|
Special physics consult
|
$641.85 |
$641.85 |
$641.85 |
$700.74
|
|
Special radiation dosimetry
|
$701.40 |
$701.40 |
$701.40 |
$445.50
|
|
Specific gravity body fluid
|
$5.40 |
$5.40 |
$5.40 |
$23.63
|
|
Spirometry bronchodilation responsiveness pre/post bronchodilator administration
|
$3,470.65 |
$3,470.65 |
$3,470.65 |
$559.96
|
|
Splint extn xsm w sof-stretch rolyan
|
$2,325.00 |
$2,325.00 |
$2,325.00 |
$41.58
|
|
Sr-89 stront chlor ther / mci
|
$14,489.45 |
$14,489.45 |
$14,489.45 |
$4,588.65
|
|
St cognitve performance testing healthcare professional each hour
|
$637.30 |
$637.30 |
$637.30 |
$313.96
|
|
St evaluation motion fluoroscopic swallow function cine/video
|
$2,821.40 |
$2,821.40 |
$2,821.40 |
$406.40
|
|
Strep b assay w/optic
|
$377.75 |
$377.75 |
$377.75 |
$32.00
|
|
Streptomycin injection
|
$211.00 |
$211.00 |
$211.00 |
$100.00
|
|
Stress test pulmonary
|
$560.00 |
$560.00 |
$560.00 |
$327.20
|
|
Sulfamethoxazole 400 mg-trimethoprim 80 mg/5 ml intravenous solution
|
$118.80 |
$118.80 |
$118.80 |
$71.09
|
|
Surgical pathology level 1 gross examination only
|
$170.70 |
$170.70 |
$170.70 |
$92.59
|
|
Surgical pathology level 2 gross & microscopic examination
|
$2,094.60 |
$2,094.60 |
$2,094.60 |
$149.76
|
|
Surgical pathology level 3 gross & microscopic examination
|
$2,949.45 |
$2,949.45 |
$2,949.45 |
$192.00
|
|
Surgical pathology level 5 gross & microscopic examination
|
$7,637.60 |
$7,637.60 |
$7,637.60 |
$494.00
|
|
Surgical pathology level 6 gross & microscopic examination
|
$7,526.70 |
$7,526.70 |
$7,526.70 |
$790.00
|
|
Susceptibility enzyme detection per enzyme
|
$1,628.15 |
$1,628.15 |
$1,628.15 |
$34.48
|
|
Suscept studies macrobroth dilution ea
|
$21.50 |
$21.50 |
$21.50 |
$48.30
|
|
Svc venogram s&i
|
$12,077.60 |
$12,077.60 |
$12,077.60 |
$1,908.00
|
|
Sweat collection by iontophoresis
|
$1,009.05 |
$1,009.05 |
$1,009.05 |
$105.21
|
|
T3 (triiodothyronine) total
|
$147.25 |
$147.25 |
$147.25 |
$94.90
|
|
Tacrolimus 5 mg/ml intravenous solution
|
$857.00 |
$857.00 |
$857.00 |
$612.11
|
|
Tacrolimus therapeutic drug level
|
$143.35 |
$143.35 |
$143.35 |
$122.40
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$610.15 |
$610.15 |
$610.15 |
$166.46
|
|
Tc-99m exame autol wbc diag per dose
|
$11,513.10 |
$11,513.10 |
$11,513.10 |
$2,393.40
|
|
Tc-99m exametazime diag
|
$11,513.75 |
$11,513.75 |
$11,513.75 |
$2,166.26
|
|
Tc-99m labeled rbc
|
$2,001.60 |
$2,001.60 |
$2,001.60 |
$323.01
|
|
Tc-99m maa
|
$1,521.50 |
$1,521.50 |
$1,521.50 |
$312.06
|
|
Tc-99m mebrofenin
|
$2,418.60 |
$2,418.60 |
$2,418.60 |
$169.53
|
|
Tc-99m medronate
|
$198.35 |
$198.35 |
$198.35 |
$122.46
|
|
Tc-99m mertiatide
|
$5,808.20 |
$5,808.20 |
$5,808.20 |
$757.25
|
|
Tc-99m pentetate dtpa
|
$184.00 |
$184.00 |
$184.00 |
$245.85
|
|
Tc-99m pentetate dtpa aerosol
|
$550.80 |
$550.80 |
$550.80 |
$244.02
|
|
Tc-99m pertechnetate per mci
|
$325.75 |
$325.75 |
$325.75 |
$28.08
|
|
Tc-99m sestamibi p study dose
|
$1,104.45 |
$1,104.45 |
$1,104.45 |
$221.60
|
|
Tc-99m sulfur colloid
|
$825.75 |
$825.75 |
$825.75 |
$245.70
|
|
Tc-99m tetrofosmin p study dose
|
$575.90 |
$575.90 |
$575.90 |
$198.05
|
|
T cells absolute cd 4 count
|
$45.65 |
$45.65 |
$45.65 |
$120.25
|
|
T cells total count
|
$25.75 |
$25.75 |
$25.75 |
$124.11
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$22,457.00 |
$22,457.00 |
$22,457.00 |
$17,652.73
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$159.00 |
$159.00 |
$159.00 |
$44.49
|
|
Test for porphobilinogen
|
$7.70 |
$7.70 |
$7.70 |
$33.57
|
|
Testicular imaging w/vasc flow
|
$1,497.30 |
$1,497.30 |
$1,497.30 |
$780.48
|
|
Test stress cardiovascular tracing only
|
$8,288.10 |
$8,288.10 |
$8,288.10 |
$1,001.55
|
|
Tetanus immune globulin inj
|
$1,419.00 |
$1,419.00 |
$1,419.00 |
$1,395.20
|
|
Theophylline therapeutic drug level
|
$876.95 |
$876.95 |
$876.95 |
$108.00
|
|
Therapy nutrition individual initial f2f w/patient each 15 minutes
|
$99.00 |
$99.00 |
$99.00 |
$55.00
|
|
Ther/proph/diag inj ia
|
$229.55 |
$229.55 |
$229.55 |
$247.33
|
|
Thyroid imaging
|
$14,047.35 |
$14,047.35 |
$14,047.35 |
$670.80
|
|
Thyroid (TSH) Test
|
$2,798.35 |
$2,798.35 |
$2,798.35 |
$120.00
|
|
Thyroxine binding globulin (tbg)
|
$11.40 |
$11.40 |
$11.40 |
$63.60
|
|
Tigecycline injection
|
$962.00 |
$962.00 |
$962.00 |
$308.75
|
|
Tilt table study
|
$1,404.00 |
$1,404.00 |
$1,404.00 |
$1,495.00
|
|
Tissue culture skin/biopsy
|
$632.25 |
$632.25 |
$632.25 |
$558.87
|
|
Tissue culture tumor
|
$662.75 |
$662.75 |
$662.75 |
$529.23
|
|
Tissue exam koh skin/hair/nails
|
$973.05 |
$973.05 |
$973.05 |
$47.40
|
|
Tl-201 thallium diag per mci
|
$1,197.15 |
$1,197.15 |
$1,197.15 |
$77.22
|
|
Tomosynthesis breast diagnostic left
|
$511.40 |
$511.40 |
$511.40 |
$63.70
|
|
Tomosynthesis breast screen bilateral
|
$368.25 |
$368.25 |
$368.25 |
$73.45
|
|
Topotecan 4 mg/4 ml (1 mg/ml) intravenous solution
|
$8,756.00 |
$8,756.00 |
$8,756.00 |
$303.88
|
|
Toxoplasma antibody igg
|
$148.50 |
$148.50 |
$148.50 |
$84.35
|
|
Toxoplasma antibody igm
|
$148.50 |
$148.50 |
$148.50 |
$83.20
|
|
Training self management diabetes individual outpatient department per 30 minutes
|
$99.00 |
$99.00 |
$99.00 |
$93.75
|
|
Tranexamic acid 1,000 mg/10 ml (100 mg/ml) intravenous solution
|
$401.15 |
$401.15 |
$401.15 |
$82.60
|
|
Transcatheter bx s&i
|
$19,947.90 |
$19,947.90 |
$19,947.90 |
$1,875.96
|
|
Transferrin
|
$299.60 |
$299.60 |
$299.60 |
$87.30
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$137.90 |
$137.90 |
$137.90 |
$241.15
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$137.90 |
$137.90 |
$137.90 |
$149.00
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$194.00 |
$194.00 |
$194.00 |
$48.22
|
|
Trichomonas assay w/optic
|
$56.70 |
$56.70 |
$56.70 |
$66.00
|
|
#tricyclicantidprssnt
|
$134.35 |
$134.35 |
$134.35 |
$57.08
|
|
Tx atrial fib pulm vein isol
|
$95,840.65 |
$95,840.65 |
$95,840.65 |
$32,426.20
|
|
Tx l/r atrial fib addl
|
$5,735.10 |
$5,735.10 |
$5,735.10 |
$7,717.80
|
|
Ultrasound encephalogram
|
$4,807.10 |
$4,807.10 |
$4,807.10 |
$481.60
|
|
Ultrasound guide intraoperative
|
$3,987.55 |
$3,987.55 |
$3,987.55 |
$632.90
|
|
Ultrasound guide tissue ablation
|
$2,572.00 |
$2,572.00 |
$2,572.00 |
$498.40
|
|
Ultrasound ob >=14wks ea addl gest
|
$489.65 |
$489.65 |
$489.65 |
$454.11
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$8,167.00 |
$8,167.00 |
$8,167.00 |
$690.48
|
|
Ultrasound transabd ea addl gest
|
$489.65 |
$489.65 |
$489.65 |
$425.10
|
|
Unlisted fluoroscopic px
|
$976.30 |
$976.30 |
$976.30 |
$324.85
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$20,154.35 |
$20,154.35 |
$20,154.35 |
$2,916.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$14,562.70 |
$14,562.70 |
$14,562.70 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$13,999.75 |
$13,999.75 |
$13,999.75 |
$2,013.08
|
|
Urea nitrogen
|
$16.70 |
$16.70 |
$16.70 |
$45.10
|
|
Urea nitrogen 24 hour urine
|
$1,032.50 |
$1,032.50 |
$1,032.50 |
$50.00
|
|
Ureteral reflux study
|
$16,558.35 |
$16,558.35 |
$16,558.35 |
$961.20
|
|
Urethrcystgrphy rtrgrde s&i
|
$4,989.10 |
$4,989.10 |
$4,989.10 |
$574.40
|
|
Urethrocystography void s&i
|
$7,187.65 |
$7,187.65 |
$7,187.65 |
$634.50
|
|
Uric acid blood
|
$377.75 |
$377.75 |
$377.75 |
$46.64
|
|
Urinalysis qual/semiquant excpt ia
|
$1,183.65 |
$1,183.65 |
$1,183.65 |
$25.72
|
|
Urinalysis (with microscopy)
|
$1,582.85 |
$1,582.85 |
$1,582.85 |
$48.14
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$7,416.00 |
$7,416.00 |
$7,416.00 |
$6,892.54
|
|
Vaccine dtap < 7 years im
|
$649.60 |
$649.60 |
$649.60 |
$87.80
|
|
Vaccine dtap-hep b-ipv im
|
$1,077.25 |
$1,077.25 |
$1,077.25 |
$193.83
|
|
Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im
|
$104.00 |
$104.00 |
$104.00 |
$85.00
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$1,573.00 |
$1,573.00 |
$1,573.00 |
$45.33
|
|
Vaccine influenza nos 0.5ml dose im
|
$50.00 |
$50.00 |
$50.00 |
$36.80
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$81.00 |
$81.00 |
$81.00 |
$48.29
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im
|
$90.00 |
$90.00 |
$90.00 |
$40.01
|
