08 |
$20,474.72
|
|
Revasc evasc ivt stent sf 1st
|
$9,759.08 |
$9,759.08 |
$9,759.08 |
$20,474.72
|
|
Revasc evasc tpvt angio cplx 1st
|
$4,879.54 |
$4,879.54 |
$4,879.54 |
$20,474.72
|
|
Revasc evasc tpvt angio sf 1st
|
$4,879.54 |
$4,879.54 |
$4,879.54 |
$16,491.68
|
|
Revasc evasc tpvt athrec cplx 1st
|
$7,748.51 |
$7,748.51 |
$7,748.51 |
$31,546.50
|
|
Revasc evasc tpvt athrec sf 1st
|
$7,748.51 |
$7,748.51 |
$7,748.51 |
$26,819.25
|
|
Rheumatoid factor quantitative
|
$16.53 |
$16.53 |
$16.53 |
$57.00
|
|
Rho(d) immune globulin 1,500 unit (300 mcg)/2 ml injection syringe
|
$58.00 |
$58.00 |
$58.00 |
$243.11
|
|
Rho d immune globulin inj
|
$58.00 |
$58.00 |
$58.00 |
$217.71
|
|
Risankizumab-rzaa 60 mg/ml intravenous solution
|
$10,507.84 |
$10,507.84 |
$10,507.84 |
$30,071.50
|
|
Risperidone microspheres 12.5 mg/2 ml inj
|
$1,275.59 |
$1,275.59 |
$1,275.59 |
$2,429.37
|
|
Rituximab 10 mg/ml concentrate,intravenous
|
$4,642.73 |
$4,642.73 |
$4,642.73 |
$9,301.22
|
|
Rituximab 1,400 mg/11.7 ml (120 mg/ml)-hyaluronidase subcutaneous soln
|
$7,428.30 |
$7,428.30 |
$7,428.30 |
$15,057.18
|
|
Rituximab-abbs 10 mg/ml intravenous solution
|
$4,178.37 |
$4,178.37 |
$4,178.37 |
$5,343.99
|
|
Rituximab-arrx 10 mg/ml intravenous solution
|
$6,036.60 |
$6,036.60 |
$6,036.60 |
$6,287.16
|
|
Rituximab-pvvr 10 mg/ml intravenous solution
|
$6,036.60 |
$6,036.60 |
$6,036.60 |
$5,309.20
|
|
Rmvl icd by tv extr
|
$1,660.83 |
$1,660.83 |
$1,660.83 |
$4,306.60
|
|
Rmvl icd gen w/rplc icd gen dual lead sys
|
$8,355.77 |
$8,355.77 |
$8,355.77 |
$26,317.20
|
|
Rmvl icd gen w/rplc icd gen mlt lead sys
|
$8,355.77 |
$8,355.77 |
$8,355.77 |
$33,467.20
|
|
Rmvl icd gen w/rplc icd gen sgl lead sys
|
$8,355.77 |
$8,355.77 |
$8,355.77 |
$24,844.79
|
|
Rmvl icd pulse gen only
|
$1,660.83 |
$1,660.83 |
$1,660.83 |
$3,977.32
|
|
Rmvl ndwellg tun pleural cath
|
$278.69 |
$278.69 |
$278.69 |
$1,156.80
|
|
Rmvl perm pm pulse gen
|
$3,677.78 |
$3,677.78 |
$3,677.78 |
$6,094.40
|
|
Rmvl pm gen w/rplc pm gen mlt lead sys
|
$6,083.91 |
$6,083.91 |
$6,083.91 |
$14,929.60
|
|
Rmvl pm gen w/rplc pm gen sgl lead sys
|
$2,569.69 |
$2,569.69 |
$2,569.69 |
$10,542.00
|
|
Rmvl subq card rhythm mntr
|
$575.36 |
$575.36 |
$575.36 |
$1,734.00
|
|
Rmvl tv pm lead dual
|
$1,660.83 |
$1,660.83 |
$1,660.83 |
$4,028.20
|
|
Rmvl tv pm lead sgl
|
$1,660.83 |
$1,660.83 |
$1,660.83 |
$4,031.69
|
|
Romidepsin 10 mg/2 ml intravenous powder for solution
|
$2,893.02 |
$2,893.02 |
$2,893.02 |
$6,333.33
|
|
Romiplostim 125 mcg subcutaneous solution
|
$5,441.71 |
$5,441.71 |
$5,441.71 |
$8,950.11
|
|
Romosozumab-aqqg 105 mg/1.17 ml subcutaneous syringe (wrapper)
|
$1,299.11 |
$1,299.11 |
$1,299.11 |
$4,820.04
|
|
Ropivacaine 0.2 % epidural pca - 1 hour dose limit
|
$123.57 |
$123.57 |
$123.57 |
$188.50
|
|
Rotavirus antibody
|
$38.57 |
$38.57 |
$38.57 |
$125.01
|
|
Rpl non-tun cvc wo sbq prt/pmp
|
$338.43 |
$338.43 |
$338.43 |
$2,173.60
|
|
Rp loclzj tum 2+area 1+d img
|
$232.00 |
$232.00 |
$232.00 |
$1,310.00
|
|
Rpl picc wo subq port/pump incl image guidnc w/s&i
|
$338.43 |
$338.43 |
$338.43 |
$2,173.60
|
|
Rpl tun cvc wo subq port
|
$856.66 |
$856.66 |
$856.66 |
$3,687.00
|
|
Rsv assay w/optic
|
$33.35 |
$33.35 |
$33.35 |
$79.38
|
|
Rubella antibody igg
|
$17.69 |
$17.69 |
$17.69 |
$77.03
|
|
Rubeola antibody igg
|
$20.88 |
$20.88 |
$20.88 |
$80.00
|
|
Russell viper venom diluted
|
$33.06 |
$33.06 |
$33.06 |
$72.54
|
|
Sacituzumab govitecan-hziy 180 mg intravenous solution
|
$2,483.89 |
$2,483.89 |
$2,483.89 |
$5,174.32
|
|
Sargramostim injection
|
$244.62 |
$244.62 |
$244.62 |
$609.00
|
|
Sarscov coronavirus ag ia
|
$71.63 |
$71.63 |
$71.63 |
$59.25
|
|
Scan duplex abd/pelvis/retroperitoneal complete
|
$106.14 |
$106.14 |
$106.14 |
$983.50
|
|
Scan duplex abd/pelvis/retroperitoneal limited
|
$71.34 |
$71.34 |
$71.34 |
$662.00
|
|
Scan duplex aorta/ivc/iliac or bypass grafts complete
|
$106.14 |
$106.14 |
$106.14 |
$750.20
|
|
Scan duplex extracranial arteries unilateral/limited study
|
$56.55 |
$56.55 |
$56.55 |
$583.00
|
|
Scan duplex extremity veins unilateral/limited study
|
$126.44 |
$126.44 |
$126.44 |
$721.60
|
|
Scan duplex lower extremity arteries complete bilateral
|
$252.01 |
$252.01 |
$252.01 |
$985.20
|
|
Scan duplex lower extremity arteries unilateral/limited study left
|
$126.44 |
$126.44 |
$126.44 |
$660.00
|
|
Scan duplex upper extremity arteries unilateral/limited study left
|
$126.44 |
$126.44 |
$126.44 |
$595.35
|
|
Screening HIV antigen/antibody combination assay
|
$51.62 |
$51.62 |
$51.62 |
$42.30
|
|
Screening Mammogram
|
$67.86 |
$67.86 |
$67.86 |
$312.55
|
|
Screening prostate cancer PSA
|
$53.65 |
$53.65 |
$53.65 |
$100.63
|
|
Screw cortex 2.0 x 10mm
|
$19,032.70 |
$19,032.70 |
$19,032.70 |
$29,055.00
|
|
Sc ther infusion reset pump
|
$31.90 |
$31.90 |
$31.90 |
$140.15
|
|
Sec art mech thrmbc non-intracranial add-on
|
$1,012.39 |
$1,012.39 |
$1,012.39 |
$4,377.50
|
|
Sedimentation rate erythrocyte automated
|
$7.83 |
$7.83 |
$7.83 |
$42.00
|
|
Semen analysis presence/motility
|
$35.09 |
$35.09 |
$35.09 |
$71.05
|
|
Set radiation therapy field
|
$123.54 |
$123.54 |
$123.54 |
$762.40
|
|
Set radiation therapy field
|
$166.46 |
$166.46 |
$166.46 |
$1,157.38
|
|
Set radiation therapy field
|
$205.32 |
$205.32 |
$205.32 |
$1,636.36
|
|
Sewho erbs palsey design abd
|
$288.26 |
$288.26 |
$288.26 |
$988.40
|
|
Shoulder MRI (with and without contrast)
|
$787.35 |
$787.35 |
$787.35 |
$2,713.80
|
|
Shoulder MRI (with contrast)
|
$515.33 |
$515.33 |
$515.33 |
$2,448.60
|
|
Shoulder MRI (without contrast)
|
$513.01 |
$513.01 |
$513.01 |
$2,065.05
|
|
Shoulder X-ray
|
$126.73 |
$126.73 |
$126.73 |
$339.50
|
|
Sialography s&i
|
$109.33 |
$109.33 |
$109.33 |
$499.20
|
|
Sickling rbc
|
$40.02 |
$40.02 |
$40.02 |
$57.92
|
|
Sincalide 5 mcg solution for injection
|
$128.94 |
$128.94 |
$128.94 |
$307.58
|
|
Sinus CT scan (with and without contrast)
|
$501.70 |
$501.70 |
$501.70 |
$1,790.00
|
|
Sinus CT scan (with contrast)
|
$334.95 |
$334.95 |
$334.95 |
$1,527.60
|
|
Sinus CT scan (without contrast)
|
$334.95 |
$334.95 |
$334.95 |
$1,292.04
|
|
Sirolimus, oral
|
$10.18 |
$10.18 |
$10.18 |
$41.25
|
|
Skin test unlisted antigen ea
|
$27.55 |
$27.55 |
$27.55 |
$48.57
|
|
Sleeve fing rolyan med
|
$71.63 |
$71.63 |
$71.63 |
$203.58
|
|
Slp pure tone screening
|
$13.63 |
$13.63 |
$13.63 |
$60.48
|
|
Smear fluorescent and/or acid fast stain
|
$13.63 |
$13.63 |
$13.63 |
$64.20
|
|
Smear gram stain
|
$12.47 |
$12.47 |
$12.47 |
$55.25
|
|
Smear special stain inclusion bodies/parasites
|
$17.40 |
$17.40 |
$17.40 |
$73.15
|
|
Smear wet mount
|
$11.89 |
$11.89 |
$11.89 |
$67.49
|
|
Sodium 24 hour urine
|
$14.21 |
$14.21 |
$14.21 |
$48.60
|
|
Sodium ferric gluconate complex in sucrose 62.5 mg/5 ml intravenous
|
$18.01 |
$18.01 |
$18.01 |
$77.77
|
|
Sodium hyaluronate 20 mg/2 ml syringe
|
$234.44 |
$234.44 |
$234.44 |
$410.40
|
|
Sodium serum/plasma/whole blood
|
$13.92 |
$13.92 |
$13.92 |
$45.60
|
|
Sodium thiosulfate 12.5 gram/50 ml (250 mg/ml) intravenous solution
|
$181.22 |
$181.22 |
$181.22 |
$177.52
|
|
Somatropin injection
|
$802.84 |
$802.84 |
$802.84 |
$2,381.48
|
|
Special physics consult
|
$160.37 |
$160.37 |
$160.37 |
$725.00
|
|
Special radiation dosimetry
|
$64.96 |
$64.96 |
$64.96 |
$392.50
|
|
Special radiation treatment
|
$376.13 |
$376.13 |
$376.13 |
$1,986.00
|
|
Special teletx port plan
|
$192.27 |
$192.27 |
$192.27 |
$1,086.99
|
|
Specific gravity body fluid
|
$6.96 |
$6.96 |
$6.96 |
$22.00
|