|
Rho d immune globulin inj
|
$144.03 |
$144.03 |
$144.03 |
$232.72
|
|
Risk ascvd tst once pr 12 mo
|
$31.50 |
$31.50 |
$31.50 |
$32.97
|
|
Rmv implant contraceptive capsule 11976
|
$414.00 |
$414.00 |
$414.00 |
$846.42
|
|
Rmvl ext fixj sys under anes
|
$937.50 |
$937.50 |
$937.50 |
$1,858.61
|
|
Rotavirus antibody
|
$52.50 |
$52.50 |
$52.50 |
$107.50
|
|
Rsv assay w/optic
|
$69.75 |
$69.75 |
$69.75 |
$64.13
|
|
Rubella antibody igg
|
$39.00 |
$39.00 |
$39.00 |
$73.05
|
|
Rubeola antibody igg
|
$28.50 |
$28.50 |
$28.50 |
$80.00
|
|
Russell viper venom diluted
|
$58.50 |
$58.50 |
$58.50 |
$73.03
|
|
Sbsq nurs facil care/day unstabl/new prob 35 min 99310
|
$94.50 |
$94.50 |
$94.50 |
$259.20
|
|
Sbsq nursing facil care/day minor complj 15 min
|
$75.00 |
$75.00 |
$75.00 |
$133.20
|
|
Sbsq nursing facil care/day new problem 25 min
|
$84.75 |
$84.75 |
$84.75 |
$187.65
|
|
Sbsq nursing facility care/day e/m stable 10 min
|
$63.75 |
$63.75 |
$63.75 |
$79.20
|
|
Scan duplex aorta/ivc/iliac or bypass grafts complete
|
$39.75 |
$39.75 |
$39.75 |
$788.40
|
|
Scan duplex extremity veins unilateral/limited study
|
$28.50 |
$28.50 |
$28.50 |
$691.07
|
|
Scan duplex lower extremity arteries complete bilateral
|
$24.00 |
$24.00 |
$24.00 |
$957.18
|
|
Scan duplex lower extremity arteries unilateral/limited study left
|
$24.00 |
$24.00 |
$24.00 |
$612.00
|
|
Scan duplex upper extremity arteries unilateral/limited study left
|
$33.00 |
$33.00 |
$33.00 |
$527.80
|
|
Screening colorectal cancer fecal occult blood immunoassay 1-3 simultaneous determinations
|
$57.00 |
$57.00 |
$57.00 |
$27.44
|
|
Screening prostate cancer PSA
|
$46.50 |
$46.50 |
$46.50 |
$96.00
|
|
Screen/visual acuity/bilat/quant 99173
|
$21.00 |
$21.00 |
$21.00 |
$29.70
|
|
Semen analysis presence/motility
|
$16.50 |
$16.50 |
$16.50 |
$79.92
|
|
Shave sgl skin lsn f/e/e/n/l/m 0.5cm/<
|
$168.75 |
$168.75 |
$168.75 |
$284.88
|
|
Shave sgl skin lsn f/e/e/n/l/m 0.6-1.0cm
|
$198.75 |
$198.75 |
$198.75 |
$286.89
|
|
Shave sgl skin lsn f/e/e/n/l/m 1.1-2cm
|
$279.00 |
$279.00 |
$279.00 |
$442.22
|
|
Shave sgl skin lsn s/n/h/f/g 0.5cm/<
|
$112.50 |
$112.50 |
$112.50 |
$258.40
|
|
Shave sgl skin lsn s/n/h/f/g 0.6-1.0 cm
|
$123.00 |
$123.00 |
$123.00 |
$231.75
|
|
Shave sgl skin lsn s/n/h/f/g 1.1-2cm
|
$142.50 |
$142.50 |
$142.50 |
$259.58
|
|
Shave sgl skin lsn t/a/l 0.5cm/<
|
$143.25 |
$143.25 |
$143.25 |
$311.25
|
|
Shave sgl skin lsn t/a/l 0.6-1.0cm
|
$112.50 |
$112.50 |
$112.50 |
$231.52
|
|
Shave sgl skin lsn t/a/l 1.1-2.0cm
|
$185.25 |
$185.25 |
$185.25 |
$304.50
|
|
Shoulder Arthroscopy (Rotator Cuff Repair)
|
$1,077.00 |
$1,077.00 |
$1,077.00 |
$5,272.00
|
|
Shoulder MRI (without contrast)
|
$81.75 |
$81.75 |
$81.75 |
$1,938.28
|
|
Shoulder X-ray
|
$72.00 |
$72.00 |
$72.00 |
$307.20
|
|
Sinus CT scan (with and without contrast)
|
$83.25 |
$83.25 |
$83.25 |
$1,610.70
|
|
Sinus CT scan (without contrast)
|
$66.75 |
$66.75 |
$66.75 |
$1,151.00
|
|
Skin Biopsy
|
$181.50 |
$181.50 |
$181.50 |
$362.40
|
|
Skin test unlisted antigen ea
|
$8.25 |
$8.25 |
$8.25 |
$43.80
|
|
Sleep Study (Polysomnography)
|
$265.50 |
$265.50 |
$265.50 |
$4,043.20
|
|
Sling arm deluxe w/pad xs
|
$21.00 |
$21.00 |
$21.00 |
$37.80
|
|
Smear gram stain
|
$17.25 |
$17.25 |
$17.25 |
$48.00
|
|
Smear nasal eosinophil
|
$18.00 |
$18.00 |
$18.00 |
$50.00
|
|
Smear wet mount
|
$44.25 |
$44.25 |
$44.25 |
$56.13
|
|
Sodium 24 hour urine
|
$15.00 |
$15.00 |
$15.00 |
$47.25
|
|
Sodium hyaluronate 20 mg/2 ml syringe
|
$250.50 |
$250.50 |
$250.50 |
$651.32
|
|
Sodium serum/plasma/whole blood
|
$23.25 |
$23.25 |
$23.25 |
$42.43
|
|
Sperm isolation simple
|
$45.00 |
$45.00 |
$45.00 |
$126.05
|
|
Spirometry bronchodilation responsiveness pre/post bronchodilator administration
|
$111.75 |
$111.75 |
$111.75 |
$526.80
|
|
Splint finger 4 prong foam sm
|
$15.75 |
$15.75 |
$15.75 |
$20.80
|
|
Strapping of ankle and/or ft 29540
|
$63.00 |
$63.00 |
$63.00 |
$185.36
|
|
Strapping of elbow or wrist 29260
|
$124.50 |
$124.50 |
$124.50 |
$176.31
|
|
Strep a ag ia
|
$39.75 |
$39.75 |
$39.75 |
$75.40
|
|
Streptomycin injection
|
$23.25 |
$23.25 |
$23.25 |
$26.21
|
|
Stress test pulmonary
|
$49.50 |
$49.50 |
$49.50 |
$330.63
|
|
Sumatriptan 6 mg/0.5 ml subcutaneous solution
|
$144.00 |
$144.00 |
$144.00 |
$52.49
|
|
Susceptibility mic per plate
|
$34.50 |
$34.50 |
$34.50 |
$89.70
|
|
Synvisc or synvisc-one
|
$296.25 |
$296.25 |
$296.25 |
$1,053.54
|
|
T3 (triiodothyronine) free
|
$23.25 |
$23.25 |
$23.25 |
$91.20
|
|
T3 (triiodothyronine) total
|
$112.50 |
$112.50 |
$112.50 |
$88.00
|
|
T4 (thyroxine) free
|
$23.25 |
$23.25 |
$23.25 |
$65.00
|
|
T4 (thyroxine) total
|
$22.50 |
$22.50 |
$22.50 |
$62.40
|
|
Tacrolimus therapeutic drug level
|
$121.50 |
$121.50 |
$121.50 |
$137.15
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$263.25 |
$263.25 |
$263.25 |
$178.40
|
|
T cells absolute cd 4 count
|
$109.50 |
$109.50 |
$109.50 |
$120.25
|
|
Telehealth original site facility fee
|
$38.25 |
$38.25 |
$38.25 |
$55.65
|
|
Tetanus immune globulin inj
|
$281.25 |
$281.25 |
$281.25 |
$1,073.02
|
|
Theophylline therapeutic drug level
|
$41.25 |
$41.25 |
$41.25 |
$101.40
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$9.75 |
$9.75 |
$9.75 |
$25.80
|
|
Thrombin time
|
$58.50 |
$58.50 |
$58.50 |
$53.50
|
|
Thromboplastin time partial (ptt) substitution fractions each
|
$58.50 |
$58.50 |
$58.50 |
$56.93
|
|
Thyroglobulin antibody
|
$99.00 |
$99.00 |
$99.00 |
$86.40
|
|
Thyroid (TSH) Test
|
$50.25 |
$50.25 |
$50.25 |
$101.40
|
|
Thyroid Ultrasound
|
$33.75 |
$33.75 |
$33.75 |
$553.80
|
|
Thyroxine binding globulin (tbg)
|
$95.25 |
$95.25 |
$95.25 |
$75.00
|
|
Tissue exam koh skin/hair/nails
|
$30.00 |
$30.00 |
$30.00 |
$45.23
|
|
Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr
|
$6.75 |
$6.75 |
$6.75 |
$72.00
|
|
Total hysterectomy
|
$2,754.00 |
$2,754.00 |
$2,754.00 |
$2,520.80
|
|
Total Knee Replacement
|
$2,115.75 |
$2,115.75 |
$2,115.75 |
$6,891.87
|
|
Toxoplasma antibody igg
|
$82.50 |
$82.50 |
$82.50 |
$83.20
|
|
Transferrin
|
$39.00 |
$39.00 |
$39.00 |
$83.07
|
|
Treat finger fracture each
|
$707.25 |
$707.25 |
$707.25 |
$1,808.00
|
|
Treatment inhalation pressurized/nonpressurized acute airway obstruction
|
$18.75 |
$18.75 |
$18.75 |
$197.60
|
|
Treatment of ankle fracture 27786
|
$213.00 |
$213.00 |
$213.00 |
$575.25
|
|
Treatment of heel fracture 28400
|
$295.50 |
$295.50 |
$295.50 |
$469.60
|
|
Treatment of toe fracture 28510
|
$144.00 |
$144.00 |
$144.00 |
$362.00
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$90.58 |
$90.58 |
$90.58 |
$28.90
|
|
Triglycerides
|
$21.75 |
$21.75 |
$21.75 |
$48.75
|
|
Trim nondyst nails
|
$14.25 |
$14.25 |
$14.25 |
$124.22
|
|
Troponin quantitative
|
$38.25 |
$38.25 |
$38.25 |
$112.80
|
|
Tx closed hip disl traumatic without anes
|
$395.25 |
$395.25 |
$395.25 |
$650.45
|
|
Ua w/micro/comp poc
|
$12.00 |
$12.00 |
$12.00 |
$25.72
|
|
Ultrasound abdomen aorta screening study aaa
|
$33.00 |
$33.00 |
$33.00 |
$394.20
|
|
Ultrasound chest
|
$273.75 |
$273.75 |
$273.75 |
$430.10
|
|
Ultrasound joint complete left
|
$35.25 |
$35.25 |
$35.25 |
$534.00
|
|
Ultrasound joint/nonvascular extremity limited left
|
$24.00 |
$24.00 |
$24.00 |
$426.60
|
|
Ultrasound scrotum and contents
|
$39.00 |
$39.00 |
$39.00 |
$558.03
|
|
Ultrasound transvaginal non obstetric
|
$41.25 |
$41.25 |
$41.25 |
$523.20
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$94.50 |
$94.50 |
$94.50 |
$1,794.00
|
|
Urea nitrogen
|
$21.75 |
$21.75 |
$21.75 |
$38.25
|
|
Uric acid blood
|
$21.75 |
$21.75 |
$21.75 |
$44.00
|
