|
Salmonella antibody
|
$291.36 |
$291.36 |
$291.36 |
$37.58
|
|
Sargramostim injection
|
$659.07 |
$659.07 |
$659.07 |
$451.34
|
|
Screening HIV antigen/antibody combination assay
|
$117.16 |
$117.16 |
$117.16 |
$26.49
|
|
Sedimentation rate erythrocyte automated
|
$12.71 |
$12.71 |
$12.71 |
$44.20
|
|
Sertraline (zoloft) - sendout
|
$17.92 |
$17.92 |
$17.92 |
$173.16
|
|
Set radiation therapy field
|
$11,538.86 |
$11,538.86 |
$11,538.86 |
$731.50
|
|
Sialidase enzyme assay
|
$48.88 |
$48.88 |
$48.88 |
$49.44
|
|
Sincalide 5 mcg solution for injection
|
$442.12 |
$442.12 |
$442.12 |
$409.96
|
|
Sinus/juglr venogram s&i
|
$11,290.55 |
$11,290.55 |
$11,290.55 |
$2,489.25
|
|
Sirolimus, oral
|
$63.20 |
$63.20 |
$63.20 |
$31.60
|
|
Skyla, 13.5 mg
|
$5,594.27 |
$5,594.27 |
$5,594.27 |
$2,343.60
|
|
Sleep Study (Polysomnography)
|
$20,619.04 |
$20,619.04 |
$20,619.04 |
$3,936.80
|
|
Sleep study unattended
|
$1,647.40 |
$1,647.40 |
$1,647.40 |
$595.50
|
|
Smear nasal eosinophil
|
$318.33 |
$318.33 |
$318.33 |
$49.50
|
|
Sodium ferric gluconate complex in sucrose 62.5 mg/5 ml intravenous
|
$782.89 |
$782.89 |
$782.89 |
$104.00
|
|
Special physics consult
|
$712.44 |
$712.44 |
$712.44 |
$700.74
|
|
Spirometry bronchodilation responsiveness pre/post bronchodilator administration
|
$1,707.37 |
$1,707.37 |
$1,707.37 |
$559.96
|
|
Split blood or products
|
$162.00 |
$162.00 |
$162.00 |
$148.98
|
|
St evaluate speech sound production comprehensive/expressive
|
$2,569.73 |
$2,569.73 |
$2,569.73 |
$393.00
|
|
St evaluation motion fluoroscopic swallow function cine/video
|
$2,245.27 |
$2,245.27 |
$2,245.27 |
$406.40
|
|
St evaluation swallow function
|
$422.13 |
$422.13 |
$422.13 |
$336.60
|
|
Strep a ag ia
|
$1,155.35 |
$1,155.35 |
$1,155.35 |
$75.40
|
|
Streptomycin injection
|
$806.99 |
$806.99 |
$806.99 |
$100.00
|
|
Streptozocin injection
|
$1,626.04 |
$1,626.04 |
$1,626.04 |
$954.71
|
|
St treatment speech individual
|
$341.40 |
$341.40 |
$341.40 |
$254.15
|
|
St treatment swallow dysfunction/oral
|
$341.40 |
$341.40 |
$341.40 |
$261.60
|
|
Sugars single quant
|
$54.29 |
$54.29 |
$54.29 |
$52.47
|
|
Sumatriptan 6 mg/0.5 ml subcutaneous solution
|
$1,536.74 |
$1,536.74 |
$1,536.74 |
$91.67
|
|
Susceptibility enzyme detection per enzyme
|
$22.37 |
$22.37 |
$22.37 |
$34.48
|
|
Suscept studies macrobroth dilution ea
|
$31.27 |
$31.27 |
$31.27 |
$48.30
|
|
T3 (triiodothyronine) free
|
$5.89 |
$5.89 |
$5.89 |
$89.82
|
|
T3 (triiodothyronine) total
|
$8.51 |
$8.51 |
$8.51 |
$94.90
|
|
T4 (thyroxine) total
|
$8.51 |
$8.51 |
$8.51 |
$73.64
|
|
Tacrolimus 5 mg/ml intravenous solution
|
$1,261.40 |
$1,261.40 |
$1,261.40 |
$612.11
|
|
Target gsa panel hmtlmph neop
|
$2,236.68 |
$2,236.68 |
$2,236.68 |
$1,928.40
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$52.74 |
$52.74 |
$52.74 |
$166.46
|
|
Tc-99m exame autol wbc diag per dose
|
$14,984.43 |
$14,984.43 |
$14,984.43 |
$2,393.40
|
|
Tc-99m labeled rbc
|
$8,360.06 |
$8,360.06 |
$8,360.06 |
$323.01
|
|
Tc-99m maa
|
$702.36 |
$702.36 |
$702.36 |
$312.06
|
|
Tc-99m mebrofenin
|
$396.66 |
$396.66 |
$396.66 |
$169.53
|
|
Tc-99m medronate
|
$842.24 |
$842.24 |
$842.24 |
$122.46
|
|
Tc-99m mertiatide
|
$1,680.27 |
$1,680.27 |
$1,680.27 |
$757.25
|
|
Tc-99m pentetate dtpa
|
$541.54 |
$541.54 |
$541.54 |
$245.85
|
|
Tc-99m pyroph diag per dose up to 25 mci
|
$918.66 |
$918.66 |
$918.66 |
$147.24
|
|
Tc-99m sestamibi p study dose
|
$6,201.28 |
$6,201.28 |
$6,201.28 |
$221.60
|
|
Tc-99m sulfur colloid
|
$1,888.14 |
$1,888.14 |
$1,888.14 |
$245.70
|
|
Tc-99m tetrofosmin p study dose
|
$6,201.28 |
$6,201.28 |
$6,201.28 |
$198.05
|
|
T cells absolute cd4/cd8 including ratio
|
$4.75 |
$4.75 |
$4.75 |
$186.00
|
|
T cells absolute cd 4 count
|
$126.10 |
$126.10 |
$126.10 |
$120.25
|
|
Telethx isodose plan cplx
|
$1,082.96 |
$1,082.96 |
$1,082.96 |
$1,617.00
|
|
Temsirolimus 30 mg/3 ml (10 mg/ml) (first dilution) intravenous soln
|
$6,498.40 |
$6,498.40 |
$6,498.40 |
$2,791.41
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$78.34 |
$78.34 |
$78.34 |
$44.49
|
|
Testicular imaging w/vasc flow
|
$3,411.73 |
$3,411.73 |
$3,411.73 |
$780.48
|
|
Tetanus immune globulin inj
|
$1,039.01 |
$1,039.01 |
$1,039.01 |
$1,395.20
|
|
Therapy nutrition individual initial f2f w/patient each 15 minutes
|
$240.53 |
$240.53 |
$240.53 |
$55.00
|
|
Therapy nutrition individual reassessment/intervention f2f w/patient each 15 minutes
|
$160.35 |
$160.35 |
$160.35 |
$50.40
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$20.82 |
$20.82 |
$20.82 |
$38.64
|
|
Thyroglobulin antibody
|
$2.95 |
$2.95 |
$2.95 |
$84.00
|
|
Thyroid imaging
|
$6,777.24 |
$6,777.24 |
$6,777.24 |
$670.80
|
|
Thyroid mets imag whole body
|
$15,319.58 |
$15,319.58 |
$15,319.58 |
$1,524.99
|
|
Thyroxine binding globulin (tbg)
|
$13.54 |
$13.54 |
$13.54 |
$63.60
|
|
Tigecycline injection
|
$538.82 |
$538.82 |
$538.82 |
$308.75
|
|
Tisagenlecleucel car-pos t
|
$8,173,188.00 |
$8,173,188.00 |
$8,173,188.00 |
$578,324.58
|
|
Tissue culture placenta
|
$1,180.73 |
$1,180.73 |
$1,180.73 |
$520.91
|
|
Tissue culture skin/biopsy
|
$1,124.82 |
$1,124.82 |
$1,124.82 |
$558.87
|
|
Tissue culture tumor
|
$136.08 |
$136.08 |
$136.08 |
$529.23
|
|
Tl-201 thallium diag per mci
|
$803.20 |
$803.20 |
$803.20 |
$77.22
|
|
Tobramycin non-comp unit
|
$484.85 |
$484.85 |
$484.85 |
$107.07
|
|
Tomosynthesis breast diagnostic left
|
$182.07 |
$182.07 |
$182.07 |
$63.70
|
|
Tomosynthesis breast screen bilateral
|
$182.07 |
$182.07 |
$182.07 |
$73.45
|
|
Topotecan 4 mg/4 ml (1 mg/ml) intravenous solution
|
$210.38 |
$210.38 |
$210.38 |
$303.88
|
|
Tranexamic acid 1,000 mg/10 ml (100 mg/ml) intravenous solution
|
$1,418.95 |
$1,418.95 |
$1,418.95 |
$82.60
|
|
Transcatheter bx s&i
|
$5,340.64 |
$5,340.64 |
$5,340.64 |
$1,875.96
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$1,245.27 |
$1,245.27 |
$1,245.27 |
$241.15
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$622.83 |
$622.83 |
$622.83 |
$149.00
|
|
Treatment radiation delivery level 2
|
$380.90 |
$380.90 |
$380.90 |
$735.00
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$644.01 |
$644.01 |
$644.01 |
$48.22
|
|
Trichinella antibody
|
$213.78 |
$213.78 |
$213.78 |
$70.65
|
|
Trichomonas assay w/optic
|
$74.40 |
$74.40 |
$74.40 |
$66.00
|
|
Trimethobenzamide hcl inj
|
$67.66 |
$67.66 |
$67.66 |
$154.09
|
|
Tx atrial fib pulm vein isol
|
$104,777.66 |
$104,777.66 |
$104,777.66 |
$32,426.20
|
|
Tx l/r atrial fib addl
|
$10,124.92 |
$10,124.92 |
$10,124.92 |
$7,717.80
|
|
Ultrasound encephalogram
|
$2,577.83 |
$2,577.83 |
$2,577.83 |
$481.60
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$1,571.22 |
$1,571.22 |
$1,571.22 |
$477.88
|
|
Ultrasound ob >=14wks ea addl gest
|
$1,571.22 |
$1,571.22 |
$1,571.22 |
$454.11
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$2,244.54 |
$2,244.54 |
$2,244.54 |
$690.48
|
|
Unlisted chemotherapy px
|
$3,266.40 |
$3,266.40 |
$3,266.40 |
$153.85
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$9,824.27 |
$9,824.27 |
$9,824.27 |
$2,916.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$7,857.35 |
$7,857.35 |
$7,857.35 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$6,544.52 |
$6,544.52 |
$6,544.52 |
$2,013.08
|
|
Urethrcystgrphy rtrgrde s&i
|
$2,886.04 |
$2,886.04 |
$2,886.04 |
$574.40
|
|
Urethrocystography void s&i
|
$6,057.96 |
$6,057.96 |
$6,057.96 |
$634.50
|
|
Vaccine dtap < 7 years im
|
$282.97 |
$282.97 |
$282.97 |
$87.80
|
|
Vaccine dtap-hep b-ipv im
|
$717.54 |
$717.54 |
$717.54 |
$193.83
|
|
Vaccine dtap-ipv/hib im
|
$390.93 |
$390.93 |
$390.93 |
$248.80
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$298.31 |
$298.31 |
$298.31 |
$45.33
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$479.10 |
$479.10 |
$479.10 |
$79.04
|
|
Vaccine influenza (iiv) preservative free antigen content im
|
$282.85 |
$282.85 |
$282.85 |
$157.41
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$72.18 |
$72.18 |
$72.18 |
$48.29
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im
|
$95.87 |
$95.87 |
$95.87 |
$40.01
|