|
St evaluation swallow function
|
$1,501.61 |
$1,501.61 |
$1,501.61 |
$336.60
|
|
Strapping of ankle and/or ft 29540
|
$438.02 |
$438.02 |
$438.02 |
$248.05
|
|
Strapping of knee
|
$438.02 |
$438.02 |
$438.02 |
$224.80
|
|
Strep b assay w/optic
|
$1,067.35 |
$1,067.35 |
$1,067.35 |
$32.00
|
|
St treatment speech individual
|
$1,375.77 |
$1,375.77 |
$1,375.77 |
$254.15
|
|
Succinylcholine chloride 20 mg/ml injection solution (wrapper)
|
$21.50 |
$21.50 |
$21.50 |
$49.13
|
|
Sugars single quant
|
$22.40 |
$22.40 |
$22.40 |
$52.47
|
|
Sumatriptan 6 mg/0.5 ml subcutaneous solution
|
$1,267.74 |
$1,267.74 |
$1,267.74 |
$91.67
|
|
Support clav 29.6-40.5in med
|
$48.58 |
$48.58 |
$48.58 |
$68.54
|
|
Surgical pathology level 1 gross examination only
|
$747.12 |
$747.12 |
$747.12 |
$92.59
|
|
Surgical pathology level 2 gross & microscopic examination
|
$2,640.25 |
$2,640.25 |
$2,640.25 |
$149.76
|
|
Surgical pathology level 3 gross & microscopic examination
|
$2,880.54 |
$2,880.54 |
$2,880.54 |
$192.00
|
|
Surgical pathology level 5 gross & microscopic examination
|
$3,366.21 |
$3,366.21 |
$3,366.21 |
$494.00
|
|
Surgical pathology level 6 gross & microscopic examination
|
$3,607.77 |
$3,607.77 |
$3,607.77 |
$790.00
|
|
Susceptibility agar dilution per agent
|
$705.66 |
$705.66 |
$705.66 |
$40.30
|
|
Susceptibility enzyme detection per enzyme
|
$36.81 |
$36.81 |
$36.81 |
$34.48
|
|
Svc venogram s&i
|
$16,531.02 |
$16,531.02 |
$16,531.02 |
$1,908.00
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$41.25 |
$41.25 |
$41.25 |
$166.46
|
|
Tc-99m disofenin
|
$827.64 |
$827.64 |
$827.64 |
$151.32
|
|
Tc-99m exame autol wbc diag per dose
|
$4,610.10 |
$4,610.10 |
$4,610.10 |
$2,393.40
|
|
Tc-99m exametazime diag
|
$17,019.86 |
$17,019.86 |
$17,019.86 |
$2,166.26
|
|
Tc-99m labeled rbc
|
$1,839.20 |
$1,839.20 |
$1,839.20 |
$323.01
|
|
Tc-99m maa
|
$1,154.34 |
$1,154.34 |
$1,154.34 |
$312.06
|
|
Tc-99m mebrofenin
|
$665.50 |
$665.50 |
$665.50 |
$169.53
|
|
Tc-99m medronate
|
$1,154.34 |
$1,154.34 |
$1,154.34 |
$122.46
|
|
Tc-99m mertiatide
|
$4,630.67 |
$4,630.67 |
$4,630.67 |
$757.25
|
|
Tc-99m pertechnetate per mci
|
$963.16 |
$963.16 |
$963.16 |
$28.08
|
|
Tc-99m sestamibi p study dose
|
$5,382.08 |
$5,382.08 |
$5,382.08 |
$221.60
|
|
Tc-99m sulfur colloid
|
$1,154.34 |
$1,154.34 |
$1,154.34 |
$245.70
|
|
Tc-99m tetrofosmin p study dose
|
$1,531.86 |
$1,531.86 |
$1,531.86 |
$198.05
|
|
T cells total count
|
$69.23 |
$69.23 |
$69.23 |
$124.11
|
|
Temozolomide
|
$1,218.04 |
$1,218.04 |
$1,218.04 |
$438.51
|
|
Temozolomide 100 mg intravenous solution
|
$5,508.85 |
$5,508.85 |
$5,508.85 |
$2,851.96
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$40.32 |
$40.32 |
$40.32 |
$44.49
|
|
Test for porphobilinogen
|
$2.80 |
$2.80 |
$2.80 |
$33.57
|
|
Testicular imaging w/vasc flow
|
$9,594.09 |
$9,594.09 |
$9,594.09 |
$780.48
|
|
Test stress cardiovascular tracing only
|
$6,628.09 |
$6,628.09 |
$6,628.09 |
$1,001.55
|
|
Test urine for porphyrins
|
$6.00 |
$6.00 |
$6.00 |
$27.30
|
|
Tetanus immune globulin inj
|
$3,672.88 |
$3,672.88 |
$3,672.88 |
$1,395.20
|
|
Theophylline therapeutic drug level
|
$938.33 |
$938.33 |
$938.33 |
$108.00
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$104.39 |
$104.39 |
$104.39 |
$38.64
|
|
Thyroglobulin antibody
|
$8.28 |
$8.28 |
$8.28 |
$84.00
|
|
Thyroid imaging
|
$6,448.09 |
$6,448.09 |
$6,448.09 |
$670.80
|
|
Thyroid mets imag whole body
|
$18,620.69 |
$18,620.69 |
$18,620.69 |
$1,524.99
|
|
Thyroid (TSH) Test
|
$1,517.05 |
$1,517.05 |
$1,517.05 |
$120.00
|
|
Thyroid Ultrasound
|
$5,505.50 |
$5,505.50 |
$5,505.50 |
$589.96
|
|
Thyroid uptake measurement
|
$8,892.29 |
$8,892.29 |
$8,892.29 |
$653.60
|
|
Thyroxine binding globulin (tbg)
|
$9.37 |
$9.37 |
$9.37 |
$63.60
|
|
Tigecycline injection
|
$879.23 |
$879.23 |
$879.23 |
$308.75
|
|
Tilt table study
|
$6,626.79 |
$6,626.79 |
$6,626.79 |
$1,495.00
|
|
Tissue culture skin/biopsy
|
$472.50 |
$472.50 |
$472.50 |
$558.87
|
|
Tissue culture tumor
|
$603.78 |
$603.78 |
$603.78 |
$529.23
|
|
Tissue exam koh skin/hair/nails
|
$673.93 |
$673.93 |
$673.93 |
$47.40
|
|
Tl-201 thallium diag per mci
|
$3,763.10 |
$3,763.10 |
$3,763.10 |
$77.22
|
|
Tomosynthesis breast diagnostic left
|
$166.98 |
$166.98 |
$166.98 |
$63.70
|
|
Tomosynthesis breast screen bilateral
|
$166.98 |
$166.98 |
$166.98 |
$73.45
|
|
Total tau
|
$208.33 |
$208.33 |
$208.33 |
$293.00
|
|
Tranexamic acid 1,000 mg/10 ml (100 mg/ml) intravenous solution
|
$19.50 |
$19.50 |
$19.50 |
$82.60
|
|
Transcatheter bx s&i
|
$3,878.05 |
$3,878.05 |
$3,878.05 |
$1,875.96
|
|
Trastuzumab 150 mg intravenous solution
|
$467.27 |
$467.27 |
$467.27 |
$3,401.26
|
|
Treponema pallidum antibody
|
$7.33 |
$7.33 |
$7.33 |
$72.80
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$343.51 |
$343.51 |
$343.51 |
$48.22
|
|
Trichinella antibody
|
$91.08 |
$91.08 |
$91.08 |
$70.65
|
|
Troponin quantitative
|
$1,292.42 |
$1,292.42 |
$1,292.42 |
$123.75
|
|
Tx atrial fib pulm vein isol
|
$154,851.88 |
$154,851.88 |
$154,851.88 |
$32,426.20
|
|
Tx l/r atrial fib addl
|
$41,539.26 |
$41,539.26 |
$41,539.26 |
$7,717.80
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$4,856.94 |
$4,856.94 |
$4,856.94 |
$340.14
|
|
Ultrasound encephalogram
|
$3,697.76 |
$3,697.76 |
$3,697.76 |
$481.60
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$6,425.10 |
$6,425.10 |
$6,425.10 |
$477.88
|
|
Ultrasound guidance for vascular access
|
$6,118.97 |
$6,118.97 |
$6,118.97 |
$340.22
|
|
Ultrasound guide tissue ablation
|
$8,736.20 |
$8,736.20 |
$8,736.20 |
$498.40
|
|
Ultrasound hips infant dynamic
|
$4,243.47 |
$4,243.47 |
$4,243.47 |
$403.00
|
|
Ultrasound infant hips ltd without stress
|
$4,243.47 |
$4,243.47 |
$4,243.47 |
$321.35
|
|
Ultrasound ob >=14wks ea addl gest
|
$6,667.10 |
$6,667.10 |
$6,667.10 |
$454.11
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$6,667.10 |
$6,667.10 |
$6,667.10 |
$690.48
|
|
Ultrasound pregnant uterus follow up per fetus
|
$5,895.12 |
$5,895.12 |
$5,895.12 |
$450.75
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$6,018.54 |
$6,018.54 |
$6,018.54 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$6,579.98 |
$6,579.98 |
$6,579.98 |
$485.48
|
|
Ultrasound scrotum and contents
|
$6,241.18 |
$6,241.18 |
$6,241.18 |
$617.28
|
|
Ultrasound transvaginal non obstetric
|
$6,579.98 |
$6,579.98 |
$6,579.98 |
$567.44
|
|
Unlisted ultrasound procedure
|
$5,294.96 |
$5,294.96 |
$5,294.96 |
$321.20
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$13,945.00 |
$13,945.00 |
$13,945.00 |
$2,916.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$7,538.00 |
$7,538.00 |
$7,538.00 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$12,087.00 |
$12,087.00 |
$12,087.00 |
$2,013.08
|
|
Ureteral reflux study
|
$5,332.47 |
$5,332.47 |
$5,332.47 |
$961.20
|
|
Urethrcystgrphy rtrgrde s&i
|
$6,935.72 |
$6,935.72 |
$6,935.72 |
$574.40
|
|
Urethrocystography void s&i
|
$5,322.79 |
$5,322.79 |
$5,322.79 |
$634.50
|
|
Uric acid blood
|
$467.89 |
$467.89 |
$467.89 |
$46.64
|
|
Urinalysis (with microscopy)
|
$947.64 |
$947.64 |
$947.64 |
$48.14
|
|
Urine Culture Test
|
$1,704.45 |
$1,704.45 |
$1,704.45 |
$84.81
|
|
Urine pregnancy test
|
$394.70 |
$394.70 |
$394.70 |
$66.40
|
|
Vaccine dtap-hep b-ipv im
|
$494.84 |
$494.84 |
$494.84 |
$193.83
|
|
Vaccine dtap-ipv/hib im
|
$405.14 |
$405.14 |
$405.14 |
$248.80
|
|
Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im
|
$209.34 |
$209.34 |
$209.34 |
$85.00
|
|
Vaccine hepatitis a (hepa) adult im
|
$92.50 |
$92.50 |
$92.50 |
$178.07
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im
|
$289.12 |
$289.12 |
$289.12 |
$84.38
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$139.67 |
$139.67 |
$139.67 |
$79.04
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.25ml dose im
|
$133.81 |
$133.81 |
$133.81 |
$26.40
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im
|
$163.16 |
$163.16 |
$163.16 |
$40.01
|
|
Vaccine mengingoccocal serogroup b 2 or 3 dose im
|
$587.90 |
$587.90 |
$587.90 |
$426.80
|
