|
Rp loclzj tum 2+area 1+d img
|
$4,147.90 |
$4,147.90 |
$4,147.90 |
$1,458.95
|
|
Rp loclzj tum spect w/ct 1
|
$8,074.30 |
$8,074.30 |
$8,074.30 |
$2,531.25
|
|
Rsv assay w/optic
|
$437.35 |
$437.35 |
$437.35 |
$73.80
|
|
Rubeola antibody igg
|
$3.60 |
$3.60 |
$3.60 |
$79.68
|
|
Sargramostim injection
|
$495.00 |
$495.00 |
$495.00 |
$451.34
|
|
Scan duplex aorta/ivc/iliac unilateral/limited
|
$1,527.55 |
$1,527.55 |
$1,527.55 |
$509.35
|
|
Scan duplex upper extremity arteries unilateral/limited study left
|
$1,027.90 |
$1,027.90 |
$1,027.90 |
$601.70
|
|
Screening prostate cancer PSA
|
$309.05 |
$309.05 |
$309.05 |
$81.31
|
|
Sedimentation rate erythrocyte automated
|
$764.25 |
$764.25 |
$764.25 |
$44.20
|
|
Set radiation therapy field
|
$803.40 |
$803.40 |
$803.40 |
$731.50
|
|
Set-up cardiovert-defibrill
|
$275.00 |
$275.00 |
$275.00 |
$354.90
|
|
Sialography s&i
|
$1,633.40 |
$1,633.40 |
$1,633.40 |
$462.40
|
|
Sincalide 5 mcg solution for injection
|
$452.00 |
$452.00 |
$452.00 |
$409.96
|
|
Sinus/juglr venogram s&i
|
$12,229.15 |
$12,229.15 |
$12,229.15 |
$2,489.25
|
|
Sirolimus, oral
|
$88.00 |
$88.00 |
$88.00 |
$31.60
|
|
Sodium 24 hour urine
|
$261.15 |
$261.15 |
$261.15 |
$48.50
|
|
Sodium chloride 0.9 % IV bolus
|
$448.00 |
$448.00 |
$448.00 |
$51.51
|
|
Sodium ferric gluconate complex in sucrose 62.5 mg/5 ml intravenous
|
$155.50 |
$155.50 |
$155.50 |
$104.00
|
|
Sodium thiosulfate 12.5 gram/50 ml (250 mg/ml) intravenous solution
|
$374.00 |
$374.00 |
$374.00 |
$223.86
|
|
Special radiation dosimetry
|
$287.60 |
$287.60 |
$287.60 |
$445.50
|
|
Specimen fat stain
|
$12.70 |
$12.70 |
$12.70 |
$32.76
|
|
Spirometry bronchodilation responsiveness pre/post bronchodilator administration
|
$3,576.95 |
$3,576.95 |
$3,576.95 |
$559.96
|
|
Split blood or products
|
$925.35 |
$925.35 |
$925.35 |
$148.98
|
|
Sputum specimen collection
|
$816.65 |
$816.65 |
$816.65 |
$180.00
|
|
St evaluation motion fluoroscopic swallow function cine/video
|
$1,269.85 |
$1,269.85 |
$1,269.85 |
$406.40
|
|
Strapping of hand or finger
|
$141.75 |
$141.75 |
$141.75 |
$194.40
|
|
Strep b assay w/optic
|
$8.90 |
$8.90 |
$8.90 |
$32.00
|
|
Streptomycin injection
|
$53.00 |
$53.00 |
$53.00 |
$100.00
|
|
Stress test pulmonary
|
$1,904.90 |
$1,904.90 |
$1,904.90 |
$327.20
|
|
Stress tte complete
|
$4,349.45 |
$4,349.45 |
$4,349.45 |
$1,964.95
|
|
Sulfonylurea screen qn-sendout
|
$112.00 |
$112.00 |
$112.00 |
$184.60
|
|
Surgical pathology level 1 gross examination only
|
$23.55 |
$23.55 |
$23.55 |
$92.59
|
|
Susceptibility enzyme detection per enzyme
|
$25.65 |
$25.65 |
$25.65 |
$34.48
|
|
Suscept studies macrobroth dilution ea
|
$35.85 |
$35.85 |
$35.85 |
$48.30
|
|
T3 (triiodothyronine) total
|
$2.85 |
$2.85 |
$2.85 |
$94.90
|
|
T4 (thyroxine) total
|
$2.85 |
$2.85 |
$2.85 |
$73.64
|
|
Tacrolimus therapeutic drug level
|
$38.90 |
$38.90 |
$38.90 |
$122.40
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$79.35 |
$79.35 |
$79.35 |
$166.46
|
|
Tc-99m depreotide
|
$11,810.75 |
$11,810.75 |
$11,810.75 |
$1,937.35
|
|
Tc-99m exametazime diag
|
$4,588.40 |
$4,588.40 |
$4,588.40 |
$2,166.26
|
|
Tc-99m labeled rbc
|
$3,190.70 |
$3,190.70 |
$3,190.70 |
$323.01
|
|
Tc-99m maa
|
$6,531.90 |
$6,531.90 |
$6,531.90 |
$312.06
|
|
Tc-99m mebrofenin
|
$816.25 |
$816.25 |
$816.25 |
$169.53
|
|
Tc-99m medronate
|
$162.75 |
$162.75 |
$162.75 |
$122.46
|
|
Tc-99m mertiatide
|
$2,613.60 |
$2,613.60 |
$2,613.60 |
$757.25
|
|
Tc-99m pentetate dtpa
|
$816.25 |
$816.25 |
$816.25 |
$245.85
|
|
Tc-99m pentetate dtpa aerosol
|
$220.00 |
$220.00 |
$220.00 |
$244.02
|
|
Tc-99m sestamibi p study dose
|
$4,947.60 |
$4,947.60 |
$4,947.60 |
$221.60
|
|
Tc-99m succimer (dmsa)
|
$3,409.60 |
$3,409.60 |
$3,409.60 |
$1,578.33
|
|
Tc-99m sulfur colloid
|
$383.20 |
$383.20 |
$383.20 |
$245.70
|
|
Tcd emboli detect w/inj
|
$805.75 |
$805.75 |
$805.75 |
$404.68
|
|
T cells absolute cd4/cd8 including ratio
|
$29.15 |
$29.15 |
$29.15 |
$186.00
|
|
T cells absolute cd 4 count
|
$133.90 |
$133.90 |
$133.90 |
$120.25
|
|
T cells total count
|
$29.15 |
$29.15 |
$29.15 |
$124.11
|
|
Temsirolimus 30 mg/3 ml (10 mg/ml) (first dilution) intravenous soln
|
$5,951.00 |
$5,951.00 |
$5,951.00 |
$2,791.41
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$32,007.25 |
$32,007.25 |
$32,007.25 |
$17,652.73
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$130.00 |
$130.00 |
$130.00 |
$44.49
|
|
Tetanus immune globulin inj
|
$1,479.00 |
$1,479.00 |
$1,479.00 |
$1,395.20
|
|
Theophylline therapeutic drug level
|
$548.85 |
$548.85 |
$548.85 |
$108.00
|
|
Therapy nutrition individual initial f2f w/patient each 15 minutes
|
$185.00 |
$185.00 |
$185.00 |
$55.00
|
|
Therapy nutrition individual reassessment/intervention f2f w/patient each 15 minutes
|
$159.05 |
$159.05 |
$159.05 |
$50.40
|
|
Thrombin time
|
$25.45 |
$25.45 |
$25.45 |
$48.75
|
|
Thyroid imaging
|
$5,660.15 |
$5,660.15 |
$5,660.15 |
$670.80
|
|
Thyroid mets imag whole body
|
$2,017.75 |
$2,017.75 |
$2,017.75 |
$1,524.99
|
|
Thyroid uptake measurement
|
$4,328.95 |
$4,328.95 |
$4,328.95 |
$653.60
|
|
Thyroxine binding globulin (tbg)
|
$14.65 |
$14.65 |
$14.65 |
$63.60
|
|
Tigecycline injection
|
$616.00 |
$616.00 |
$616.00 |
$308.75
|
|
Tilt table study
|
$3,691.75 |
$3,691.75 |
$3,691.75 |
$1,495.00
|
|
Tissue amnio epifix inj 100mg
|
$2,421.00 |
$2,421.00 |
$2,421.00 |
$5,081.76
|
|
Tissue culture skin/biopsy
|
$610.25 |
$610.25 |
$610.25 |
$558.87
|
|
Tl-201 thallium diag per mci
|
$3,191.35 |
$3,191.35 |
$3,191.35 |
$77.22
|
|
Topotecan 4 mg/4 ml (1 mg/ml) intravenous solution
|
$548.00 |
$548.00 |
$548.00 |
$303.88
|
|
Toxoplasma antibody igg
|
$13.65 |
$13.65 |
$13.65 |
$84.35
|
|
Toxoplasma antibody igm
|
$18.35 |
$18.35 |
$18.35 |
$83.20
|
|
Tranexamic acid 1,000 mg/10 ml (100 mg/ml) intravenous solution
|
$126.10 |
$126.10 |
$126.10 |
$82.60
|
|
Transferrin
|
$3.10 |
$3.10 |
$3.10 |
$87.30
|
|
Trastuzumab 150 mg intravenous solution
|
$353.00 |
$353.00 |
$353.00 |
$3,401.26
|
|
Trastuzumab-anns 150 mg intravenous solution
|
$5,546.00 |
$5,546.00 |
$5,546.00 |
$7,620.16
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$927.60 |
$927.60 |
$927.60 |
$241.15
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$800.60 |
$800.60 |
$800.60 |
$149.00
|
|
Triamcinolone a inj prs-free
|
$67.25 |
$67.25 |
$67.25 |
$225.43
|
|
Trimethobenzamide hcl inj
|
$108.00 |
$108.00 |
$108.00 |
$154.09
|
|
Tube drain vert dev st 5-40f
|
$75.00 |
$75.00 |
$75.00 |
$72.21
|
|
Tx atrial fib pulm vein isol
|
$64,058.95 |
$64,058.95 |
$64,058.95 |
$32,426.20
|
|
Tx l/r atrial fib addl
|
$64,058.95 |
$64,058.95 |
$64,058.95 |
$7,717.80
|
|
Ultrasound abdomen aorta screening study aaa
|
$616.40 |
$616.40 |
$616.40 |
$403.26
|
|
Ultrasound encephalogram
|
$1,131.10 |
$1,131.10 |
$1,131.10 |
$481.60
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$1,090.25 |
$1,090.25 |
$1,090.25 |
$477.88
|
|
Ultrasound guide intraoperative
|
$1,131.10 |
$1,131.10 |
$1,131.10 |
$632.90
|
|
Ultrasound hips infant dynamic
|
$999.90 |
$999.90 |
$999.90 |
$403.00
|
|
Ultrasound nrv&acc strux 1xtr compre
|
$701.55 |
$701.55 |
$701.55 |
$280.02
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$725.10 |
$725.10 |
$725.10 |
$326.54
|
|
Ultrasound pregnant uterus follow up per fetus
|
$697.90 |
$697.90 |
$697.90 |
$450.75
|
|
Ultrasound prostate/transrectal
|
$2,815.55 |
$2,815.55 |
$2,815.55 |
$545.16
|
|
Ultrasound spinal canal and contents
|
$1,090.25 |
$1,090.25 |
$1,090.25 |
$450.60
|
|
Ultrasound transabd ea addl gest
|
$501.00 |
$501.00 |
$501.00 |
$425.10
|
|
Unlisted px med radj physics
|
$2,046.00 |
$2,046.00 |
$2,046.00 |
$376.03
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$5,273.65 |
$5,273.65 |
$5,273.65 |
$2,916.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$3,902.35 |
$3,902.35 |
$3,902.35 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$3,637.30 |
$3,637.30 |
$3,637.30 |
$2,013.08
|
