|
Renal venogram bil s&i
|
$14,283.52 |
$14,283.52 |
$14,283.52 |
$3,615.28
|
|
#resp virpnl dfa-adenovirus
|
$124.48 |
$124.48 |
$124.48 |
$48.00
|
|
Reticulocyte automated
|
$127.67 |
$127.67 |
$127.67 |
$54.60
|
|
Rheumatoid factor qualitative
|
$77.90 |
$77.90 |
$77.90 |
$54.60
|
|
Rho(d) immune globulin 1,500 unit (300 mcg)/2 ml injection syringe
|
$1,094.00 |
$1,094.00 |
$1,094.00 |
$255.26
|
|
Rho(d) immune globulin h, sd
|
$3,296.00 |
$3,296.00 |
$3,296.00 |
$2,034.31
|
|
Rho d immune globulin inj
|
$566.00 |
$566.00 |
$566.00 |
$334.53
|
|
Ring barrier skin cx 1 9/16 adapt
|
$34.00 |
$34.00 |
$34.00 |
$10.02
|
|
Risperidone microspheres 12.5 mg/2 ml inj
|
$2,951.00 |
$2,951.00 |
$2,951.00 |
$2,233.44
|
|
Rituximab-abbs 10 mg/ml intravenous solution
|
$717.78 |
$717.78 |
$717.78 |
$6,877.90
|
|
Rituximab-pvvr 10 mg/ml intravenous solution
|
$203.25 |
$203.25 |
$203.25 |
$7,582.77
|
|
Rotavirus antibody
|
$11.51 |
$11.51 |
$11.51 |
$38.40
|
|
Rozanolixizumab-noli 140 mg/ml subcutaneous solution
|
$18,150.00 |
$18,150.00 |
$18,150.00 |
$22.80
|
|
Rp loclzj tum 2+area 1+d img
|
$9,744.97 |
$9,744.97 |
$9,744.97 |
$1,458.95
|
|
Salivary gland function exam
|
$11,092.46 |
$11,092.46 |
$11,092.46 |
$549.70
|
|
Salmonella antibody
|
$24.00 |
$24.00 |
$24.00 |
$37.58
|
|
Sargramostim injection
|
$4,589.00 |
$4,589.00 |
$4,589.00 |
$451.34
|
|
Sarscov coronavirus ag ia
|
$91.15 |
$91.15 |
$91.15 |
$60.40
|
|
Screening Mammogram
|
$267.08 |
$267.08 |
$267.08 |
$303.55
|
|
Sc ther infusion reset pump
|
$694.01 |
$694.01 |
$694.01 |
$126.75
|
|
Sedimentation rate erythrocyte automated
|
$818.40 |
$818.40 |
$818.40 |
$44.20
|
|
Semen analysis w/count
|
$1,213.60 |
$1,213.60 |
$1,213.60 |
$56.44
|
|
Set radiation therapy field
|
$483.90 |
$483.90 |
$483.90 |
$731.50
|
|
Set radiation therapy field
|
$805.70 |
$805.70 |
$805.70 |
$1,102.40
|
|
Set radiation therapy field
|
$947.20 |
$947.20 |
$947.20 |
$1,636.36
|
|
Signal avg ecg w or without ecg 93278
|
$2,485.55 |
$2,485.55 |
$2,485.55 |
$309.52
|
|
Sincalide 5 mcg solution for injection
|
$1,065.00 |
$1,065.00 |
$1,065.00 |
$409.96
|
|
Sinus CT scan (with and without contrast)
|
$17,561.25 |
$17,561.25 |
$17,561.25 |
$1,815.00
|
|
Sinus CT scan (with contrast)
|
$16,377.69 |
$16,377.69 |
$16,377.69 |
$1,519.50
|
|
Sinus CT scan (without contrast)
|
$15,207.65 |
$15,207.65 |
$15,207.65 |
$1,279.50
|
|
Sinus/juglr venogram s&i
|
$12,617.13 |
$12,617.13 |
$12,617.13 |
$2,489.25
|
|
Sleep Study (Polysomnography)
|
$16,564.94 |
$16,564.94 |
$16,564.94 |
$3,936.80
|
|
Smear nasal eosinophil
|
$802.87 |
$802.87 |
$802.87 |
$49.50
|
|
Sodium 24 hour urine
|
$1,159.18 |
$1,159.18 |
$1,159.18 |
$48.50
|
|
Sodium chloride 0.9 % intravenous solution
|
$280.00 |
$280.00 |
$280.00 |
$46.43
|
|
Sodium chloride 0.9 % IV bolus
|
$280.00 |
$280.00 |
$280.00 |
$51.51
|
|
Sodium chloride 3 % ivpb
|
$48.07 |
$48.07 |
$48.07 |
$65.33
|
|
Sodium hyaluronate 20 mg/2 ml syringe
|
$491.66 |
$491.66 |
$491.66 |
$651.32
|
|
Sodium serum/plasma/whole blood
|
$1,159.18 |
$1,159.18 |
$1,159.18 |
$42.70
|
|
Somatosensory testing
|
$5,130.48 |
$5,130.48 |
$5,130.48 |
$583.80
|
|
Special radiation dosimetry
|
$388.80 |
$388.80 |
$388.80 |
$445.50
|
|
Special teletx port plan
|
$562.70 |
$562.70 |
$562.70 |
$1,046.65
|
|
Speech evaluation complex
|
$3,641.44 |
$3,641.44 |
$3,641.44 |
$527.06
|
|
Spirometry bronchodilation responsiveness pre/post bronchodilator administration
|
$358.66 |
$358.66 |
$358.66 |
$559.96
|
|
Splint rstrc wrst/cmc right med
|
$100.75 |
$100.75 |
$100.75 |
$73.11
|
|
Sr-89 stront chlor ther / mci
|
$8,385.01 |
$8,385.01 |
$8,385.01 |
$4,588.65
|
|
St analysis behavior qualitative voice/resonance
|
$710.75 |
$710.75 |
$710.75 |
$300.00
|
|
St cognitve performance testing healthcare professional each hour
|
$267.53 |
$267.53 |
$267.53 |
$313.96
|
|
Streptozocin injection
|
$1,860.00 |
$1,860.00 |
$1,860.00 |
$954.71
|
|
Stress test pulmonary
|
$960.49 |
$960.49 |
$960.49 |
$327.20
|
|
Succinylcholine chloride 20 mg/ml injection solution (wrapper)
|
$4.45 |
$4.45 |
$4.45 |
$49.13
|
|
Sugars single quant
|
$26.16 |
$26.16 |
$26.16 |
$52.47
|
|
Sumatriptan 6 mg/0.5 ml subcutaneous solution
|
$1,212.00 |
$1,212.00 |
$1,212.00 |
$91.67
|
|
Support clav 29.6-40.5in med
|
$107.43 |
$107.43 |
$107.43 |
$68.54
|
|
Surgical pathology level 1 gross examination only
|
$701.75 |
$701.75 |
$701.75 |
$92.59
|
|
Surgical pathology level 2 gross & microscopic examination
|
$802.87 |
$802.87 |
$802.87 |
$149.76
|
|
Surgical pathology level 3 gross & microscopic examination
|
$2,579.64 |
$2,579.64 |
$2,579.64 |
$192.00
|
|
Surgical pathology level 5 gross & microscopic examination
|
$5,229.38 |
$5,229.38 |
$5,229.38 |
$494.00
|
|
Surgical pathology level 6 gross & microscopic examination
|
$6,749.51 |
$6,749.51 |
$6,749.51 |
$790.00
|
|
Susceptibility agar dilution per agent
|
$7.84 |
$7.84 |
$7.84 |
$40.30
|
|
Tc-99m apcitide diag
|
$377.83 |
$377.83 |
$377.83 |
$1,765.30
|
|
Tc-99m bicisate
|
$4,728.89 |
$4,728.89 |
$4,728.89 |
$1,969.45
|
|
Tc-99m disofenin
|
$4,728.89 |
$4,728.89 |
$4,728.89 |
$151.32
|
|
Tc-99m exame autol wbc diag per dose
|
$13,245.73 |
$13,245.73 |
$13,245.73 |
$2,393.40
|
|
Tc-99m exametazime diag
|
$19,541.10 |
$19,541.10 |
$19,541.10 |
$2,166.26
|
|
Tc-99m labeled rbc
|
$4,728.89 |
$4,728.89 |
$4,728.89 |
$323.01
|
|
Tc-99m maa
|
$2,052.42 |
$2,052.42 |
$2,052.42 |
$312.06
|
|
Tc-99m mebrofenin
|
$947.01 |
$947.01 |
$947.01 |
$169.53
|
|
Tc-99m medronate
|
$232.88 |
$232.88 |
$232.88 |
$122.46
|
|
Tc-99m mertiatide
|
$4,621.79 |
$4,621.79 |
$4,621.79 |
$757.25
|
|
Tc-99m oxidronate
|
$215.91 |
$215.91 |
$215.91 |
$124.23
|
|
Tc-99m pentetate dtpa
|
$232.88 |
$232.88 |
$232.88 |
$245.85
|
|
Tc-99m pertechnetate per mci
|
$4,728.89 |
$4,728.89 |
$4,728.89 |
$28.08
|
|
Tc-99m pyroph diag per dose up to 25 mci
|
$232.88 |
$232.88 |
$232.88 |
$147.24
|
|
Tc-99m sestamibi p study dose
|
$3,378.22 |
$3,378.22 |
$3,378.22 |
$221.60
|
|
Tc-99m sulfur colloid
|
$754.53 |
$754.53 |
$754.53 |
$245.70
|
|
Tc-99m tetrofosmin p study dose
|
$4,728.89 |
$4,728.89 |
$4,728.89 |
$198.05
|
|
T cells absolute cd 4 count
|
$18.73 |
$18.73 |
$18.73 |
$120.25
|
|
T cells total count
|
$25.00 |
$25.00 |
$25.00 |
$124.11
|
|
Telavancin injection
|
$4,225.00 |
$4,225.00 |
$4,225.00 |
$1,216.45
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$20.00 |
$20.00 |
$20.00 |
$44.49
|
|
Test for porphobilinogen
|
$2.80 |
$2.80 |
$2.80 |
$33.57
|
|
Testicular imaging w/vasc flow
|
$10,126.90 |
$10,126.90 |
$10,126.90 |
$780.48
|
|
Tetanus immune globulin inj
|
$402.00 |
$402.00 |
$402.00 |
$1,395.20
|
|
Theophylline therapeutic drug level
|
$3,143.00 |
$3,143.00 |
$3,143.00 |
$108.00
|
|
Therapeutic procd strg endur
|
$235.73 |
$235.73 |
$235.73 |
$81.36
|
|
Ther nma rdctj intus/obstrcj
|
$5,086.10 |
$5,086.10 |
$5,086.10 |
$534.32
|
|
Ther/proph/diag inj ia
|
$664.27 |
$664.27 |
$664.27 |
$247.33
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$159.00 |
$159.00 |
$159.00 |
$38.64
|
|
Thyroid imaging
|
$7,627.42 |
$7,627.42 |
$7,627.42 |
$670.80
|
|
Thyroid mets imag whole body
|
$11,971.18 |
$11,971.18 |
$11,971.18 |
$1,524.99
|
|
Thyroid met uptake
|
$5,983.36 |
$5,983.36 |
$5,983.36 |
$380.00
|
|
Thyroid uptake measurement
|
$7,627.42 |
$7,627.42 |
$7,627.42 |
$653.60
|
|
Thyrotropin releasing hormone
|
$41.54 |
$41.54 |
$41.54 |
$55.45
|
|
Thyroxine binding globulin (tbg)
|
$8.68 |
$8.68 |
$8.68 |
$63.60
|
|
Tigecycline injection
|
$1,424.00 |
$1,424.00 |
$1,424.00 |
$308.75
|
|
Tissue culture tumor
|
$1,366.64 |
$1,366.64 |
$1,366.64 |
$529.23
|
|
Tissue exam koh skin/hair/nails
|
$722.05 |
$722.05 |
$722.05 |
$47.40
|
|
Tl-201 thallium diag per mci
|
$1,529.19 |
$1,529.19 |
$1,529.19 |
$77.22
|
|
Tomosynthesis breast diagnostic left
|
$68.43 |
$68.43 |
$68.43 |
$63.70
|
