|
Scan duplex abd/pelvis/retroperitoneal complete
|
$4,113.00 |
$4,113.00 |
$4,113.00 |
$1,012.55
|
|
Scan duplex abd/pelvis/retroperitoneal limited
|
$1,379.25 |
$1,379.25 |
$1,379.25 |
$670.00
|
|
Scan duplex aorta/ivc/iliac or bypass grafts complete
|
$3,873.75 |
$3,873.75 |
$3,873.75 |
$815.66
|
|
Scan duplex extracranial arteries unilateral/limited study
|
$1,676.75 |
$1,676.75 |
$1,676.75 |
$589.60
|
|
Scan duplex lower extremity arteries complete bilateral
|
$4,113.00 |
$4,113.00 |
$4,113.00 |
$1,006.85
|
|
Screening colorectal cancer fecal occult blood immunoassay 1-3 simultaneous determinations
|
$92.00 |
$92.00 |
$92.00 |
$27.44
|
|
Screening Mammogram
|
$1,259.50 |
$1,259.50 |
$1,259.50 |
$303.55
|
|
Sedation moderate same physician performing a gastrointestinal endoscopic service >= 5 years initial 15 minutes intra-service time
|
$5,154.75 |
$5,154.75 |
$5,154.75 |
$195.60
|
|
Sedimentation rate erythrocyte automated
|
$283.50 |
$283.50 |
$283.50 |
$44.20
|
|
Serpina1 gene
|
$176.00 |
$176.00 |
$176.00 |
$191.73
|
|
Shuntogram nonvascular supervision & interpretation
|
$819.00 |
$819.00 |
$819.00 |
$345.00
|
|
Sialography s&i
|
$1,138.00 |
$1,138.00 |
$1,138.00 |
$462.40
|
|
Signal avg ecg w or without ecg 93278
|
$2,090.00 |
$2,090.00 |
$2,090.00 |
$309.52
|
|
Sincalide 5 mcg solution for injection
|
$587.00 |
$587.00 |
$587.00 |
$409.96
|
|
Sinus CT scan (with and without contrast)
|
$16,459.50 |
$16,459.50 |
$16,459.50 |
$1,815.00
|
|
Sinus CT scan (with contrast)
|
$12,708.00 |
$12,708.00 |
$12,708.00 |
$1,519.50
|
|
Sinus CT scan (without contrast)
|
$12,152.50 |
$12,152.50 |
$12,152.50 |
$1,279.50
|
|
Sinus/juglr venogram s&i
|
$6,176.75 |
$6,176.75 |
$6,176.75 |
$2,489.25
|
|
Sleep Study (Polysomnography)
|
$15,686.00 |
$15,686.00 |
$15,686.00 |
$3,936.80
|
|
Smear nasal eosinophil
|
$314.00 |
$314.00 |
$314.00 |
$49.50
|
|
Smear wet mount
|
$219.75 |
$219.75 |
$219.75 |
$68.63
|
|
Sodium 24 hour urine
|
$47.00 |
$47.00 |
$47.00 |
$48.50
|
|
Sodium chloride 0.9 % intravenous solution
|
$46.00 |
$46.00 |
$46.00 |
$46.43
|
|
Sodium chloride 0.9 % IV bolus
|
$46.00 |
$46.00 |
$46.00 |
$51.51
|
|
Sodium serum/plasma/whole blood
|
$92.00 |
$92.00 |
$92.00 |
$42.70
|
|
Special physics consult
|
$606.50 |
$606.50 |
$606.50 |
$700.74
|
|
Specific gravity body fluid
|
$92.00 |
$92.00 |
$92.00 |
$23.63
|
|
Spirometry bronchodilation responsiveness pre/post bronchodilator administration
|
$1,592.00 |
$1,592.00 |
$1,592.00 |
$559.96
|
|
St analysis behavior qualitative voice/resonance
|
$170.00 |
$170.00 |
$170.00 |
$300.00
|
|
St evaluate speech sound production
|
$170.00 |
$170.00 |
$170.00 |
$300.00
|
|
St evaluate speech sound production comprehensive/expressive
|
$170.00 |
$170.00 |
$170.00 |
$393.00
|
|
St evaluation motion fluoroscopic swallow function cine/video
|
$1,162.50 |
$1,162.50 |
$1,162.50 |
$406.40
|
|
St evaluation swallow function
|
$715.00 |
$715.00 |
$715.00 |
$336.60
|
|
Streptomycin injection
|
$97.25 |
$97.25 |
$97.25 |
$100.00
|
|
St treatment speech individual
|
$444.00 |
$444.00 |
$444.00 |
$254.15
|
|
St treatment swallow dysfunction/oral
|
$530.75 |
$530.75 |
$530.75 |
$261.60
|
|
Succinylcholine chloride 20 mg/ml injection solution (wrapper)
|
$3.00 |
$3.00 |
$3.00 |
$49.13
|
|
Sugars single quant
|
$26.25 |
$26.25 |
$26.25 |
$52.47
|
|
Sulfamethoxazole 400 mg-trimethoprim 80 mg/5 ml intravenous solution
|
$55.00 |
$55.00 |
$55.00 |
$71.09
|
|
Sumatriptan 6 mg/0.5 ml subcutaneous solution
|
$951.50 |
$951.50 |
$951.50 |
$91.67
|
|
Susceptibility agar dilution per agent
|
$10.00 |
$10.00 |
$10.00 |
$40.30
|
|
Svc venogram s&i
|
$6,176.75 |
$6,176.75 |
$6,176.75 |
$1,908.00
|
|
Tacrolimus 5 mg/ml intravenous solution
|
$1,197.00 |
$1,197.00 |
$1,197.00 |
$612.11
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$46.75 |
$46.75 |
$46.75 |
$166.46
|
|
Tc-99m bicisate
|
$14,932.50 |
$14,932.50 |
$14,932.50 |
$1,969.45
|
|
Tc-99m depreotide
|
$24,254.50 |
$24,254.50 |
$24,254.50 |
$1,937.35
|
|
Tc-99m exametazime diag
|
$9,306.00 |
$9,306.00 |
$9,306.00 |
$2,166.26
|
|
Tc-99m labeled rbc
|
$1,573.00 |
$1,573.00 |
$1,573.00 |
$323.01
|
|
Tc-99m maa
|
$991.75 |
$991.75 |
$991.75 |
$312.06
|
|
Tc-99m mebrofenin
|
$991.75 |
$991.75 |
$991.75 |
$169.53
|
|
Tc-99m medronate
|
$363.00 |
$363.00 |
$363.00 |
$122.46
|
|
Tc-99m mertiatide
|
$4,818.75 |
$4,818.75 |
$4,818.75 |
$757.25
|
|
Tc-99m pentetate dtpa
|
$991.75 |
$991.75 |
$991.75 |
$245.85
|
|
Tc-99m sestamibi p study dose
|
$3,764.75 |
$3,764.75 |
$3,764.75 |
$221.60
|
|
Tc-99m succimer (dmsa)
|
$2,994.25 |
$2,994.25 |
$2,994.25 |
$1,578.33
|
|
Tc-99m sulfur colloid
|
$627.00 |
$627.00 |
$627.00 |
$245.70
|
|
T cells absolute cd 4 count
|
$178.75 |
$178.75 |
$178.75 |
$120.25
|
|
T cells total count
|
$30.50 |
$30.50 |
$30.50 |
$124.11
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$17,112.25 |
$17,112.25 |
$17,112.25 |
$17,652.73
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$60.00 |
$60.00 |
$60.00 |
$44.49
|
|
Testicular imaging w/vasc flow
|
$8,962.50 |
$8,962.50 |
$8,962.50 |
$780.48
|
|
Tetanus immune globulin inj
|
$1,204.50 |
$1,204.50 |
$1,204.50 |
$1,395.20
|
|
Theophylline therapeutic drug level
|
$157.75 |
$157.75 |
$157.75 |
$108.00
|
|
Therapy nutrition individual initial f2f w/patient each 15 minutes
|
$312.75 |
$312.75 |
$312.75 |
$55.00
|
|
Therapy nutrition individual reassessment/intervention f2f w/patient each 15 minutes
|
$155.75 |
$155.75 |
$155.75 |
$50.40
|
|
Thyroid imaging
|
$1,147.50 |
$1,147.50 |
$1,147.50 |
$670.80
|
|
Thyroid mets imag whole body
|
$12,697.00 |
$12,697.00 |
$12,697.00 |
$1,524.99
|
|
Thyroid Ultrasound
|
$4,434.00 |
$4,434.00 |
$4,434.00 |
$589.96
|
|
Thyroxine binding globulin (tbg)
|
$13.50 |
$13.50 |
$13.50 |
$63.60
|
|
Tigecycline injection
|
$538.00 |
$538.00 |
$538.00 |
$308.75
|
|
Tilt table study
|
$2,621.75 |
$2,621.75 |
$2,621.75 |
$1,495.00
|
|
Tissue culture placenta
|
$170.25 |
$170.25 |
$170.25 |
$520.91
|
|
Tissue culture tumor
|
$170.75 |
$170.75 |
$170.75 |
$529.23
|
|
Tissue exam koh skin/hair/nails
|
$283.50 |
$283.50 |
$283.50 |
$47.40
|
|
Tl-201 thallium diag per mci
|
$896.75 |
$896.75 |
$896.75 |
$77.22
|
|
Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr
|
$42.00 |
$42.00 |
$42.00 |
$125.87
|
|
Tobramycin non-comp unit
|
$50.25 |
$50.25 |
$50.25 |
$107.07
|
|
Tomosynthesis breast diagnostic left
|
$299.75 |
$299.75 |
$299.75 |
$63.70
|
|
Tomosynthesis breast screen bilateral
|
$299.75 |
$299.75 |
$299.75 |
$73.45
|
|
Topotecan 4 mg/4 ml (1 mg/ml) intravenous solution
|
$4,907.00 |
$4,907.00 |
$4,907.00 |
$303.88
|
|
Transcatheter bx s&i
|
$9,923.00 |
$9,923.00 |
$9,923.00 |
$1,875.96
|
|
Trastuzumab 150 mg intravenous solution
|
$304.00 |
$304.00 |
$304.00 |
$3,401.26
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$627.00 |
$627.00 |
$627.00 |
$241.15
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$473.25 |
$473.25 |
$473.25 |
$149.00
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$66.00 |
$66.00 |
$66.00 |
$48.22
|
|
Trichinella antibody
|
$106.00 |
$106.00 |
$106.00 |
$70.65
|
|
Trichomonas assay w/optic
|
$58.25 |
$58.25 |
$58.25 |
$66.00
|
|
Trimethobenzamide hcl inj
|
$93.00 |
$93.00 |
$93.00 |
$154.09
|
|
Tx atrial fib pulm vein isol
|
$116,827.50 |
$116,827.50 |
$116,827.50 |
$32,426.20
|
|
Tx l/r atrial fib addl
|
$38,945.00 |
$38,945.00 |
$38,945.00 |
$7,717.80
|
|
Ultrasound abdomen aorta screening study aaa
|
$777.00 |
$777.00 |
$777.00 |
$403.26
|
|
Ultrasound chest
|
$1,052.25 |
$1,052.25 |
$1,052.25 |
$459.55
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$1,262.25 |
$1,262.25 |
$1,262.25 |
$477.88
|
|
Ultrasound guide intraoperative
|
$4,366.25 |
$4,366.25 |
$4,366.25 |
$632.90
|
|
Ultrasound joint complete left
|
$1,816.00 |
$1,816.00 |
$1,816.00 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$1,709.25 |
$1,709.25 |
$1,709.25 |
$448.50
|
|
Ultrasound ob >=14wks ea addl gest
|
$4,205.75 |
$4,205.75 |
$4,205.75 |
$454.11
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$684.25 |
$684.25 |
$684.25 |
$326.54
|
|
Ultrasound pregnant uterus follow up per fetus
|
$1,557.00 |
$1,557.00 |
$1,557.00 |
$450.75
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$2,121.50 |
$2,121.50 |
$2,121.50 |
$459.00
|
