|
Radphm lcl tomogr sgl area sgl day
|
$1,044.54 |
$1,044.54 |
$1,044.54 |
$2,177.00
|
|
Radphm lcl tumor plr sgl day
|
$614.46 |
$614.46 |
$614.46 |
$1,075.78
|
|
Rapid Strep Test
|
$25.20 |
$25.20 |
$25.20 |
$67.80
|
|
Red blood cells each unit
|
$356.58 |
$356.58 |
$356.58 |
$380.25
|
|
Red blood cells leukocytes reduced each unit
|
$562.38 |
$562.38 |
$562.38 |
$519.35
|
|
Red blood cells leukocytes reduced irradiated each unit
|
$714.84 |
$714.84 |
$714.84 |
$645.45
|
|
Removal devitalized tissue non-selective debridement without anesthesia per session
|
$197.82 |
$197.82 |
$197.82 |
$236.64
|
|
Removal foreign body foot subcutaneous right
|
$1,432.20 |
$1,432.20 |
$1,432.20 |
$1,256.00
|
|
Renal venogram bil s&i
|
$1,551.48 |
$1,551.48 |
$1,551.48 |
$3,386.25
|
|
Reptilase test
|
$45.05 |
$45.05 |
$45.05 |
$65.72
|
|
Resuscitation cardiopulmonary
|
$947.94 |
$947.94 |
$947.94 |
$895.44
|
|
Reticulocyte automated
|
$6.30 |
$6.30 |
$6.30 |
$54.27
|
|
Rheumatoid factor qualitative
|
$16.80 |
$16.80 |
$16.80 |
$54.60
|
|
Rheumatoid factor quantitative
|
$25.62 |
$25.62 |
$25.62 |
$59.80
|
|
Rituximab 10 mg/ml concentrate,intravenous
|
$550.97 |
$550.97 |
$550.97 |
$201.92
|
|
Ropivacaine 0.2 % epidural pca - 1 hour dose limit
|
$11.18 |
$11.18 |
$11.18 |
$60.40
|
|
Rp loclzj tum 2+area 1+d img
|
$1,310.82 |
$1,310.82 |
$1,310.82 |
$1,283.66
|
|
Rubella antibody igg
|
$29.82 |
$29.82 |
$29.82 |
$73.05
|
|
Russell viper venom diluted
|
$3.57 |
$3.57 |
$3.57 |
$73.03
|
|
Salmonella antibody
|
$118.86 |
$118.86 |
$118.86 |
$37.58
|
|
Screen cerv/vag thin layer
|
$47.04 |
$47.04 |
$47.04 |
$61.20
|
|
Screening prostate cancer PSA
|
$39.90 |
$39.90 |
$39.90 |
$96.00
|
|
Semen analysis presence/motility
|
$46.20 |
$46.20 |
$46.20 |
$79.92
|
|
Shoulder X-ray
|
$137.34 |
$137.34 |
$137.34 |
$307.20
|
|
Shrinker prosth above knee
|
$48.30 |
$48.30 |
$48.30 |
$157.49
|
|
Shrinker prosth below knee
|
$30.24 |
$30.24 |
$30.24 |
$90.54
|
|
Sialography s&i
|
$225.96 |
$225.96 |
$225.96 |
$403.70
|
|
Sickling rbc
|
$11.76 |
$11.76 |
$11.76 |
$53.40
|
|
Sinus CT scan (with and without contrast)
|
$896.70 |
$896.70 |
$896.70 |
$1,610.70
|
|
Sinus CT scan (with contrast)
|
$869.40 |
$869.40 |
$869.40 |
$1,419.18
|
|
Sinus CT scan (without contrast)
|
$736.68 |
$736.68 |
$736.68 |
$1,151.00
|
|
Sleep Study (Polysomnography)
|
$3,093.72 |
$3,093.72 |
$3,093.72 |
$4,043.20
|
|
Sleep study unattended
|
$396.90 |
$396.90 |
$396.90 |
$631.55
|
|
Sling arm deluxe w/pad xs
|
$5.88 |
$5.88 |
$5.88 |
$37.80
|
|
Sling pelv split sam med
|
$28.56 |
$28.56 |
$28.56 |
$134.09
|
|
Smear fluorescent and/or acid fast stain
|
$16.59 |
$16.59 |
$16.59 |
$50.70
|
|
Smear gram stain
|
$9.24 |
$9.24 |
$9.24 |
$48.00
|
|
Smear nasal eosinophil
|
$10.08 |
$10.08 |
$10.08 |
$50.00
|
|
Smear special stain inclusion bodies/parasites
|
$13.02 |
$13.02 |
$13.02 |
$60.00
|
|
Smear wet mount
|
$9.24 |
$9.24 |
$9.24 |
$56.13
|
|
Sodium 24 hour urine
|
$18.06 |
$18.06 |
$18.06 |
$47.25
|
|
Sodium chloride 0.9 % IV bolus
|
$7.56 |
$7.56 |
$7.56 |
$42.25
|
|
Sodium ferric gluconate complex in sucrose 62.5 mg/5 ml intravenous
|
$4.20 |
$4.20 |
$4.20 |
$28.46
|
|
Specific gravity body fluid
|
$5.88 |
$5.88 |
$5.88 |
$21.55
|
|
Specimen fat stain
|
$8.46 |
$8.46 |
$8.46 |
$40.00
|
|
Spirometry bronchodilation responsiveness pre/post bronchodilator administration
|
$166.32 |
$166.32 |
$166.32 |
$526.80
|
|
Spleen imaging
|
$271.32 |
$271.32 |
$271.32 |
$529.65
|
|
Splint extn xsm w sof-stretch rolyan
|
$32.76 |
$32.76 |
$32.76 |
$93.00
|
|
Splint rstrc wrst/cmc right med
|
$57.54 |
$57.54 |
$57.54 |
$74.97
|
|
St evaluation motion fluoroscopic swallow function cine/video
|
$124.32 |
$124.32 |
$124.32 |
$336.00
|
|
Strep a dna dir probe
|
$43.26 |
$43.26 |
$43.26 |
$50.40
|
|
Succinylcholine chloride 20 mg/ml injection solution (wrapper)
|
$4.13 |
$4.13 |
$4.13 |
$22.19
|
|
Sulfonylurea screen qn-sendout
|
$96.12 |
$96.12 |
$96.12 |
$151.45
|
|
Surgical pathology level 1 gross examination only
|
$29.82 |
$29.82 |
$29.82 |
$81.00
|
|
Surgical pathology level 2 gross & microscopic examination
|
$182.28 |
$182.28 |
$182.28 |
$138.00
|
|
Surgical pathology level 3 gross & microscopic examination
|
$182.28 |
$182.28 |
$182.28 |
$181.00
|
|
Surgical pathology level 4 gross & microscopic examination
|
$1,696.38 |
$1,696.38 |
$1,696.38 |
$239.85
|
|
Surgical pathology level 5 gross & microscopic examination
|
$437.22 |
$437.22 |
$437.22 |
$489.00
|
|
Surgical pathology level 6 gross & microscopic examination
|
$889.14 |
$889.14 |
$889.14 |
$720.75
|
|
Susceptibility agar dilution per agent
|
$5.04 |
$5.04 |
$5.04 |
$38.58
|
|
Susceptibility mic per plate
|
$18.06 |
$18.06 |
$18.06 |
$89.70
|
|
Svc venogram s&i
|
$830.34 |
$830.34 |
$830.34 |
$1,908.00
|
|
Sweat collection by iontophoresis
|
$57.96 |
$57.96 |
$57.96 |
$100.20
|
|
Syphilis test non-treponemal antibody quantitative rpr
|
$17.22 |
$17.22 |
$17.22 |
$45.70
|
|
T3 (triiodothyronine) free
|
$36.96 |
$36.96 |
$36.96 |
$91.20
|
|
T3 (triiodothyronine) total
|
$42.84 |
$42.84 |
$42.84 |
$88.00
|
|
T4 (thyroxine) free
|
$29.40 |
$29.40 |
$29.40 |
$65.00
|
|
T4 (thyroxine) total
|
$19.74 |
$19.74 |
$19.74 |
$62.40
|
|
Tacrolimus therapeutic drug level
|
$5.32 |
$5.32 |
$5.32 |
$137.15
|
|
Tbo-filgrastim 300 mcg/0.5 ml subcutaneous syringe
|
$5.08 |
$5.08 |
$5.08 |
$760.95
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$19.82 |
$19.82 |
$19.82 |
$178.40
|
|
Tc-99m bicisate
|
$400.68 |
$400.68 |
$400.68 |
$2,398.20
|
|
Tc-99m disofenin
|
$372.96 |
$372.96 |
$372.96 |
$151.32
|
|
Tc-99m exame autol wbc diag per dose
|
$843.36 |
$843.36 |
$843.36 |
$2,393.40
|
|
Tc-99m exametazime diag
|
$843.36 |
$843.36 |
$843.36 |
$2,236.65
|
|
Tc-99m labeled rbc
|
$717.78 |
$717.78 |
$717.78 |
$312.70
|
|
Tc-99m maa
|
$81.90 |
$81.90 |
$81.90 |
$306.60
|
|
Tc-99m medronate
|
$147.00 |
$147.00 |
$147.00 |
$120.35
|
|
Tc-99m pyroph diag per dose up to 25 mci
|
$68.88 |
$68.88 |
$68.88 |
$137.01
|
|
Tc-99m sestamibi p study dose
|
$143.64 |
$143.64 |
$143.64 |
$221.60
|
|
Tc-99m sulfur colloid
|
$72.66 |
$72.66 |
$72.66 |
$240.50
|
|
Tc-99m tetrofosmin p study dose
|
$96.18 |
$96.18 |
$96.18 |
$198.05
|
|
T cells absolute cd4/cd8 including ratio
|
$62.90 |
$62.90 |
$62.90 |
$189.60
|
|
T cells total count
|
$85.26 |
$85.26 |
$85.26 |
$126.90
|
|
Tenotomy open tndn flxr toe sgl tndn spx
|
$2,250.36 |
$2,250.36 |
$2,250.36 |
$1,985.00
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$2.50 |
$2.50 |
$2.50 |
$39.33
|
|
Test for chlorohydrocarbons
|
$177.77 |
$177.77 |
$177.77 |
$71.04
|
|
Test stress cardiovascular tracing only
|
$607.74 |
$607.74 |
$607.74 |
$1,016.00
|
|
Tetanus immune globulin inj
|
$670.33 |
$670.33 |
$670.33 |
$1,073.02
|
|
Theophylline therapeutic drug level
|
$24.05 |
$24.05 |
$24.05 |
$101.40
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$6.72 |
$6.72 |
$6.72 |
$25.80
|
|
Throat x-ray & fluoroscopy
|
$202.02 |
$202.02 |
$202.02 |
$188.00
|
|
Thrombin time
|
$4.21 |
$4.21 |
$4.21 |
$53.50
|
|
Thromboplastin time partial (ptt) substitution fractions each
|
$38.01 |
$38.01 |
$38.01 |
$56.93
|
|
Thyroglobulin antibody
|
$10.49 |
$10.49 |
$10.49 |
$86.40
|
|
Thyroid mets imag whole body
|
$1,021.86 |
$1,021.86 |
$1,021.86 |
$1,320.00
|
|
Thyroid (TSH) Test
|
$35.28 |
$35.28 |
$35.28 |
$101.40
|
|
Thyroid Ultrasound
|
$217.14 |
$217.14 |
$217.14 |
$553.80
|
|
Thyroxine binding globulin (tbg)
|
$13.14 |
$13.14 |
$13.14 |
$75.00
|
|
Tilt table study
|
$1,578.78 |
$1,578.78 |
$1,578.78 |
$1,488.24
|
