|
Reptilase test
|
$247.00 |
$247.00 |
$247.00 |
$65.65
|
|
Reticulocyte automated
|
$1,468.09 |
$1,468.09 |
$1,468.09 |
$54.60
|
|
Rheumatoid factor quantitative
|
$22.63 |
$22.63 |
$22.63 |
$58.00
|
|
Rho(d) immune globulin 1,500 unit (300 mcg)/2 ml injection syringe
|
$675.00 |
$675.00 |
$675.00 |
$255.26
|
|
Rho(d) immune globulin h, sd
|
$9,198.00 |
$9,198.00 |
$9,198.00 |
$2,034.31
|
|
Rifampin in ns IV syringe 3 mg/ml (neo/ped) - cnr
|
$651.00 |
$651.00 |
$651.00 |
$539.70
|
|
Right ventric recording
|
$15,228.03 |
$15,228.03 |
$15,228.03 |
$1,980.36
|
|
Rp loclzj tum 2+area 1+d img
|
$7,087.58 |
$7,087.58 |
$7,087.58 |
$1,458.95
|
|
Rubeola antibody igg
|
$214.00 |
$214.00 |
$214.00 |
$79.68
|
|
Russell viper venom diluted
|
$26.00 |
$26.00 |
$26.00 |
$70.16
|
|
Salmonella antibody
|
$61.00 |
$61.00 |
$61.00 |
$37.58
|
|
Scan duplex abd/pelvis/retroperitoneal complete
|
$5,696.68 |
$5,696.68 |
$5,696.68 |
$1,012.55
|
|
Scan duplex abd/pelvis/retroperitoneal limited
|
$2,905.57 |
$2,905.57 |
$2,905.57 |
$670.00
|
|
Scan duplex aorta/ivc/iliac or bypass grafts complete
|
$5,696.68 |
$5,696.68 |
$5,696.68 |
$815.66
|
|
Scan duplex extracranial arteries unilateral/limited study
|
$3,861.23 |
$3,861.23 |
$3,861.23 |
$589.60
|
|
Scan duplex lower extremity arteries complete bilateral
|
$8,104.46 |
$8,104.46 |
$8,104.46 |
$1,006.85
|
|
Screening Mammogram
|
$492.47 |
$492.47 |
$492.47 |
$303.55
|
|
Semen analysis w/count
|
$33.00 |
$33.00 |
$33.00 |
$56.44
|
|
Set radiation therapy field
|
$1,151.00 |
$1,151.00 |
$1,151.00 |
$731.50
|
|
Set radiation therapy field
|
$1,151.00 |
$1,151.00 |
$1,151.00 |
$1,102.40
|
|
Set radiation therapy field
|
$1,151.00 |
$1,151.00 |
$1,151.00 |
$1,636.36
|
|
Shrinker prosth below knee
|
$375.28 |
$375.28 |
$375.28 |
$153.13
|
|
Shuntogram nonvascular supervision & interpretation
|
$2,872.30 |
$2,872.30 |
$2,872.30 |
$345.00
|
|
Sialidase enzyme assay
|
$73.93 |
$73.93 |
$73.93 |
$49.44
|
|
Sialography s&i
|
$3,772.05 |
$3,772.05 |
$3,772.05 |
$462.40
|
|
Sickling rbc
|
$12.00 |
$12.00 |
$12.00 |
$53.55
|
|
Signal avg ecg w or without ecg 93278
|
$4,265.35 |
$4,265.35 |
$4,265.35 |
$309.52
|
|
Sincalide 5 mcg solution for injection
|
$444.00 |
$444.00 |
$444.00 |
$409.96
|
|
Sinus CT scan (with and without contrast)
|
$11,876.77 |
$11,876.77 |
$11,876.77 |
$1,815.00
|
|
Sinus CT scan (with contrast)
|
$9,751.40 |
$9,751.40 |
$9,751.40 |
$1,519.50
|
|
Sinus CT scan (without contrast)
|
$6,646.84 |
$6,646.84 |
$6,646.84 |
$1,279.50
|
|
Sinus/juglr venogram s&i
|
$23,675.83 |
$23,675.83 |
$23,675.83 |
$2,489.25
|
|
Sirolimus, oral
|
$195.00 |
$195.00 |
$195.00 |
$31.60
|
|
Slp pure tone screening
|
$163.00 |
$163.00 |
$163.00 |
$67.60
|
|
Sm-153 lexidron ther
|
$62,780.61 |
$62,780.61 |
$62,780.61 |
$11,563.30
|
|
Smear special stain inclusion bodies/parasites
|
$31.00 |
$31.00 |
$31.00 |
$64.35
|
|
Sodium 24 hour urine
|
$640.21 |
$640.21 |
$640.21 |
$48.50
|
|
Sodium chloride 0.9 % intravenous solution
|
$15.00 |
$15.00 |
$15.00 |
$46.43
|
|
Sodium chloride 0.9 % IV bolus
|
$41.00 |
$41.00 |
$41.00 |
$51.51
|
|
Sodium serum/plasma/whole blood
|
$379.34 |
$379.34 |
$379.34 |
$42.70
|
|
Sodium thiosulfate 12.5 gram/50 ml (250 mg/ml) intravenous solution
|
$654.75 |
$654.75 |
$654.75 |
$223.86
|
|
Special physics consult
|
$1,079.00 |
$1,079.00 |
$1,079.00 |
$700.74
|
|
Special radiation dosimetry
|
$1,556.00 |
$1,556.00 |
$1,556.00 |
$445.50
|
|
Specific gravity body fluid
|
$810.58 |
$810.58 |
$810.58 |
$23.63
|
|
Specimen fat stain
|
$34.00 |
$34.00 |
$34.00 |
$32.76
|
|
Sperm antibody test
|
$82.00 |
$82.00 |
$82.00 |
$56.44
|
|
Spirometry bronchodilation responsiveness pre/post bronchodilator administration
|
$2,791.11 |
$2,791.11 |
$2,791.11 |
$559.96
|
|
Split blood or products
|
$352.43 |
$352.43 |
$352.43 |
$148.98
|
|
St analysis behavior qualitative voice/resonance
|
$1,992.51 |
$1,992.51 |
$1,992.51 |
$300.00
|
|
St cognitve performance testing healthcare professional each hour
|
$1,484.07 |
$1,484.07 |
$1,484.07 |
$313.96
|
|
St evaluate speech sound production
|
$1,992.51 |
$1,992.51 |
$1,992.51 |
$300.00
|
|
St evaluate speech sound production comprehensive/expressive
|
$1,992.51 |
$1,992.51 |
$1,992.51 |
$393.00
|
|
St evaluation motion fluoroscopic swallow function cine/video
|
$1,819.48 |
$1,819.48 |
$1,819.48 |
$406.40
|
|
St evaluation swallow function
|
$1,992.51 |
$1,992.51 |
$1,992.51 |
$336.60
|
|
Strep a ag ia
|
$831.88 |
$831.88 |
$831.88 |
$75.40
|
|
Strep b assay w/optic
|
$883.78 |
$883.78 |
$883.78 |
$32.00
|
|
Stress test pulmonary
|
$327.43 |
$327.43 |
$327.43 |
$327.20
|
|
Sugars single quant
|
$24.00 |
$24.00 |
$24.00 |
$52.47
|
|
Sumatriptan 6 mg/0.5 ml subcutaneous solution
|
$192.00 |
$192.00 |
$192.00 |
$91.67
|
|
Susceptibility agar dilution per agent
|
$506.81 |
$506.81 |
$506.81 |
$40.30
|
|
Suscept studies macrobroth dilution ea
|
$69.00 |
$69.00 |
$69.00 |
$48.30
|
|
Syphilis test non-treponemal antibody quantitative rpr
|
$247.00 |
$247.00 |
$247.00 |
$44.85
|
|
T3 (triiodothyronine) total
|
$628.23 |
$628.23 |
$628.23 |
$94.90
|
|
Tacrolimus therapeutic drug level
|
$219.00 |
$219.00 |
$219.00 |
$122.40
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$53.00 |
$53.00 |
$53.00 |
$166.46
|
|
Tc-99m bicisate
|
$11,960.37 |
$11,960.37 |
$11,960.37 |
$1,969.45
|
|
Tc-99m exametazime diag
|
$17,096.70 |
$17,096.70 |
$17,096.70 |
$2,166.26
|
|
Tc-99m labeled rbc
|
$1,312.37 |
$1,312.37 |
$1,312.37 |
$323.01
|
|
Tc-99m maa
|
$4,667.82 |
$4,667.82 |
$4,667.82 |
$312.06
|
|
Tc-99m mebrofenin
|
$1,035.52 |
$1,035.52 |
$1,035.52 |
$169.53
|
|
Tc-99m medronate
|
$1,261.79 |
$1,261.79 |
$1,261.79 |
$122.46
|
|
Tc-99m mertiatide
|
$3,784.03 |
$3,784.03 |
$3,784.03 |
$757.25
|
|
Tc-99m pentetate dtpa
|
$819.90 |
$819.90 |
$819.90 |
$245.85
|
|
Tc-99m pentetate dtpa aerosol
|
$1,638.46 |
$1,638.46 |
$1,638.46 |
$244.02
|
|
Tc-99m pertechnetate per mci
|
$149.07 |
$149.07 |
$149.07 |
$28.08
|
|
Tc-99m pyroph diag per dose up to 25 mci
|
$2,092.33 |
$2,092.33 |
$2,092.33 |
$147.24
|
|
Tc-99m sestamibi p study dose
|
$3,680.22 |
$3,680.22 |
$3,680.22 |
$221.60
|
|
Tc-99m succimer (dmsa)
|
$3,622.98 |
$3,622.98 |
$3,622.98 |
$1,578.33
|
|
Tc-99m sulfur colloid
|
$512.44 |
$512.44 |
$512.44 |
$245.70
|
|
Tc-99m tetrofosmin p study dose
|
$3,962.39 |
$3,962.39 |
$3,962.39 |
$198.05
|
|
T cells absolute cd4/cd8 including ratio
|
$28.00 |
$28.00 |
$28.00 |
$186.00
|
|
T cells absolute cd 4 count
|
$247.00 |
$247.00 |
$247.00 |
$120.25
|
|
T cells total count
|
$28.00 |
$28.00 |
$28.00 |
$124.11
|
|
Telehealth original site facility fee
|
$504.45 |
$504.45 |
$504.45 |
$44.85
|
|
Telethx isodose plan cplx
|
$4,635.00 |
$4,635.00 |
$4,635.00 |
$1,617.00
|
|
Telethx isodose plan simple
|
$1,556.00 |
$1,556.00 |
$1,556.00 |
$848.72
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$23,899.00 |
$23,899.00 |
$23,899.00 |
$17,652.73
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$286.00 |
$286.00 |
$286.00 |
$44.49
|
|
Test for porphobilinogen
|
$23.00 |
$23.00 |
$23.00 |
$33.57
|
|
Test for urine cystines
|
$10.00 |
$10.00 |
$10.00 |
$26.00
|
|
Testicular imaging w/vasc flow
|
$8,977.60 |
$8,977.60 |
$8,977.60 |
$780.48
|
|
Test stress cardiovascular tracing only
|
$9,162.95 |
$9,162.95 |
$9,162.95 |
$1,001.55
|
|
Tetanus immune globulin inj
|
$3,068.00 |
$3,068.00 |
$3,068.00 |
$1,395.20
|
|
Theophylline therapeutic drug level
|
$492.47 |
$492.47 |
$492.47 |
$108.00
|
|
Therapeutic procd strg endur
|
$173.03 |
$173.03 |
$173.03 |
$81.36
|
|
Therapy nutrition individual initial f2f w/patient each 15 minutes
|
$182.35 |
$182.35 |
$182.35 |
$55.00
|
|
Therapy nutrition individual reassessment/intervention f2f w/patient each 15 minutes
|
$173.03 |
$173.03 |
$173.03 |
$50.40
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$72.00 |
$72.00 |
$72.00 |
$38.64
|
|
Thrombin time
|
$882.45 |
$882.45 |
$882.45 |
$48.75
|
|
Thyroid mets imag whole body
|
$11,919.11 |
$11,919.11 |
$11,919.11 |
$1,524.99
|
