|
Smear wet mount
|
$679.72 |
$679.72 |
$679.72 |
$68.64
|
|
Sodium 24 hour urine
|
$827.46 |
$827.46 |
$827.46 |
$48.50
|
|
Sodium chloride 0.9 % intravenous solution
|
$129.59 |
$129.59 |
$129.59 |
$46.85
|
|
Sodium chloride 0.9 % IV bolus
|
$129.59 |
$129.59 |
$129.59 |
$51.51
|
|
Sodium serum/plasma/whole blood
|
$837.09 |
$837.09 |
$837.09 |
$43.00
|
|
Specific gravity body fluid
|
$401.42 |
$401.42 |
$401.42 |
$23.63
|
|
Specimen fat stain
|
$2.89 |
$2.89 |
$2.89 |
$32.76
|
|
Splint finger fold over sm
|
$67.10 |
$67.10 |
$67.10 |
$57.33
|
|
Sputum specimen collection
|
$3,901.00 |
$3,901.00 |
$3,901.00 |
$180.00
|
|
Succinylcholine chloride 20 mg/ml injection solution (wrapper)
|
$15.86 |
$15.86 |
$15.86 |
$49.13
|
|
Sulfamethoxazole 400 mg-trimethoprim 80 mg/5 ml intravenous solution
|
$85.10 |
$85.10 |
$85.10 |
$66.80
|
|
Surgical pathology level 1 gross examination only
|
$1,036.82 |
$1,036.82 |
$1,036.82 |
$92.95
|
|
Surgical pathology level 2 gross & microscopic examination
|
$1,489.96 |
$1,489.96 |
$1,489.96 |
$150.40
|
|
Surgical pathology level 3 gross & microscopic examination
|
$2,149.97 |
$2,149.97 |
$2,149.97 |
$195.06
|
|
Surgical pathology level 5 gross & microscopic examination
|
$3,364.09 |
$3,364.09 |
$3,364.09 |
$494.40
|
|
Surgical pathology level 6 gross & microscopic examination
|
$3,937.93 |
$3,937.93 |
$3,937.93 |
$791.85
|
|
Susceptibility agar dilution per agent
|
$861.96 |
$861.96 |
$861.96 |
$40.68
|
|
Syphilis test non-treponemal antibody quantitative rpr
|
$2.50 |
$2.50 |
$2.50 |
$44.85
|
|
T3 (triiodothyronine) free
|
$150.66 |
$150.66 |
$150.66 |
$89.82
|
|
T3 (triiodothyronine) total
|
$137.81 |
$137.81 |
$137.81 |
$93.60
|
|
T4 (thyroxine) free
|
$95.03 |
$95.03 |
$95.03 |
$83.65
|
|
T4 (thyroxine) total
|
$1,337.28 |
$1,337.28 |
$1,337.28 |
$73.64
|
|
Tacrolimus therapeutic drug level
|
$134.16 |
$134.16 |
$134.16 |
$122.50
|
|
Tbo-filgrastim 300 mcg/0.5 ml subcutaneous syringe
|
$19.50 |
$19.50 |
$19.50 |
$959.55
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$60.00 |
$60.00 |
$60.00 |
$166.46
|
|
Tc-99m bicisate
|
$3,567.60 |
$3,567.60 |
$3,567.60 |
$1,969.45
|
|
Tc-99m disofenin
|
$2,815.03 |
$2,815.03 |
$2,815.03 |
$151.32
|
|
Tc-99m exame autol wbc diag per dose
|
$7,841.89 |
$7,841.89 |
$7,841.89 |
$2,393.40
|
|
Tc-99m exametazime diag
|
$12,801.02 |
$12,801.02 |
$12,801.02 |
$2,166.26
|
|
Tc-99m maa
|
$1,457.80 |
$1,457.80 |
$1,457.80 |
$312.06
|
|
Tc-99m mebrofenin
|
$1,457.80 |
$1,457.80 |
$1,457.80 |
$169.53
|
|
Tc-99m medronate
|
$1,457.80 |
$1,457.80 |
$1,457.80 |
$122.46
|
|
Tc-99m mertiatide
|
$1,781.27 |
$1,781.27 |
$1,781.27 |
$757.25
|
|
Tc-99m oxidronate
|
$106.58 |
$106.58 |
$106.58 |
$124.23
|
|
Tc-99m pentetate dtpa
|
$1,457.80 |
$1,457.80 |
$1,457.80 |
$240.46
|
|
Tc-99m pertechnetate per mci
|
$15.90 |
$15.90 |
$15.90 |
$28.08
|
|
Tc-99m pyroph diag per dose up to 25 mci
|
$751.84 |
$751.84 |
$751.84 |
$147.24
|
|
Tc-99m sestamibi p study dose
|
$2,391.03 |
$2,391.03 |
$2,391.03 |
$221.60
|
|
Tc-99m succimer (dmsa)
|
$214.55 |
$214.55 |
$214.55 |
$1,578.33
|
|
Tc-99m sulfur colloid
|
$1,457.80 |
$1,457.80 |
$1,457.80 |
$245.70
|
|
Tc-99m tetrofosmin p study dose
|
$1,493.87 |
$1,493.87 |
$1,493.87 |
$198.05
|
|
T cells absolute cd4/cd8 including ratio
|
$78.29 |
$78.29 |
$78.29 |
$185.28
|
|
T cells absolute cd 4 count
|
$218.00 |
$218.00 |
$218.00 |
$120.25
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$24,680.81 |
$24,680.81 |
$24,680.81 |
$17,652.73
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$11.14 |
$11.14 |
$11.14 |
$44.76
|
|
Theophylline therapeutic drug level
|
$1,573.94 |
$1,573.94 |
$1,573.94 |
$108.00
|
|
Thrombin time
|
$5.00 |
$5.00 |
$5.00 |
$48.75
|
|
Thromboplastin time partial (ptt) substitution fractions each
|
$1,553.99 |
$1,553.99 |
$1,553.99 |
$57.17
|
|
Thyroglobulin antibody
|
$1.81 |
$1.81 |
$1.81 |
$84.00
|
|
Thyroid imaging
|
$5,345.96 |
$5,345.96 |
$5,345.96 |
$662.20
|
|
Thyroid (TSH) Test
|
$1,647.10 |
$1,647.10 |
$1,647.10 |
$118.80
|
|
Thyroid Ultrasound
|
$3,650.08 |
$3,650.08 |
$3,650.08 |
$586.95
|
|
Thyroid uptake measurement
|
$5,345.96 |
$5,345.96 |
$5,345.96 |
$619.20
|
|
Thyroxine binding globulin (tbg)
|
$11.50 |
$11.50 |
$11.50 |
$63.05
|
|
Tissue culture skin/biopsy
|
$958.50 |
$958.50 |
$958.50 |
$558.87
|
|
Tissue culture tumor
|
$158.48 |
$158.48 |
$158.48 |
$529.23
|
|
Tl-201 thallium diag per mci
|
$2,286.13 |
$2,286.13 |
$2,286.13 |
$77.22
|
|
Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr
|
$36.24 |
$36.24 |
$36.24 |
$131.70
|
|
Toxoplasma antibody igg
|
$139.65 |
$139.65 |
$139.65 |
$84.60
|
|
Toxoplasma antibody igm
|
$139.72 |
$139.72 |
$139.72 |
$84.00
|
|
Tranexamic acid 1,000 mg/10 ml (100 mg/ml) intravenous solution
|
$19.50 |
$19.50 |
$19.50 |
$82.60
|
|
Transferrin
|
$126.13 |
$126.13 |
$126.13 |
$85.56
|
|
Treponema pallidum antibody
|
$9.81 |
$9.81 |
$9.81 |
$72.80
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$171.66 |
$171.66 |
$171.66 |
$45.75
|
|
Trichinella antibody
|
$91.08 |
$91.08 |
$91.08 |
$72.15
|
|
Triglycerides
|
$452.41 |
$452.41 |
$452.41 |
$54.60
|
|
Troponin quantitative
|
$1,479.10 |
$1,479.10 |
$1,479.10 |
$123.75
|
|
Ultrasound breast complete
|
$566.20 |
$566.20 |
$566.20 |
$519.75
|
|
Ultrasound breast unilateral limited (both sides)
|
$566.20 |
$566.20 |
$566.20 |
$452.00
|
|
Ultrasound chest
|
$4,022.01 |
$4,022.01 |
$4,022.01 |
$458.44
|
|
Ultrasound joint/nonvascular extremity limited left
|
$1,890.72 |
$1,890.72 |
$1,890.72 |
$449.60
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$4,964.05 |
$4,964.05 |
$4,964.05 |
$690.48
|
|
Ultrasound pregnant uterus follow up per fetus
|
$3,995.27 |
$3,995.27 |
$3,995.27 |
$450.75
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$3,168.95 |
$3,168.95 |
$3,168.95 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$1,064.49 |
$1,064.49 |
$1,064.49 |
$485.16
|
|
Ultrasound prostate/transrectal
|
$4,970.70 |
$4,970.70 |
$4,970.70 |
$545.16
|
|
Ultrasound retroperitoneal limited
|
$4,919.49 |
$4,919.49 |
$4,919.49 |
$494.65
|
|
Ultrasound scrotum and contents
|
$2,859.47 |
$2,859.47 |
$2,859.47 |
$617.28
|
|
Ultrasound transvaginal non obstetric
|
$1,204.82 |
$1,204.82 |
$1,204.82 |
$563.55
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$14,510.62 |
$14,510.62 |
$14,510.62 |
$2,919.75
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$12,429.88 |
$12,429.88 |
$12,429.88 |
$2,013.08
|
|
Urea nitrogen
|
$899.39 |
$899.39 |
$899.39 |
$45.10
|
|
Urea nitrogen 24 hour urine
|
$59.65 |
$59.65 |
$59.65 |
$50.40
|
|
Uric acid blood
|
$1,536.00 |
$1,536.00 |
$1,536.00 |
$46.64
|
|
Urinalysis microscopic only
|
$1,045.66 |
$1,045.66 |
$1,045.66 |
$26.46
|
|
Urinalysis (with microscopy)
|
$2,085.94 |
$2,085.94 |
$2,085.94 |
$48.14
|
|
Urinalysis (without microscopy)
|
$758.51 |
$758.51 |
$758.51 |
$39.00
|
|
Urine Culture Test
|
$1,320.03 |
$1,320.03 |
$1,320.03 |
$86.45
|
|
Urine pregnancy test
|
$2,020.94 |
$2,020.94 |
$2,020.94 |
$66.60
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$191.36 |
$191.36 |
$191.36 |
$79.04
|
|
Vaccine mmr live subcutaneous
|
$611.21 |
$611.21 |
$611.21 |
$224.04
|
|
Vaccine tdap >=7 years im
|
$356.94 |
$356.94 |
$356.94 |
$150.76
|
|
Vaccine td preservative free >= 7 years im
|
$246.63 |
$246.63 |
$246.63 |
$131.77
|
|
Valproic acid total therapeutic drug level
|
$1,373.46 |
$1,373.46 |
$1,373.46 |
$115.00
|
|
Vancomycin 750 mg intravenous solution
|
$54.93 |
$54.93 |
$54.93 |
$129.78
|
|
Vancomycin peak therapeutic drug level
|
$1,435.79 |
$1,435.79 |
$1,435.79 |
$127.20
|
|
Varicella zoster antibody igg
|
$24.29 |
$24.29 |
$24.29 |
$84.38
|
|
Vitamin b-12
|
$145.31 |
$145.31 |
$145.31 |
$93.84
|
|
Vitamin D Test
|
$265.76 |
$265.76 |
$265.76 |
$132.00
|
|
Volume measurement urine timed
|
$34.49 |
$34.49 |
$34.49 |
$21.45
|
