|
Scan duplex extremity veins unilateral/limited study
|
$444.86 |
$444.86 |
$444.86 |
$691.07
|
|
Scan duplex lower extremity arteries complete bilateral
|
$389.69 |
$389.69 |
$389.69 |
$957.18
|
|
Scan duplex lower extremity arteries unilateral/limited study left
|
$418.47 |
$418.47 |
$418.47 |
$612.00
|
|
Scan duplex upper extremity arteries unilateral/limited study left
|
$366.44 |
$366.44 |
$366.44 |
$527.80
|
|
Screening Colonoscopy (average risk)
|
$1,093.16 |
$1,093.16 |
$1,093.16 |
$1,093.16
|
|
Screening Colonoscopy (high risk)
|
$1,093.16 |
$1,093.16 |
$1,093.16 |
$1,575.00
|
|
Screening Mammogram
|
$189.54 |
$189.54 |
$189.54 |
$287.12
|
|
Screen pap by tech w md supv
|
$27.65 |
$27.65 |
$27.65 |
$27.65
|
|
Semen analysis presence/motility
|
$51.29 |
$51.29 |
$51.29 |
$79.92
|
|
Shoulder MRI (with and without contrast)
|
$1,138.83 |
$1,138.83 |
$1,138.83 |
$2,628.75
|
|
Shoulder MRI (with contrast)
|
$972.71 |
$972.71 |
$972.71 |
$2,353.60
|
|
Shoulder MRI (without contrast)
|
$936.15 |
$936.15 |
$936.15 |
$1,938.28
|
|
Shoulder X-ray
|
$150.29 |
$150.29 |
$150.29 |
$307.20
|
|
Shuntogram nonvascular supervision & interpretation
|
$142.49 |
$142.49 |
$142.49 |
$342.54
|
|
Sickling rbc
|
$156.71 |
$156.71 |
$156.71 |
$53.40
|
|
Sigmoidoscopy and biopsy
|
$672.75 |
$672.75 |
$672.75 |
$1,351.63
|
|
Sigmoidoscopy flex decompression 45337
|
$672.75 |
$672.75 |
$672.75 |
$1,009.14
|
|
Sigmoidoscopy for bleeding
|
$1,093.16 |
$1,093.16 |
$1,093.16 |
$1,594.50
|
|
Sigmoidoscopy/submucosal injection 45335
|
$672.75 |
$672.75 |
$672.75 |
$1,278.72
|
|
Sigmoidoscopy w/ablation
|
$1,093.16 |
$1,093.16 |
$1,093.16 |
$2,604.00
|
|
Sigmoidoscopy w/fb removal 45332
|
$672.75 |
$672.75 |
$672.75 |
$1,370.25
|
|
Sigmoidoscopy w/plcmt stent
|
$2,859.02 |
$2,859.02 |
$2,859.02 |
$4,379.25
|
|
Sigmoidoscopy w/tumr remove
|
$1,093.16 |
$1,093.16 |
$1,093.16 |
$1,350.83
|
|
Sigmoidoscopy w/ultrasound
|
$1,093.16 |
$1,093.16 |
$1,093.16 |
$1,233.60
|
|
Sigmoidoscopy w/us guide bx
|
$1,093.16 |
$1,093.16 |
$1,093.16 |
$1,388.56
|
|
Sigmoid/rmv tumor/polyp/hot bx for 45333
|
$1,093.16 |
$1,093.16 |
$1,093.16 |
$1,183.20
|
|
Sig w/tndsc balloon dilation
|
$1,093.16 |
$1,093.16 |
$1,093.16 |
$1,364.66
|
|
Sincalide 5 mcg solution for injection
|
$280.40 |
$280.40 |
$280.40 |
$309.14
|
|
Sinus CT scan (with and without contrast)
|
$691.10 |
$691.10 |
$691.10 |
$1,610.70
|
|
Sinus CT scan (with contrast)
|
$622.91 |
$622.91 |
$622.91 |
$1,419.18
|
|
Sinus CT scan (without contrast)
|
$554.03 |
$554.03 |
$554.03 |
$1,151.00
|
|
Small bowel endoscopy
|
$1,261.31 |
$1,261.31 |
$1,261.31 |
$2,200.46
|
|
Small bowel endoscopy
|
$1,261.31 |
$1,261.31 |
$1,261.31 |
$2,101.52
|
|
Small bowel endoscopy
|
$1,261.31 |
$1,261.31 |
$1,261.31 |
$2,455.20
|
|
Small bowel endoscopy
|
$1,261.31 |
$1,261.31 |
$1,261.31 |
$2,101.52
|
|
Small bowel endoscopy
|
$1,261.31 |
$1,261.31 |
$1,261.31 |
$2,200.46
|
|
Small bowel endoscopy
|
$1,261.31 |
$1,261.31 |
$1,261.31 |
$1,104.13
|
|
Small bowel endoscopy >2nd w/remove 44363
|
$1,261.31 |
$1,261.31 |
$1,261.31 |
$2,101.52
|
|
Small bowel endoscopy 44365
|
$1,261.31 |
$1,261.31 |
$1,261.31 |
$2,073.18
|
|
Small bowel endoscopy/biopsy
|
$1,261.31 |
$1,261.31 |
$1,261.31 |
$2,178.16
|
|
Small bowel endoscopy br/wa
|
$1,261.31 |
$1,261.31 |
$1,261.31 |
$1,247.13
|
|
Small bowel endoscopy br/wa
|
$1,201.25 |
$1,201.25 |
$1,201.25 |
$2,218.50
|
|
Smear fluorescent and/or acid fast stain
|
$46.43 |
$46.43 |
$46.43 |
$50.70
|
|
Smear gram stain
|
$41.27 |
$41.27 |
$41.27 |
$48.00
|
|
Smear special stain inclusion bodies/parasites
|
$58.32 |
$58.32 |
$58.32 |
$60.00
|
|
Smear wet mount
|
$42.57 |
$42.57 |
$42.57 |
$56.13
|
|
Sodium 24 hour urine
|
$40.10 |
$40.10 |
$40.10 |
$47.25
|
|
Sodium chloride 0.9 % intravenous solution
|
$46.35 |
$46.35 |
$46.35 |
$46.35
|
|
Sodium chloride 0.9 % IV bolus
|
$46.35 |
$46.35 |
$46.35 |
$42.25
|
|
Sodium chloride 0.9 % IV bolus
|
$46.35 |
$46.35 |
$46.35 |
$42.25
|
|
Sodium ferric gluconate complex in sucrose 62.5 mg/5 ml intravenous
|
$13.67 |
$13.67 |
$13.67 |
$28.46
|
|
Sodium serum/plasma/whole blood
|
$26.93 |
$26.93 |
$26.93 |
$42.43
|
|
Specific gravity body fluid
|
$29.67 |
$29.67 |
$29.67 |
$21.55
|
|
Spirometry bronchodilation responsiveness pre/post bronchodilator administration
|
$536.34 |
$536.34 |
$536.34 |
$526.80
|
|
Staph a dna amp probe
|
$94.53 |
$94.53 |
$94.53 |
$116.39
|
|
St evaluate speech sound production comprehensive/expressive
|
$148.26 |
$148.26 |
$148.26 |
$387.00
|
|
St evaluation motion fluoroscopic swallow function cine/video
|
$161.94 |
$161.94 |
$161.94 |
$336.00
|
|
St evaluation swallow function
|
$154.29 |
$154.29 |
$154.29 |
$323.72
|
|
Stress test pulmonary
|
$118.40 |
$118.40 |
$118.40 |
$330.63
|
|
St treatment speech individual
|
$76.77 |
$76.77 |
$76.77 |
$246.87
|
|
St treatment swallow dysfunction/oral
|
$112.47 |
$112.47 |
$112.47 |
$221.00
|
|
Succinylcholine chloride 20 mg/ml injection solution (wrapper)
|
$5.33 |
$5.33 |
$5.33 |
$22.19
|
|
Sumatriptan 6 mg/0.5 ml subcutaneous solution
|
$23.64 |
$23.64 |
$23.64 |
$52.49
|
|
Surg dx exam anorectal
|
$2,363.76 |
$2,363.76 |
$2,363.76 |
$2,814.85
|
|
Surgical pathology level 1 gross examination only
|
$30.20 |
$30.20 |
$30.20 |
$81.00
|
|
Surgical pathology level 2 gross & microscopic examination
|
$65.42 |
$65.42 |
$65.42 |
$138.00
|
|
Surgical pathology level 3 gross & microscopic examination
|
$104.06 |
$104.06 |
$104.06 |
$181.00
|
|
Surgical pathology level 4 gross & microscopic examination
|
$112.20 |
$112.20 |
$112.20 |
$239.85
|
|
Surgical pathology level 5 gross & microscopic examination
|
$161.76 |
$161.76 |
$161.76 |
$489.00
|
|
Surgical pathology level 6 gross & microscopic examination
|
$368.46 |
$368.46 |
$368.46 |
$720.75
|
|
Susceptibility enzyme detection per enzyme
|
$46.89 |
$46.89 |
$46.89 |
$31.85
|
|
Susceptibility mic per plate
|
$107.91 |
$107.91 |
$107.91 |
$89.70
|
|
Suscept studies macrobroth dilution ea
|
$67.58 |
$67.58 |
$67.58 |
$47.17
|
|
Syphilis test non-treponemal antibody quantitative rpr
|
$118.29 |
$118.29 |
$118.29 |
$45.70
|
|
T3 (triiodothyronine) free
|
$82.88 |
$82.88 |
$82.88 |
$91.20
|
|
T3 (triiodothyronine) total
|
$52.46 |
$52.46 |
$52.46 |
$88.00
|
|
T4 (thyroxine) free
|
$161.18 |
$161.18 |
$161.18 |
$65.00
|
|
T4 (thyroxine) total
|
$44.97 |
$44.97 |
$44.97 |
$62.40
|
|
Tacrolimus 1 mg capsule, immediate-release
|
$3.48 |
$3.48 |
$3.48 |
$4.87
|
|
Tacrolimus therapeutic drug level
|
$173.70 |
$173.70 |
$173.70 |
$137.15
|
|
Target gsa panel hmtlmph neop
|
$4,117.83 |
$4,117.83 |
$4,117.83 |
$1,928.40
|
|
Tbo-filgrastim 300 mcg/0.5 ml subcutaneous syringe
|
$1.79 |
$1.79 |
$1.79 |
$760.95
|
|
Tbs techl calculation only
|
$129.47 |
$129.47 |
$129.47 |
$119.66
|
|
Tbs techl prep&transmis data
|
$129.47 |
$129.47 |
$129.47 |
$105.08
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$166.46 |
$166.46 |
$166.46 |
$178.40
|
|
Tc-99m exame autol wbc diag per dose
|
$3,612.06 |
$3,612.06 |
$3,612.06 |
$2,393.40
|
|
Tc-99m maa
|
$267.74 |
$267.74 |
$267.74 |
$306.60
|
|
Tc-99m mebrofenin
|
$99.54 |
$99.54 |
$99.54 |
$169.53
|
|
Tc-99m medronate
|
$39.09 |
$39.09 |
$39.09 |
$120.35
|
|
Tc-99m mertiatide
|
$554.84 |
$554.84 |
$554.84 |
$757.25
|
|
Tc-99m pentetate dtpa
|
$161.52 |
$161.52 |
$161.52 |
$222.60
|
|
Tc-99m pentetate dtpa aerosol
|
$181.37 |
$181.37 |
$181.37 |
$231.60
|
|
Tc-99m pertechnetate per mci
|
$49.20 |
$49.20 |
$49.20 |
$22.10
|
|
Tc-99m pyroph diag per dose up to 25 mci
|
$77.01 |
$77.01 |
$77.01 |
$137.01
|
|
Tc-99m sestamibi p study dose
|
$251.54 |
$251.54 |
$251.54 |
$221.60
|
|
Tc-99m sulfur colloid
|
$229.64 |
$229.64 |
$229.64 |
$240.50
|
|
Tc-99m tilmanocept diag
|
$1,108.52 |
$1,108.52 |
$1,108.52 |
$1,007.79
|
|
T cells absolute cd4/cd8 including ratio
|
$255.24 |
$255.24 |
$255.24 |
$189.60
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$213.27 |
$213.27 |
$213.27 |
$16,233.59
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$8.60 |
$8.60 |
$8.60 |
$39.33
|