|
Spirometry bronchodilation responsiveness pre/post bronchodilator administration
|
$1,502.82 |
$1,502.82 |
$1,502.82 |
$559.96
|
|
Split blood or products
|
$1,257.65 |
$1,257.65 |
$1,257.65 |
$148.98
|
|
St evaluation motion fluoroscopic swallow function cine/video
|
$1,854.93 |
$1,854.93 |
$1,854.93 |
$406.40
|
|
Strep a ag ia
|
$1,372.14 |
$1,372.14 |
$1,372.14 |
$75.40
|
|
Stress test pulmonary
|
$1,620.19 |
$1,620.19 |
$1,620.19 |
$327.20
|
|
Succinylcholine chloride 20 mg/ml injection solution (wrapper)
|
$142.74 |
$142.74 |
$142.74 |
$49.13
|
|
Sulfamethoxazole 400 mg-trimethoprim 80 mg/5 ml intravenous solution
|
$49.82 |
$49.82 |
$49.82 |
$71.09
|
|
Sumatriptan 6 mg/0.5 ml subcutaneous solution
|
$1,292.47 |
$1,292.47 |
$1,292.47 |
$91.67
|
|
Surgical pathology level 1 gross examination only
|
$1,681.90 |
$1,681.90 |
$1,681.90 |
$92.59
|
|
Surgical pathology level 2 gross & microscopic examination
|
$2,204.62 |
$2,204.62 |
$2,204.62 |
$149.76
|
|
Surgical pathology level 3 gross & microscopic examination
|
$2,802.36 |
$2,802.36 |
$2,802.36 |
$192.00
|
|
Surgical pathology level 5 gross & microscopic examination
|
$3,996.63 |
$3,996.63 |
$3,996.63 |
$494.00
|
|
Surgical pathology level 6 gross & microscopic examination
|
$4,594.37 |
$4,594.37 |
$4,594.37 |
$790.00
|
|
Susceptibility agar dilution per agent
|
$1,006.72 |
$1,006.72 |
$1,006.72 |
$40.30
|
|
Susceptibility enzyme detection per enzyme
|
$254.10 |
$254.10 |
$254.10 |
$34.48
|
|
T3 (triiodothyronine) total
|
$15.73 |
$15.73 |
$15.73 |
$94.90
|
|
T4 (thyroxine) total
|
$12.10 |
$12.10 |
$12.10 |
$73.64
|
|
Tacrolimus therapeutic drug level
|
$348.48 |
$348.48 |
$348.48 |
$122.40
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$40.00 |
$40.00 |
$40.00 |
$166.46
|
|
Tc-99m exame autol wbc diag per dose
|
$20,844.67 |
$20,844.67 |
$20,844.67 |
$2,393.40
|
|
Tc-99m exametazime diag
|
$22,410.41 |
$22,410.41 |
$22,410.41 |
$2,166.26
|
|
Tc-99m labeled rbc
|
$1,113.20 |
$1,113.20 |
$1,113.20 |
$323.01
|
|
Tc-99m maa
|
$1,115.62 |
$1,115.62 |
$1,115.62 |
$312.06
|
|
Tc-99m mebrofenin
|
$217.80 |
$217.80 |
$217.80 |
$169.53
|
|
Tc-99m medronate
|
$880.88 |
$880.88 |
$880.88 |
$122.46
|
|
Tc-99m oxidronate
|
$393.25 |
$393.25 |
$393.25 |
$124.23
|
|
Tc-99m pentetate dtpa aerosol
|
$186.34 |
$186.34 |
$186.34 |
$244.02
|
|
Tc-99m pertechnetate per mci
|
$41.14 |
$41.14 |
$41.14 |
$28.08
|
|
Tc-99m pyroph diag per dose up to 25 mci
|
$306.13 |
$306.13 |
$306.13 |
$147.24
|
|
Tc-99m sestamibi p study dose
|
$1,395.13 |
$1,395.13 |
$1,395.13 |
$221.60
|
|
Tc-99m sulfur colloid
|
$353.32 |
$353.32 |
$353.32 |
$245.70
|
|
T cells absolute cd4/cd8 including ratio
|
$162.14 |
$162.14 |
$162.14 |
$186.00
|
|
T cells absolute cd 4 count
|
$16.00 |
$16.00 |
$16.00 |
$120.25
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$28.35 |
$28.35 |
$28.35 |
$44.49
|
|
Test for chlorohydrocarbons
|
$61.09 |
$61.09 |
$61.09 |
$71.04
|
|
Test for urine cystines
|
$50.00 |
$50.00 |
$50.00 |
$26.00
|
|
Testicular imaging w/vasc flow
|
$3,822.39 |
$3,822.39 |
$3,822.39 |
$780.48
|
|
Test urine for porphyrins
|
$16.00 |
$16.00 |
$16.00 |
$27.30
|
|
Tetanus immune globulin inj
|
$1,741.76 |
$1,741.76 |
$1,741.76 |
$1,395.20
|
|
Theophylline therapeutic drug level
|
$1,938.42 |
$1,938.42 |
$1,938.42 |
$108.00
|
|
Therapeutic procd strg endur
|
$129.47 |
$129.47 |
$129.47 |
$81.36
|
|
Therapy nutrition individual initial f2f w/patient each 15 minutes
|
$58.08 |
$58.08 |
$58.08 |
$55.00
|
|
Therapy nutrition individual reassessment/intervention f2f w/patient each 15 minutes
|
$53.85 |
$53.85 |
$53.85 |
$50.40
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$74.05 |
$74.05 |
$74.05 |
$38.64
|
|
Thyroid imaging
|
$1,189.43 |
$1,189.43 |
$1,189.43 |
$670.80
|
|
Thyroid mets imag whole body
|
$7,903.72 |
$7,903.72 |
$7,903.72 |
$1,524.99
|
|
Thyroid uptake measurement
|
$2,526.48 |
$2,526.48 |
$2,526.48 |
$653.60
|
|
Thyrotropin releasing hormone
|
$198.75 |
$198.75 |
$198.75 |
$55.45
|
|
Thyroxine binding globulin (tbg)
|
$9.37 |
$9.37 |
$9.37 |
$63.60
|
|
Tigecycline injection
|
$734.39 |
$734.39 |
$734.39 |
$308.75
|
|
Tissue culture placenta
|
$255.00 |
$255.00 |
$255.00 |
$520.91
|
|
Tissue culture skin/biopsy
|
$255.00 |
$255.00 |
$255.00 |
$558.87
|
|
Tissue culture tumor
|
$255.00 |
$255.00 |
$255.00 |
$529.23
|
|
Tl-201 thallium diag per mci
|
$908.71 |
$908.71 |
$908.71 |
$77.22
|
|
Tomosynthesis breast diagnostic left
|
$1,027.29 |
$1,027.29 |
$1,027.29 |
$63.70
|
|
Tomosynthesis breast screen bilateral
|
$894.19 |
$894.19 |
$894.19 |
$73.45
|
|
Topotecan 4 mg/4 ml (1 mg/ml) intravenous solution
|
$4,183.89 |
$4,183.89 |
$4,183.89 |
$303.88
|
|
Toxoplasma antibody igg
|
$59.29 |
$59.29 |
$59.29 |
$84.35
|
|
Toxoplasma antibody igm
|
$101.64 |
$101.64 |
$101.64 |
$83.20
|
|
Training self management diabetes individual outpatient department per 30 minutes
|
$160.93 |
$160.93 |
$160.93 |
$93.75
|
|
Tranexamic acid 1,000 mg/10 ml (100 mg/ml) intravenous solution
|
$19.86 |
$19.86 |
$19.86 |
$82.60
|
|
Transcatheter bx s&i
|
$11,614.79 |
$11,614.79 |
$11,614.79 |
$1,875.96
|
|
Transferrin
|
$59.29 |
$59.29 |
$59.29 |
$87.30
|
|
Trastuzumab 150 mg intravenous solution
|
$372.70 |
$372.70 |
$372.70 |
$3,401.26
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$402.93 |
$402.93 |
$402.93 |
$241.15
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$402.93 |
$402.93 |
$402.93 |
$149.00
|
|
Trg gene rearrangement anal
|
$150.00 |
$150.00 |
$150.00 |
$455.70
|
|
Trichomonas assay w/optic
|
$207.90 |
$207.90 |
$207.90 |
$66.00
|
|
Trimethobenzamide hcl inj
|
$103.15 |
$103.15 |
$103.15 |
$154.09
|
|
Troponin quantitative
|
$1,919.06 |
$1,919.06 |
$1,919.06 |
$123.75
|
|
Ultrasound abdomen aorta screening study aaa
|
$2,429.68 |
$2,429.68 |
$2,429.68 |
$403.26
|
|
Ultrasound elastography ea l target les
|
$695.75 |
$695.75 |
$695.75 |
$136.11
|
|
Ultrasound elastography parenchyma
|
$792.55 |
$792.55 |
$792.55 |
$284.25
|
|
Ultrasound guide intraoperative
|
$3,765.52 |
$3,765.52 |
$3,765.52 |
$632.90
|
|
Ultrasound guide tissue ablation
|
$9,361.77 |
$9,361.77 |
$9,361.77 |
$498.40
|
|
Ultrasound spinal canal and contents
|
$3,925.24 |
$3,925.24 |
$3,925.24 |
$450.60
|
|
Unlisted dx gi procedure
|
$646.80 |
$646.80 |
$646.80 |
$482.90
|
|
Unlisted misc path test
|
$1,068.43 |
$1,068.43 |
$1,068.43 |
$89.40
|
|
Unlisted ultrasound procedure
|
$2,112.66 |
$2,112.66 |
$2,112.66 |
$321.20
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$19,013.16 |
$19,013.16 |
$19,013.16 |
$2,916.00
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$17,373.43 |
$17,373.43 |
$17,373.43 |
$2,013.08
|
|
Urethrocystography void s&i
|
$6,647.74 |
$6,647.74 |
$6,647.74 |
$634.50
|
|
Uric acid blood
|
$1,240.25 |
$1,240.25 |
$1,240.25 |
$46.64
|
|
Urinalysis (with microscopy)
|
$1,788.38 |
$1,788.38 |
$1,788.38 |
$48.14
|
|
Urine Culture Test
|
$1,355.20 |
$1,355.20 |
$1,355.20 |
$84.81
|
|
Urine pregnancy test
|
$965.58 |
$965.58 |
$965.58 |
$66.40
|
|
Use 1st target lesion
|
$792.55 |
$792.55 |
$792.55 |
$245.30
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im
|
$140.63 |
$140.63 |
$140.63 |
$40.01
|
|
Vaccine pneumonococcal conjugate 15 valent (pcv15) im
|
$769.16 |
$769.16 |
$769.16 |
$385.45
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$922.54 |
$922.54 |
$922.54 |
$715.41
|
|
Vaccine rabies im
|
$1,513.42 |
$1,513.42 |
$1,513.42 |
$945.46
|
|
Vaccine tdap >=7 years im
|
$17.56 |
$17.56 |
$17.56 |
$150.76
|
|
Vaccine td preservative free >= 7 years im
|
$171.92 |
$171.92 |
$171.92 |
$131.77
|
|
Valproic acid total therapeutic drug level
|
$1,172.49 |
$1,172.49 |
$1,172.49 |
$115.00
|
|
Vancomycin 750 mg intravenous solution
|
$46.13 |
$46.13 |
$46.13 |
$129.78
|
|
Vein x-ray adrenal glands
|
$14,287.68 |
$14,287.68 |
$14,287.68 |
$3,999.60
|
|
Vein x-ray kidney
|
$14,287.68 |
$14,287.68 |
$14,287.68 |
$2,716.20
|
|
Vein x-ray liver
|
$12,502.93 |
$12,502.93 |
$12,502.93 |
$3,320.80
|
|
Vein x-ray liver w/hemodynam
|
$13,393.49 |
$13,393.49 |
$13,393.49 |
$3,413.25
|
|
Vein x-ray liver w/hemodynam
|
$14,287.68 |
$14,287.68 |
$14,287.68 |
$3,439.84
|
