|
Spirometry bronchodilation responsiveness pre/post bronchodilator administration
|
$1,490.92 |
$1,490.92 |
$1,490.92 |
$559.96
|
|
St analysis behavior qualitative voice/resonance
|
$157.53 |
$157.53 |
$157.53 |
$300.00
|
|
St evaluate speech sound production
|
$157.53 |
$157.53 |
$157.53 |
$300.00
|
|
St evaluate speech sound production comprehensive/expressive
|
$157.53 |
$157.53 |
$157.53 |
$393.00
|
|
St evaluation motion fluoroscopic swallow function cine/video
|
$1,069.65 |
$1,069.65 |
$1,069.65 |
$406.40
|
|
St evaluation swallow function
|
$658.76 |
$658.76 |
$658.76 |
$336.60
|
|
Streptomycin injection
|
$97.20 |
$97.20 |
$97.20 |
$100.00
|
|
Stress test pulmonary
|
$665.97 |
$665.97 |
$665.97 |
$327.20
|
|
St treatment speech individual
|
$406.49 |
$406.49 |
$406.49 |
$254.15
|
|
St treatment swallow dysfunction/oral
|
$489.11 |
$489.11 |
$489.11 |
$261.60
|
|
Succinylcholine chloride 20 mg/ml injection solution (wrapper)
|
$97.20 |
$97.20 |
$97.20 |
$49.13
|
|
Sugars single quant
|
$26.37 |
$26.37 |
$26.37 |
$52.47
|
|
Sumatriptan 6 mg/0.5 ml subcutaneous solution
|
$1,010.88 |
$1,010.88 |
$1,010.88 |
$91.67
|
|
Susceptibility mic per plate
|
$177.73 |
$177.73 |
$177.73 |
$94.38
|
|
Svc venogram s&i
|
$4,689.96 |
$4,689.96 |
$4,689.96 |
$1,908.00
|
|
Tacrolimus 5 mg/ml intravenous solution
|
$1,292.76 |
$1,292.76 |
$1,292.76 |
$612.11
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$52.82 |
$52.82 |
$52.82 |
$166.46
|
|
Tc-99m bicisate
|
$13,978.20 |
$13,978.20 |
$13,978.20 |
$1,969.45
|
|
Tc-99m depreotide
|
$22,706.18 |
$22,706.18 |
$22,706.18 |
$1,937.35
|
|
Tc-99m exametazime diag
|
$9,148.79 |
$9,148.79 |
$9,148.79 |
$2,166.26
|
|
Tc-99m labeled rbc
|
$1,472.84 |
$1,472.84 |
$1,472.84 |
$323.01
|
|
Tc-99m maa
|
$928.65 |
$928.65 |
$928.65 |
$312.06
|
|
Tc-99m mebrofenin
|
$928.65 |
$928.65 |
$928.65 |
$169.53
|
|
Tc-99m medronate
|
$340.39 |
$340.39 |
$340.39 |
$122.46
|
|
Tc-99m mertiatide
|
$4,511.05 |
$4,511.05 |
$4,511.05 |
$757.25
|
|
Tc-99m pentetate dtpa
|
$928.65 |
$928.65 |
$928.65 |
$245.85
|
|
Tc-99m pertechnetate per mci
|
$31.95 |
$31.95 |
$31.95 |
$28.08
|
|
Tc-99m sestamibi p study dose
|
$3,524.02 |
$3,524.02 |
$3,524.02 |
$221.60
|
|
Tc-99m succimer (dmsa)
|
$2,804.67 |
$2,804.67 |
$2,804.67 |
$1,578.33
|
|
Tc-99m sulfur colloid
|
$589.36 |
$589.36 |
$589.36 |
$245.70
|
|
T cells absolute cd 4 count
|
$162.43 |
$162.43 |
$162.43 |
$120.25
|
|
T cells total count
|
$30.66 |
$30.66 |
$30.66 |
$124.11
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$16,288.56 |
$16,288.56 |
$16,288.56 |
$17,652.73
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$64.80 |
$64.80 |
$64.80 |
$44.49
|
|
Testicular imaging w/vasc flow
|
$8,810.60 |
$8,810.60 |
$8,810.60 |
$780.48
|
|
Tetanus immune globulin inj
|
$1,301.40 |
$1,301.40 |
$1,301.40 |
$1,395.20
|
|
Theophylline therapeutic drug level
|
$145.95 |
$145.95 |
$145.95 |
$108.00
|
|
Therapy nutrition individual initial f2f w/patient each 15 minutes
|
$327.89 |
$327.89 |
$327.89 |
$55.00
|
|
Therapy nutrition individual reassessment/intervention f2f w/patient each 15 minutes
|
$162.76 |
$162.76 |
$162.76 |
$50.40
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$50.76 |
$50.76 |
$50.76 |
$38.64
|
|
Thyroid imaging
|
$1,074.06 |
$1,074.06 |
$1,074.06 |
$670.80
|
|
Thyroid mets imag whole body
|
$12,481.13 |
$12,481.13 |
$12,481.13 |
$1,524.99
|
|
Thyroid Ultrasound
|
$4,030.88 |
$4,030.88 |
$4,030.88 |
$589.96
|
|
Thyroid uptake measurement
|
$2,999.66 |
$2,999.66 |
$2,999.66 |
$653.60
|
|
Thyroxine binding globulin (tbg)
|
$13.53 |
$13.53 |
$13.53 |
$63.60
|
|
Tigecycline injection
|
$581.04 |
$581.04 |
$581.04 |
$308.75
|
|
Tissue culture placenta
|
$171.84 |
$171.84 |
$171.84 |
$520.91
|
|
Tissue culture skin/biopsy
|
$373.11 |
$373.11 |
$373.11 |
$558.87
|
|
Tissue culture tumor
|
$172.15 |
$172.15 |
$172.15 |
$529.23
|
|
Tissue exam koh skin/hair/nails
|
$258.94 |
$258.94 |
$258.94 |
$47.40
|
|
Tl-201 thallium diag per mci
|
$838.32 |
$838.32 |
$838.32 |
$77.22
|
|
Topotecan 4 mg/4 ml (1 mg/ml) intravenous solution
|
$5,299.56 |
$5,299.56 |
$5,299.56 |
$303.88
|
|
Tranexamic acid 1,000 mg/10 ml (100 mg/ml) intravenous solution
|
$11.09 |
$11.09 |
$11.09 |
$82.60
|
|
Transcatheter bx s&i
|
$6,848.28 |
$6,848.28 |
$6,848.28 |
$1,875.96
|
|
Trastuzumab 150 mg intravenous solution
|
$328.32 |
$328.32 |
$328.32 |
$3,401.26
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$518.85 |
$518.85 |
$518.85 |
$241.15
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$391.07 |
$391.07 |
$391.07 |
$149.00
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$71.28 |
$71.28 |
$71.28 |
$48.22
|
|
Trichinella antibody
|
$107.21 |
$107.21 |
$107.21 |
$70.65
|
|
Trichomonas assay w/optic
|
$67.28 |
$67.28 |
$67.28 |
$66.00
|
|
Trimethobenzamide hcl inj
|
$100.44 |
$100.44 |
$100.44 |
$154.09
|
|
Tube drain vert dev st 5-40f
|
$385.69 |
$385.69 |
$385.69 |
$72.21
|
|
Tx atrial fib pulm vein isol
|
$99,585.74 |
$99,585.74 |
$99,585.74 |
$32,426.20
|
|
Tx l/r atrial fib addl
|
$33,197.82 |
$33,197.82 |
$33,197.82 |
$7,717.80
|
|
Ultrasound abdomen aorta screening study aaa
|
$705.67 |
$705.67 |
$705.67 |
$403.26
|
|
Ultrasound chest
|
$957.53 |
$957.53 |
$957.53 |
$459.55
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$788.83 |
$788.83 |
$788.83 |
$340.14
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$1,147.61 |
$1,147.61 |
$1,147.61 |
$477.88
|
|
Ultrasound guide intraoperative
|
$3,970.30 |
$3,970.30 |
$3,970.30 |
$632.90
|
|
Ultrasound joint complete left
|
$1,651.32 |
$1,651.32 |
$1,651.32 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$1,553.90 |
$1,553.90 |
$1,553.90 |
$448.50
|
|
Ultrasound ob >=14wks ea addl gest
|
$3,822.98 |
$3,822.98 |
$3,822.98 |
$454.11
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$622.51 |
$622.51 |
$622.51 |
$326.54
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$788.83 |
$788.83 |
$788.83 |
$690.48
|
|
Ultrasound pregnant uterus follow up per fetus
|
$1,416.10 |
$1,416.10 |
$1,416.10 |
$450.75
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$1,928.12 |
$1,928.12 |
$1,928.12 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$4,155.62 |
$4,155.62 |
$4,155.62 |
$485.48
|
|
Ultrasound prostate/transrectal
|
$2,972.38 |
$2,972.38 |
$2,972.38 |
$545.16
|
|
Ultrasound retroperitoneal limited
|
$1,553.90 |
$1,553.90 |
$1,553.90 |
$498.00
|
|
Ultrasound scrotum and contents
|
$4,279.18 |
$4,279.18 |
$4,279.18 |
$617.28
|
|
Ultrasound spinal canal and contents
|
$4,420.55 |
$4,420.55 |
$4,420.55 |
$450.60
|
|
Ultrasound transabd ea addl gest
|
$788.83 |
$788.83 |
$788.83 |
$425.10
|
|
Ultrasound transvaginal non obstetric
|
$4,155.62 |
$4,155.62 |
$4,155.62 |
$567.44
|
|
Unlisted mr procedure
|
$17,610.10 |
$17,610.10 |
$17,610.10 |
$1,032.20
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$20,423.66 |
$20,423.66 |
$20,423.66 |
$2,916.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$16,055.82 |
$16,055.82 |
$16,055.82 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$5,741.38 |
$5,741.38 |
$5,741.38 |
$2,013.08
|
|
Urea nitrogen 24 hour urine
|
$4.33 |
$4.33 |
$4.33 |
$50.00
|
|
Ureteral reflux study
|
$3,238.70 |
$3,238.70 |
$3,238.70 |
$961.20
|
|
Urethrcystgrphy rtrgrde s&i
|
$5,445.78 |
$5,445.78 |
$5,445.78 |
$574.40
|
|
Urethrocystography void s&i
|
$3,973.92 |
$3,973.92 |
$3,973.92 |
$634.50
|
|
Uric acid blood
|
$145.95 |
$145.95 |
$145.95 |
$46.64
|
|
Urinalysis qual/semiquant excpt ia
|
$36.49 |
$36.49 |
$36.49 |
$25.72
|
|
Urinalysis (with microscopy)
|
$211.86 |
$211.86 |
$211.86 |
$48.14
|
|
Urine Culture Test
|
$710.91 |
$710.91 |
$710.91 |
$84.81
|
|
Urine pregnancy test
|
$104.75 |
$104.75 |
$104.75 |
$66.40
|
|
Urography inf drip &/or bolus
|
$4,285.02 |
$4,285.02 |
$4,285.02 |
$641.69
|
|
Vaccine dtap < 7 years im
|
$171.72 |
$171.72 |
$171.72 |
$87.80
|
|
Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im
|
$124.20 |
$124.20 |
$124.20 |
$85.00
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$273.24 |
$273.24 |
$273.24 |
$45.33
|
