|
Succinylcholine chloride 20 mg/ml injection solution (wrapper)
|
$25.91 |
$25.91 |
$25.91 |
$49.13
|
|
Sumatriptan 6 mg/0.5 ml subcutaneous solution
|
$1,134.14 |
$1,134.14 |
$1,134.14 |
$91.67
|
|
Surgical pathology level 1 gross examination only
|
$320.06 |
$320.06 |
$320.06 |
$92.59
|
|
Surgical pathology level 2 gross & microscopic examination
|
$731.85 |
$731.85 |
$731.85 |
$149.76
|
|
Surgical pathology level 3 gross & microscopic examination
|
$867.29 |
$867.29 |
$867.29 |
$192.00
|
|
Surgical pathology level 4 gross & microscopic examination
|
$1,004.92 |
$1,004.92 |
$1,004.92 |
$253.75
|
|
Surgical pathology level 5 gross & microscopic examination
|
$2,373.59 |
$2,373.59 |
$2,373.59 |
$494.00
|
|
Surgical pathology level 6 gross & microscopic examination
|
$2,838.67 |
$2,838.67 |
$2,838.67 |
$790.00
|
|
Suscept studies macrobroth dilution ea
|
$1,650.70 |
$1,650.70 |
$1,650.70 |
$48.30
|
|
Svc venogram s&i
|
$5,111.17 |
$5,111.17 |
$5,111.17 |
$1,908.00
|
|
Sweat collection by iontophoresis
|
$1,988.87 |
$1,988.87 |
$1,988.87 |
$105.21
|
|
Syphilis test non-treponemal antibody quantitative rpr
|
$141.85 |
$141.85 |
$141.85 |
$44.85
|
|
T3 (triiodothyronine) free
|
$561.00 |
$561.00 |
$561.00 |
$89.82
|
|
T3 (triiodothyronine) total
|
$556.87 |
$556.87 |
$556.87 |
$94.90
|
|
T4 (thyroxine) total
|
$556.87 |
$556.87 |
$556.87 |
$73.64
|
|
Tacrolimus 1 mg capsule, immediate-release
|
$57.50 |
$57.50 |
$57.50 |
$9.99
|
|
Tacrolimus therapeutic drug level
|
$514.60 |
$514.60 |
$514.60 |
$122.40
|
|
Target gsa panel hmtlmph neop
|
$6,210.61 |
$6,210.61 |
$6,210.61 |
$1,928.40
|
|
Target gsa panel organ neop
|
$6,484.49 |
$6,484.49 |
$6,484.49 |
$1,913.00
|
|
Tb test cell mediated immunity antigen response enumeration gamma interferon t-cells
|
$179.01 |
$179.01 |
$179.01 |
$200.00
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$669.49 |
$669.49 |
$669.49 |
$166.46
|
|
Tc-99m bicisate
|
$7,730.47 |
$7,730.47 |
$7,730.47 |
$1,969.45
|
|
Tc-99m exametazime diag
|
$11,968.20 |
$11,968.20 |
$11,968.20 |
$2,166.26
|
|
Tc-99m pentetate dtpa
|
$1,287.91 |
$1,287.91 |
$1,287.91 |
$245.85
|
|
Tc-99m pertechnetate per mci
|
$3,912.36 |
$3,912.36 |
$3,912.36 |
$28.08
|
|
Tc-99m pyroph diag per dose up to 25 mci
|
$1,287.91 |
$1,287.91 |
$1,287.91 |
$147.24
|
|
Tc-99m succimer (dmsa)
|
$3,809.82 |
$3,809.82 |
$3,809.82 |
$1,578.33
|
|
T cells absolute cd4/cd8 including ratio
|
$776.93 |
$776.93 |
$776.93 |
$186.00
|
|
T cells absolute cd 4 count
|
$1,735.70 |
$1,735.70 |
$1,735.70 |
$120.25
|
|
T cells total count
|
$132.63 |
$132.63 |
$132.63 |
$124.11
|
|
Telethx isodose plan cplx
|
$17,958.88 |
$17,958.88 |
$17,958.88 |
$1,617.00
|
|
Telethx isodose plan simple
|
$9,787.63 |
$9,787.63 |
$9,787.63 |
$848.72
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$482.32 |
$482.32 |
$482.32 |
$44.49
|
|
Tert gene targeted seq alys
|
$531.52 |
$531.52 |
$531.52 |
$304.59
|
|
Test for porphobilinogen
|
$395.69 |
$395.69 |
$395.69 |
$33.57
|
|
Tetanus immune globulin inj
|
$854.52 |
$854.52 |
$854.52 |
$1,395.20
|
|
Theophylline therapeutic drug level
|
$574.41 |
$574.41 |
$574.41 |
$108.00
|
|
Therapeutic procd strg endur
|
$118.95 |
$118.95 |
$118.95 |
$81.36
|
|
Ther/proph/diag inj ia
|
$119.30 |
$119.30 |
$119.30 |
$247.33
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$71.75 |
$71.75 |
$71.75 |
$38.64
|
|
Thromboplastin time partial (ptt) substitution fractions each
|
$882.30 |
$882.30 |
$882.30 |
$56.93
|
|
Thromboxane urine
|
$164.17 |
$164.17 |
$164.17 |
$52.22
|
|
Thyroglobulin antibody
|
$1,173.67 |
$1,173.67 |
$1,173.67 |
$84.00
|
|
Thyroid imaging
|
$5,144.34 |
$5,144.34 |
$5,144.34 |
$670.80
|
|
Thyroid mets imag whole body
|
$7,037.31 |
$7,037.31 |
$7,037.31 |
$1,524.99
|
|
Thyroid uptake measurement
|
$3,092.83 |
$3,092.83 |
$3,092.83 |
$653.60
|
|
Thyrotropin alfa 0.9 mg intramuscular solution
|
$14,707.95 |
$14,707.95 |
$14,707.95 |
$4,886.55
|
|
Thyroxine binding globulin (tbg)
|
$708.76 |
$708.76 |
$708.76 |
$63.60
|
|
Tigecycline injection
|
$866.22 |
$866.22 |
$866.22 |
$308.75
|
|
Tissue culture skin/biopsy
|
$1,591.54 |
$1,591.54 |
$1,591.54 |
$558.87
|
|
Tissue culture tumor
|
$1,668.40 |
$1,668.40 |
$1,668.40 |
$529.23
|
|
Tissue exam koh skin/hair/nails
|
$280.04 |
$280.04 |
$280.04 |
$47.40
|
|
Tl-201 thallium diag per mci
|
$1,287.91 |
$1,287.91 |
$1,287.91 |
$77.22
|
|
Tobramycin non-comp unit
|
$1,121.51 |
$1,121.51 |
$1,121.51 |
$107.07
|
|
Tobramycin peak therapeutic drug level
|
$565.12 |
$565.12 |
$565.12 |
$121.55
|
|
Toxoplasma antibody igg
|
$642.64 |
$642.64 |
$642.64 |
$84.35
|
|
Toxoplasma antibody igm
|
$642.64 |
$642.64 |
$642.64 |
$83.20
|
|
Tranexamic acid 1,000 mg/10 ml (100 mg/ml) intravenous solution
|
$230.42 |
$230.42 |
$230.42 |
$82.60
|
|
Transcatheter bx s&i
|
$5,276.40 |
$5,276.40 |
$5,276.40 |
$1,875.96
|
|
Transferrin
|
$481.81 |
$481.81 |
$481.81 |
$87.30
|
|
Transfusion blood/blood component(s)
|
$1,503.04 |
$1,503.04 |
$1,503.04 |
$988.24
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$237.81 |
$237.81 |
$237.81 |
$241.15
|
|
Treprostinil injection
|
$841.84 |
$841.84 |
$841.84 |
$528.60
|
|
Trg gene rearrangement anal
|
$954.88 |
$954.88 |
$954.88 |
$455.70
|
|
Trichinella antibody
|
$501.09 |
$501.09 |
$501.09 |
$70.65
|
|
Trimethobenzamide hcl inj
|
$200.72 |
$200.72 |
$200.72 |
$154.09
|
|
Tte w or without fol w/con,stres
|
$5,650.50 |
$5,650.50 |
$5,650.50 |
$1,446.48
|
|
Tx atrial fib pulm vein isol
|
$139,554.78 |
$139,554.78 |
$139,554.78 |
$32,426.20
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$528.45 |
$528.45 |
$528.45 |
$340.14
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$3,174.51 |
$3,174.51 |
$3,174.51 |
$477.88
|
|
Ultrasound nrv&acc strux 1xtr compre
|
$355.67 |
$355.67 |
$355.67 |
$280.02
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$3,662.97 |
$3,662.97 |
$3,662.97 |
$690.48
|
|
Unlisted mr procedure
|
$17,056.88 |
$17,056.88 |
$17,056.88 |
$1,032.20
|
|
Unsched dialysis esrd pt hos
|
$14,230.81 |
$14,230.81 |
$14,230.81 |
$1,505.29
|
|
Urea nitrogen 24 hour urine
|
$241.76 |
$241.76 |
$241.76 |
$50.00
|
|
Urea nitrogen clearance
|
$627.14 |
$627.14 |
$627.14 |
$33.57
|
|
Ureteral reflux study
|
$12,688.30 |
$12,688.30 |
$12,688.30 |
$961.20
|
|
Urinalysis microscopic only
|
$299.49 |
$299.49 |
$299.49 |
$26.35
|
|
Urinalysis qual/semiquant excpt ia
|
$49.88 |
$49.88 |
$49.88 |
$25.72
|
|
Vaccine dtap < 7 years im
|
$218.97 |
$218.97 |
$218.97 |
$87.80
|
|
Vaccine dtap-ipv/hib im
|
$714.96 |
$714.96 |
$714.96 |
$248.80
|
|
Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im
|
$518.71 |
$518.71 |
$518.71 |
$85.00
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$518.71 |
$518.71 |
$518.71 |
$45.33
|
|
Vaccine hepatitis a (hepa) adult im
|
$1,376.78 |
$1,376.78 |
$1,376.78 |
$178.07
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im
|
$747.33 |
$747.33 |
$747.33 |
$84.38
|
|
Vaccine hepatitis b (hepb) adolescent 2 dose im
|
$707.69 |
$707.69 |
$707.69 |
$61.50
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$707.69 |
$707.69 |
$707.69 |
$173.98
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$317.80 |
$317.80 |
$317.80 |
$79.04
|
|
Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im
|
$2,338.41 |
$2,338.41 |
$2,338.41 |
$686.67
|
|
Vaccine mengingoccocal serogroup b 2 or 3 dose im
|
$1,852.26 |
$1,852.26 |
$1,852.26 |
$426.80
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$1,369.95 |
$1,369.95 |
$1,369.95 |
$408.70
|
|
Vaccine mmr live subcutaneous
|
$771.71 |
$771.71 |
$771.71 |
$224.04
|
|
Vaccine pneumococcal conjugate 13 valent (pcv13) im
|
$1,288.11 |
$1,288.11 |
$1,288.11 |
$397.18
|
|
Vaccine pneumonococcal conjugate 15 valent (pcv15) im
|
$2,029.14 |
$2,029.14 |
$2,029.14 |
$385.45
|
|
Vaccine polio (ipv) subcutaneous/im
|
$470.61 |
$470.61 |
$470.61 |
$119.17
|
|
Vaccine rabies im
|
$2,316.06 |
$2,316.06 |
$2,316.06 |
$945.46
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 0.5 ml im
|
$2,419.49 |
$2,419.49 |
$2,419.49 |
$1,196.00
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 1 ml im
|
$2,419.49 |
$2,419.49 |
$2,419.49 |
$1,159.00
|
|
Vaccine td preservative free >= 7 years im
|
$572.91 |
$572.91 |
$572.91 |
$131.77
|
|
Vaccine varicella live subcutaneous
|
$2,134.83 |
$2,134.83 |
$2,134.83 |
$447.80
|
