|
Screening Mammogram
|
$908.00 |
$908.00 |
$908.00 |
$310.20
|
|
Screening prostate cancer PSA
|
$927.00 |
$927.00 |
$927.00 |
$101.60
|
|
Scrotal (Testicle) Ultrasound
|
$6,081.00 |
$6,081.00 |
$6,081.00 |
$611.91
|
|
Sedimentation rate erythrocyte automated
|
$980.00 |
$980.00 |
$980.00 |
$42.00
|
|
Self-Care and Home Skills Training (each 15 minutes)
|
$271.00 |
$271.00 |
$271.00 |
$96.00
|
|
Serpina1 gene
|
$570.15 |
$570.15 |
$570.15 |
$197.00
|
|
Shuntogram nonvascular supervision & interpretation
|
$1,847.00 |
$1,847.00 |
$1,847.00 |
$355.80
|
|
Sickling rbc
|
$4.00 |
$4.00 |
$4.00 |
$59.40
|
|
Sincalide 5 mcg solution for injection
|
$392.00 |
$392.00 |
$392.00 |
$309.14
|
|
Small Bowel Barium X-ray (Follow-Through)
|
$7,145.00 |
$7,145.00 |
$7,145.00 |
$557.70
|
|
Smear special stain inclusion bodies/parasites
|
$12.00 |
$12.00 |
$12.00 |
$73.50
|
|
Sodium 24 hour urine
|
$243.00 |
$243.00 |
$243.00 |
$48.98
|
|
Sodium chloride 0.9 % intravenous solution
|
$534.00 |
$534.00 |
$534.00 |
$49.07
|
|
Sodium chloride 0.9 % IV bolus
|
$609.00 |
$609.00 |
$609.00 |
$45.62
|
|
Sodium ferric gluconate complex in sucrose 62.5 mg/5 ml intravenous
|
$397.00 |
$397.00 |
$397.00 |
$80.14
|
|
Sodium serum/plasma/whole blood
|
$334.00 |
$334.00 |
$334.00 |
$46.26
|
|
Speech and Language Evaluation (comprehensive)
|
$1,844.00 |
$1,844.00 |
$1,844.00 |
$384.80
|
|
Speech Therapy Session (one-on-one)
|
$543.00 |
$543.00 |
$543.00 |
$246.87
|
|
Split blood or products
|
$25.00 |
$25.00 |
$25.00 |
$127.80
|
|
St analysis behavior qualitative voice/resonance
|
$676.00 |
$676.00 |
$676.00 |
$297.60
|
|
St evaluate speech sound production
|
$1,395.00 |
$1,395.00 |
$1,395.00 |
$292.95
|
|
St evaluation motion fluoroscopic swallow function cine/video
|
$1,150.00 |
$1,150.00 |
$1,150.00 |
$400.00
|
|
Stomach Emptying Scan (Nuclear Medicine)
|
$11,832.00 |
$11,832.00 |
$11,832.00 |
$1,345.40
|
|
Stress test pulmonary
|
$494.00 |
$494.00 |
$494.00 |
$324.00
|
|
Succinylcholine chloride 20 mg/ml injection solution (wrapper)
|
$13.00 |
$13.00 |
$13.00 |
$54.80
|
|
Sulfamethoxazole 400 mg-trimethoprim 80 mg/5 ml intravenous solution
|
$1,070.00 |
$1,070.00 |
$1,070.00 |
$82.46
|
|
Sumatriptan 6 mg/0.5 ml subcutaneous solution
|
$1,485.00 |
$1,485.00 |
$1,485.00 |
$129.89
|
|
Surgical pathology level 1 gross examination only
|
$944.00 |
$944.00 |
$944.00 |
$81.00
|
|
Surgical pathology level 2 gross & microscopic examination
|
$1,251.00 |
$1,251.00 |
$1,251.00 |
$143.55
|
|
Surgical pathology level 3 gross & microscopic examination
|
$1,772.00 |
$1,772.00 |
$1,772.00 |
$184.21
|
|
Surgical pathology level 4 gross & microscopic examination
|
$2,703.00 |
$2,703.00 |
$2,703.00 |
$250.20
|
|
Surgical pathology level 5 gross & microscopic examination
|
$3,968.00 |
$3,968.00 |
$3,968.00 |
$480.60
|
|
Surgical pathology level 6 gross & microscopic examination
|
$4,591.00 |
$4,591.00 |
$4,591.00 |
$720.75
|
|
Surgigraft, 1 sq cm
|
$1.00 |
$1.00 |
$1.00 |
$1.00
|
|
Susceptibility enzyme detection per enzyme
|
$15.00 |
$15.00 |
$15.00 |
$35.89
|
|
Suscept studies macrobroth dilution ea
|
$265.00 |
$265.00 |
$265.00 |
$59.28
|
|
Swallowing Evaluation (Bedside)
|
$837.00 |
$837.00 |
$837.00 |
$316.80
|
|
Swallowing Therapy Session
|
$470.00 |
$470.00 |
$470.00 |
$232.56
|
|
T3 (triiodothyronine) free
|
$224.00 |
$224.00 |
$224.00 |
$100.32
|
|
T3 (triiodothyronine) total
|
$1,624.00 |
$1,624.00 |
$1,624.00 |
$93.52
|
|
T4 (thyroxine) free
|
$828.00 |
$828.00 |
$828.00 |
$89.60
|
|
T4 (thyroxine) total
|
$1,005.00 |
$1,005.00 |
$1,005.00 |
$70.20
|
|
Tacrolimus therapeutic drug level
|
$35.00 |
$35.00 |
$35.00 |
$122.50
|
|
Talymed
|
$1.00 |
$1.00 |
$1.00 |
$199.00
|
|
Tbo-filgrastim 300 mcg/0.5 ml subcutaneous syringe
|
$400.00 |
$400.00 |
$400.00 |
$937.50
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$46.00 |
$46.00 |
$46.00 |
$179.95
|
|
Tc-99m exametazime diag
|
$8,187.00 |
$8,187.00 |
$8,187.00 |
$2,135.70
|
|
Tc-99m labeled rbc
|
$68.00 |
$68.00 |
$68.00 |
$306.00
|
|
Tc-99m maa
|
$79.00 |
$79.00 |
$79.00 |
$312.06
|
|
Tc-99m mebrofenin
|
$247.00 |
$247.00 |
$247.00 |
$157.65
|
|
Tc-99m medronate
|
$1,004.00 |
$1,004.00 |
$1,004.00 |
$111.01
|
|
Tc-99m mertiatide
|
$639.00 |
$639.00 |
$639.00 |
$756.00
|
|
Tc-99m pentetate dtpa aerosol
|
$647.00 |
$647.00 |
$647.00 |
$191.50
|
|
Tc-99m pertechnetate per mci
|
$93.00 |
$93.00 |
$93.00 |
$18.67
|
|
Tc-99m pyroph diag per dose up to 25 mci
|
$2,519.00 |
$2,519.00 |
$2,519.00 |
$141.00
|
|
Tc-99m sestamibi p study dose
|
$6,651.00 |
$6,651.00 |
$6,651.00 |
$287.20
|
|
Tc-99m sulfur colloid
|
$1,482.00 |
$1,482.00 |
$1,482.00 |
$245.70
|
|
T cells absolute cd4/cd8 including ratio
|
$111.56 |
$111.56 |
$111.56 |
$184.00
|
|
T cells absolute cd 4 count
|
$86.00 |
$86.00 |
$86.00 |
$111.20
|
|
T cells total count
|
$122.00 |
$122.00 |
$122.00 |
$130.20
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$104.00 |
$104.00 |
$104.00 |
$39.33
|
|
Test for urine cystines
|
$29.53 |
$29.53 |
$29.53 |
$26.00
|
|
Test stress cardiovascular tracing only
|
$7,503.00 |
$7,503.00 |
$7,503.00 |
$953.40
|
|
Tetanus immune globulin inj
|
$1,405.00 |
$1,405.00 |
$1,405.00 |
$1,285.36
|
|
Theophylline therapeutic drug level
|
$561.00 |
$561.00 |
$561.00 |
$108.00
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$87.00 |
$87.00 |
$87.00 |
$25.54
|
|
Three-Phase Bone Scan (Nuclear Medicine)
|
$25,620.00 |
$25,620.00 |
$25,620.00 |
$1,703.45
|
|
Thrombin time
|
$243.00 |
$243.00 |
$243.00 |
$54.18
|
|
Thyroglobulin antibody
|
$70.00 |
$70.00 |
$70.00 |
$82.50
|
|
Thyroid imaging
|
$5,631.00 |
$5,631.00 |
$5,631.00 |
$695.60
|
|
Thyroid (TSH) Test
|
$1,950.00 |
$1,950.00 |
$1,950.00 |
$112.70
|
|
Thyroid Ultrasound
|
$6,870.00 |
$6,870.00 |
$6,870.00 |
$588.50
|
|
Thyroxine binding globulin (tbg)
|
$11.00 |
$11.00 |
$11.00 |
$64.51
|
|
Tigecycline injection
|
$437.00 |
$437.00 |
$437.00 |
$235.29
|
|
Tl-201 thallium diag per mci
|
$1,698.00 |
$1,698.00 |
$1,698.00 |
$80.10
|
|
Tobramycin non-comp unit
|
$930.00 |
$930.00 |
$930.00 |
$108.42
|
|
Tomosynthesis breast diagnostic left
|
$375.00 |
$375.00 |
$375.00 |
$74.10
|
|
Tomosynthesis breast screen bilateral
|
$375.00 |
$375.00 |
$375.00 |
$74.10
|
|
Toxoplasma antibody igg
|
$208.00 |
$208.00 |
$208.00 |
$91.65
|
|
Toxoplasma antibody igm
|
$208.00 |
$208.00 |
$208.00 |
$87.75
|
|
Tranexamic acid 1,000 mg/10 ml (100 mg/ml) intravenous solution
|
$18.46 |
$18.46 |
$18.46 |
$56.38
|
|
Transferrin
|
$701.00 |
$701.00 |
$701.00 |
$82.00
|
|
Transvaginal Pelvic Ultrasound (not pregnancy)
|
$6,345.00 |
$6,345.00 |
$6,345.00 |
$561.60
|
|
Transvaginal Pregnancy Ultrasound
|
$5,875.00 |
$5,875.00 |
$5,875.00 |
$499.20
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$162.00 |
$162.00 |
$162.00 |
$43.09
|
|
Trichomonas assay w/optic
|
$53.52 |
$53.52 |
$53.52 |
$57.40
|
|
Truskin, per sq centimeter
|
$1.00 |
$1.00 |
$1.00 |
$1.00
|
|
Ultrasound hips infant dynamic
|
$4,173.00 |
$4,173.00 |
$4,173.00 |
$403.88
|
|
Ultrasound joint complete left
|
$4,054.00 |
$4,054.00 |
$4,054.00 |
$557.99
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$1,796.00 |
$1,796.00 |
$1,796.00 |
$334.50
|
|
Ultrasound pregnant uterus follow up per fetus
|
$1,707.00 |
$1,707.00 |
$1,707.00 |
$425.60
|
|
Ultrasound spinal canal and contents
|
$6,222.00 |
$6,222.00 |
$6,222.00 |
$463.00
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$5,030.00 |
$5,030.00 |
$5,030.00 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$4,024.00 |
$4,024.00 |
$4,024.00 |
$2,369.00
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$3,354.00 |
$3,354.00 |
$3,354.00 |
$2,034.41
|
|
Upper GI Barium X-ray (barium and gas)
|
$9,020.00 |
$9,020.00 |
$9,020.00 |
$660.40
|
|
Upper GI Barium X-ray (barium only)
|
$9,402.00 |
$9,402.00 |
$9,402.00 |
$607.20
|
|
Urea nitrogen
|
$783.00 |
$783.00 |
$783.00 |
$42.25
|
|
Urea nitrogen 24 hour urine
|
$783.00 |
$783.00 |
$783.00 |
$52.00
|
|
Urethrocystography void s&i
|
$4,587.00 |
$4,587.00 |
$4,587.00 |
$631.40
|
