|
Sinus CT scan (with contrast)
|
$11,792.50 |
$11,792.50 |
$11,792.50 |
$1,519.50
|
|
Sinus CT scan (without contrast)
|
$11,125.50 |
$11,125.50 |
$11,125.50 |
$1,279.50
|
|
Smear nasal eosinophil
|
$423.00 |
$423.00 |
$423.00 |
$49.50
|
|
Sodium 24 hour urine
|
$195.75 |
$195.75 |
$195.75 |
$48.50
|
|
Sodium chloride 0.9 % intravenous solution
|
$66.25 |
$66.25 |
$66.25 |
$46.43
|
|
Sodium ferric gluconate complex in sucrose 62.5 mg/5 ml intravenous
|
$91.00 |
$91.00 |
$91.00 |
$104.00
|
|
Sodium serum/plasma/whole blood
|
$195.75 |
$195.75 |
$195.75 |
$42.70
|
|
Specimen fat stain
|
$143.00 |
$143.00 |
$143.00 |
$32.76
|
|
Sperm antibody test
|
$327.25 |
$327.25 |
$327.25 |
$56.44
|
|
Spirometry bronchodilation responsiveness pre/post bronchodilator administration
|
$2,718.00 |
$2,718.00 |
$2,718.00 |
$559.96
|
|
Split blood or products
|
$240.50 |
$240.50 |
$240.50 |
$148.98
|
|
Sputum specimen collection
|
$362.25 |
$362.25 |
$362.25 |
$180.00
|
|
St analysis behavior qualitative voice/resonance
|
$2,079.00 |
$2,079.00 |
$2,079.00 |
$300.00
|
|
Staph a dna amp probe
|
$896.50 |
$896.50 |
$896.50 |
$116.39
|
|
St evaluate speech sound production
|
$2,079.00 |
$2,079.00 |
$2,079.00 |
$300.00
|
|
St evaluate speech sound production comprehensive/expressive
|
$2,079.00 |
$2,079.00 |
$2,079.00 |
$393.00
|
|
St evaluation motion fluoroscopic swallow function cine/video
|
$2,289.75 |
$2,289.75 |
$2,289.75 |
$406.40
|
|
St evaluation swallow function
|
$767.00 |
$767.00 |
$767.00 |
$336.60
|
|
Strep a ag ia
|
$492.00 |
$492.00 |
$492.00 |
$75.40
|
|
Strep b assay w/optic
|
$381.25 |
$381.25 |
$381.25 |
$32.00
|
|
Strep b dna amp probe
|
$896.50 |
$896.50 |
$896.50 |
$139.20
|
|
Streptokinase antibody
|
$268.75 |
$268.75 |
$268.75 |
$13.93
|
|
Stress test pulmonary
|
$430.75 |
$430.75 |
$430.75 |
$327.20
|
|
St treatment speech individual
|
$806.75 |
$806.75 |
$806.75 |
$254.15
|
|
St treatment swallow dysfunction/oral
|
$459.00 |
$459.00 |
$459.00 |
$261.60
|
|
Succinylcholine chloride 20 mg/ml injection solution (wrapper)
|
$80.00 |
$80.00 |
$80.00 |
$49.13
|
|
Sumatriptan 6 mg/0.5 ml subcutaneous solution
|
$507.00 |
$507.00 |
$507.00 |
$91.67
|
|
Surgical pathology level 6 gross & microscopic examination
|
$1,755.25 |
$1,755.25 |
$1,755.25 |
$790.00
|
|
Susceptibility enzyme detection per enzyme
|
$41.75 |
$41.75 |
$41.75 |
$34.48
|
|
Suscept studies macrobroth dilution ea
|
$179.25 |
$179.25 |
$179.25 |
$48.30
|
|
Svc venogram s&i
|
$13,832.25 |
$13,832.25 |
$13,832.25 |
$1,908.00
|
|
Sweat collection by iontophoresis
|
$347.25 |
$347.25 |
$347.25 |
$105.21
|
|
T3 (triiodothyronine) free
|
$194.25 |
$194.25 |
$194.25 |
$89.82
|
|
T3 (triiodothyronine) total
|
$150.25 |
$150.25 |
$150.25 |
$94.90
|
|
T4 (thyroxine) total
|
$779.25 |
$779.25 |
$779.25 |
$73.64
|
|
Tc-99m apcitide diag
|
$6,123.00 |
$6,123.00 |
$6,123.00 |
$1,765.30
|
|
Tc-99m bicisate
|
$3,830.50 |
$3,830.50 |
$3,830.50 |
$1,969.45
|
|
Tc-99m exame autol wbc diag per dose
|
$6,111.25 |
$6,111.25 |
$6,111.25 |
$2,393.40
|
|
Tc-99m labeled rbc
|
$1,294.00 |
$1,294.00 |
$1,294.00 |
$323.01
|
|
Tc-99m maa
|
$1,321.50 |
$1,321.50 |
$1,321.50 |
$312.06
|
|
Tc-99m mebrofenin
|
$390.00 |
$390.00 |
$390.00 |
$169.53
|
|
Tc-99m medronate
|
$2,952.25 |
$2,952.25 |
$2,952.25 |
$122.46
|
|
Tc-99m mertiatide
|
$1,747.25 |
$1,747.25 |
$1,747.25 |
$757.25
|
|
Tc-99m pentetate dtpa
|
$1,021.25 |
$1,021.25 |
$1,021.25 |
$245.85
|
|
Tc-99m pentetate dtpa aerosol
|
$1,021.25 |
$1,021.25 |
$1,021.25 |
$244.02
|
|
Tc-99m pertechnetate per mci
|
$174.25 |
$174.25 |
$174.25 |
$28.08
|
|
Tc-99m pyroph diag per dose up to 25 mci
|
$305.25 |
$305.25 |
$305.25 |
$147.24
|
|
Tc-99m sestamibi p study dose
|
$3,230.50 |
$3,230.50 |
$3,230.50 |
$221.60
|
|
Tc-99m succimer (dmsa)
|
$2,738.00 |
$2,738.00 |
$2,738.00 |
$1,578.33
|
|
Tc-99m sulfur colloid
|
$707.50 |
$707.50 |
$707.50 |
$245.70
|
|
Tc-99m tetrofosmin p study dose
|
$3,622.25 |
$3,622.25 |
$3,622.25 |
$198.05
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$44.00 |
$44.00 |
$44.00 |
$44.49
|
|
Test for chlorohydrocarbons
|
$190.00 |
$190.00 |
$190.00 |
$71.04
|
|
Test for porphobilinogen
|
$133.50 |
$133.50 |
$133.50 |
$33.57
|
|
Test for urine cystines
|
$250.75 |
$250.75 |
$250.75 |
$26.00
|
|
Test stress cardiovascular tracing only
|
$6,182.75 |
$6,182.75 |
$6,182.75 |
$1,001.55
|
|
Test urine for porphyrins
|
$261.50 |
$261.50 |
$261.50 |
$27.30
|
|
Tetanus immune globulin inj
|
$1,395.00 |
$1,395.00 |
$1,395.00 |
$1,395.20
|
|
Theophylline therapeutic drug level
|
$320.50 |
$320.50 |
$320.50 |
$108.00
|
|
Ther/proph/diag inj ia
|
$1,288.00 |
$1,288.00 |
$1,288.00 |
$247.33
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$28.00 |
$28.00 |
$28.00 |
$38.64
|
|
Thrombin time titer
|
$146.75 |
$146.75 |
$146.75 |
$9.10
|
|
Thyroid imaging
|
$2,902.75 |
$2,902.75 |
$2,902.75 |
$670.80
|
|
Thyroid (TSH) Test
|
$1,410.75 |
$1,410.75 |
$1,410.75 |
$120.00
|
|
Tigecycline injection
|
$509.00 |
$509.00 |
$509.00 |
$308.75
|
|
Tissue culture placenta
|
$1,191.25 |
$1,191.25 |
$1,191.25 |
$520.91
|
|
Tissue culture skin/biopsy
|
$688.25 |
$688.25 |
$688.25 |
$558.87
|
|
Tissue culture tumor
|
$1,191.25 |
$1,191.25 |
$1,191.25 |
$529.23
|
|
Tl-201 thallium diag per mci
|
$1,297.50 |
$1,297.50 |
$1,297.50 |
$77.22
|
|
Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr
|
$44.00 |
$44.00 |
$44.00 |
$125.87
|
|
Tranexamic acid 1,000 mg/10 ml (100 mg/ml) intravenous solution
|
$664.00 |
$664.00 |
$664.00 |
$82.60
|
|
Transferrin
|
$146.75 |
$146.75 |
$146.75 |
$87.30
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$1,286.50 |
$1,286.50 |
$1,286.50 |
$241.15
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$74.25 |
$74.25 |
$74.25 |
$149.00
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$108.00 |
$108.00 |
$108.00 |
$48.22
|
|
Trichomonas assay w/optic
|
$362.25 |
$362.25 |
$362.25 |
$66.00
|
|
Troponin quantitative
|
$646.50 |
$646.50 |
$646.50 |
$123.75
|
|
Ultrasound exam k transpl w/doppler
|
$1,757.00 |
$1,757.00 |
$1,757.00 |
$570.44
|
|
Ultrasound guidance for vascular access
|
$587.52 |
$587.52 |
$587.52 |
$340.22
|
|
Ultrasound guided needle placement supervision & interpretation
|
$460.50 |
$460.50 |
$460.50 |
$701.35
|
|
Ultrasound guide intraoperative
|
$1,925.00 |
$1,925.00 |
$1,925.00 |
$632.90
|
|
Ultrasound joint complete left
|
$441.75 |
$441.75 |
$441.75 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$331.75 |
$331.75 |
$331.75 |
$448.50
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$692.50 |
$692.50 |
$692.50 |
$326.54
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$243.75 |
$243.75 |
$243.75 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$1,078.00 |
$1,078.00 |
$1,078.00 |
$485.48
|
|
Ultrasound prostate/transrectal
|
$1,450.00 |
$1,450.00 |
$1,450.00 |
$545.16
|
|
Ultrasound retroperitoneal limited
|
$1,812.75 |
$1,812.75 |
$1,812.75 |
$498.00
|
|
Ultrasound transvaginal non obstetric
|
$829.00 |
$829.00 |
$829.00 |
$567.44
|
|
Ultraviolet therapy
|
$115.75 |
$115.75 |
$115.75 |
$42.60
|
|
Unlisted cytogenetic study
|
$239.75 |
$239.75 |
$239.75 |
$132.48
|
|
Unlisted misc path test
|
$289.25 |
$289.25 |
$289.25 |
$89.40
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$10,076.25 |
$10,076.25 |
$10,076.25 |
$2,916.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$9,244.25 |
$9,244.25 |
$9,244.25 |
$2,364.35
|
|
Urethrcystgrphy rtrgrde s&i
|
$2,785.75 |
$2,785.75 |
$2,785.75 |
$574.40
|
|
Urethrocystography void s&i
|
$3,253.25 |
$3,253.25 |
$3,253.25 |
$634.50
|
|
Uric acid blood
|
$900.00 |
$900.00 |
$900.00 |
$46.64
|
|
Urinalysis (with microscopy)
|
$808.75 |
$808.75 |
$808.75 |
$48.14
|
|
Urine Culture Test
|
$429.75 |
$429.75 |
$429.75 |
$84.81
|
|
Urine pregnancy test
|
$286.75 |
$286.75 |
$286.75 |
$66.40
|
