|
Shoulder MRI (with and without contrast)
|
$1,631.60 |
$1,631.60 |
$1,631.60 |
$2,705.30
|
|
Shoulder MRI (with contrast)
|
$1,563.60 |
$1,563.60 |
$1,563.60 |
$2,449.80
|
|
Shoulder MRI (without contrast)
|
$1,467.60 |
$1,467.60 |
$1,467.60 |
$2,051.28
|
|
Shoulder X-ray
|
$430.40 |
$430.40 |
$430.40 |
$367.02
|
|
Sialography s&i
|
$481.20 |
$481.20 |
$481.20 |
$462.40
|
|
Sickling rbc
|
$83.72 |
$83.72 |
$83.72 |
$53.55
|
|
Sinus CT scan (with and without contrast)
|
$2,230.40 |
$2,230.40 |
$2,230.40 |
$1,815.00
|
|
Sinus CT scan (with contrast)
|
$1,728.80 |
$1,728.80 |
$1,728.80 |
$1,519.50
|
|
Sinus CT scan (without contrast)
|
$1,629.20 |
$1,629.20 |
$1,629.20 |
$1,279.50
|
|
Sinus/juglr venogram s&i
|
$1,472.80 |
$1,472.80 |
$1,472.80 |
$2,489.25
|
|
Sipuleucel-t - su
|
$37,055.88 |
$37,055.88 |
$37,055.88 |
$95,750.46
|
|
Sirolimus, oral
|
$61.12 |
$61.12 |
$61.12 |
$42.11
|
|
Sleep Study (Polysomnography)
|
$3,304.40 |
$3,304.40 |
$3,304.40 |
$3,936.80
|
|
Smear fluorescent and/or acid fast stain
|
$33.00 |
$33.00 |
$33.00 |
$64.20
|
|
Smear gram stain
|
$42.16 |
$42.16 |
$42.16 |
$57.85
|
|
Smear nasal eosinophil
|
$18.84 |
$18.84 |
$18.84 |
$49.50
|
|
Smear special stain inclusion bodies/parasites
|
$49.20 |
$49.20 |
$49.20 |
$64.35
|
|
Smear wet mount
|
$37.72 |
$37.72 |
$37.72 |
$68.63
|
|
Sodium 24 hour urine
|
$26.92 |
$26.92 |
$26.92 |
$48.50
|
|
Sodium chloride 0.9 % intravenous solution
|
$32.28 |
$32.28 |
$32.28 |
$46.43
|
|
Sodium chloride 0.9 % IV bolus
|
$12.72 |
$12.72 |
$12.72 |
$47.27
|
|
Sodium chloride 0.9 % IV bolus
|
$8.00 |
$8.00 |
$8.00 |
$43.78
|
|
Sodium chloride 3 % ivpb
|
$4.27 |
$4.27 |
$4.27 |
$48.11
|
|
Sodium ferric gluconate complex in sucrose 62.5 mg/5 ml intravenous
|
$19.44 |
$19.44 |
$19.44 |
$84.80
|
|
Sodium hyaluronate 20 mg/2 ml syringe
|
$111.02 |
$111.02 |
$111.02 |
$539.57
|
|
Sodium serum/plasma/whole blood
|
$20.36 |
$20.36 |
$20.36 |
$42.70
|
|
Sodium thiosulfate 12.5 gram/50 ml (250 mg/ml) intravenous solution
|
$1.44 |
$1.44 |
$1.44 |
$195.48
|
|
Special physics consult
|
$824.00 |
$824.00 |
$824.00 |
$700.74
|
|
Special radiation dosimetry
|
$512.00 |
$512.00 |
$512.00 |
$445.50
|
|
Special radiation treatment
|
$1,445.60 |
$1,445.60 |
$1,445.60 |
$1,934.03
|
|
Special teletx port plan
|
$964.00 |
$964.00 |
$964.00 |
$1,046.65
|
|
Specimen fat stain
|
$12.48 |
$12.48 |
$12.48 |
$32.76
|
|
Split blood or products
|
$63.20 |
$63.20 |
$63.20 |
$148.98
|
|
Sr-89 stront chlor ther / mci
|
$2,479.20 |
$2,479.20 |
$2,479.20 |
$4,588.65
|
|
Srs linear based
|
$3,441.20 |
$3,441.20 |
$3,441.20 |
$14,124.25
|
|
St analysis behavior qualitative voice/resonance
|
$275.60 |
$275.60 |
$275.60 |
$300.00
|
|
Staph a dna amp probe
|
$61.08 |
$61.08 |
$61.08 |
$116.39
|
|
St cognitve performance testing healthcare professional each hour
|
$356.80 |
$356.80 |
$356.80 |
$313.96
|
|
St evaluate speech sound production
|
$275.60 |
$275.60 |
$275.60 |
$300.00
|
|
St evaluate speech sound production comprehensive/expressive
|
$268.00 |
$268.00 |
$268.00 |
$393.00
|
|
Strep a ag ia
|
$20.44 |
$20.44 |
$20.44 |
$75.40
|
|
Strep b dna amp probe
|
$90.48 |
$90.48 |
$90.48 |
$139.20
|
|
Streptozocin injection
|
$358.56 |
$358.56 |
$358.56 |
$943.23
|
|
Stress tte complete
|
$1,754.40 |
$1,754.40 |
$1,754.40 |
$1,964.95
|
|
St treatment speech individual
|
$276.00 |
$276.00 |
$276.00 |
$254.15
|
|
St treatment swallow dysfunction/oral
|
$72.80 |
$72.80 |
$72.80 |
$261.60
|
|
Succinylcholine chloride 20 mg/ml injection solution (wrapper)
|
$26.00 |
$26.00 |
$26.00 |
$49.13
|
|
Sugars single quant
|
$10.72 |
$10.72 |
$10.72 |
$52.47
|
|
Sulfamethoxazole 400 mg-trimethoprim 80 mg/5 ml intravenous solution
|
$1.04 |
$1.04 |
$1.04 |
$74.79
|
|
Sumatriptan 6 mg/0.5 ml subcutaneous solution
|
$120.40 |
$120.40 |
$120.40 |
$151.29
|
|
Surgical pathology level 1 gross examination only
|
$55.20 |
$55.20 |
$55.20 |
$92.59
|
|
Surgical pathology level 2 gross & microscopic examination
|
$90.00 |
$90.00 |
$90.00 |
$149.76
|
|
Surgical pathology level 3 gross & microscopic examination
|
$116.00 |
$116.00 |
$116.00 |
$192.00
|
|
Surgical pathology level 4 gross & microscopic examination
|
$154.80 |
$154.80 |
$154.80 |
$253.75
|
|
Surgical pathology level 5 gross & microscopic examination
|
$277.20 |
$277.20 |
$277.20 |
$494.00
|
|
Surgical pathology level 6 gross & microscopic examination
|
$417.60 |
$417.60 |
$417.60 |
$790.00
|
|
Susceptibility enzyme detection per enzyme
|
$18.92 |
$18.92 |
$18.92 |
$34.48
|
|
Susceptibility mic per plate
|
$79.92 |
$79.92 |
$79.92 |
$94.38
|
|
Svc venogram s&i
|
$2,140.80 |
$2,140.80 |
$2,140.80 |
$1,908.00
|
|
Sweat collection by iontophoresis
|
$38.44 |
$38.44 |
$38.44 |
$105.21
|
|
Synvisc or synvisc-one
|
$12.01 |
$12.01 |
$12.01 |
$1,232.66
|
|
Syphilis test non-treponemal antibody quantitative rpr
|
$21.64 |
$21.64 |
$21.64 |
$44.85
|
|
T3 (triiodothyronine) free
|
$71.24 |
$71.24 |
$71.24 |
$89.82
|
|
T3 (triiodothyronine) total
|
$98.68 |
$98.68 |
$98.68 |
$94.90
|
|
T4 (thyroxine) free
|
$36.92 |
$36.92 |
$36.92 |
$81.60
|
|
T4 (thyroxine) total
|
$28.72 |
$28.72 |
$28.72 |
$73.64
|
|
Tacrolimus 1 mg capsule, immediate-release
|
$6.88 |
$6.88 |
$6.88 |
$12.25
|
|
Tacrolimus therapeutic drug level
|
$180.28 |
$180.28 |
$180.28 |
$122.40
|
|
Tafasitamab-cxix 200 mg intravenous solution
|
$14.30 |
$14.30 |
$14.30 |
$3,817.00
|
|
Talimogene laherparepvec 10exp6 (1 million) pfu/ml susp for injection
|
$46.60 |
$46.60 |
$46.60 |
$21,795.67
|
|
Talquetamab-tgvs 2 mg/ml subcutaneous solution
|
$76.60 |
$76.60 |
$76.60 |
$31,080.00
|
|
Target gsa panel hmtlmph neop
|
$1,248.00 |
$1,248.00 |
$1,248.00 |
$1,928.40
|
|
Target gsa panel organ/hmtlmph neop
|
$1,508.00 |
$1,508.00 |
$1,508.00 |
$3,385.00
|
|
Target gsa panel organ neop
|
$720.00 |
$720.00 |
$720.00 |
$1,913.00
|
|
Tbo-filgrastim 300 mcg/0.5 ml subcutaneous syringe
|
$1.94 |
$1.94 |
$1.94 |
$959.55
|
|
Tbs techl calculation only
|
$158.80 |
$158.80 |
$158.80 |
$123.30
|
|
Tbs techl prep&transmis data
|
$158.80 |
$158.80 |
$158.80 |
$104.19
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$115.72 |
$115.72 |
$115.72 |
$166.46
|
|
Tc-99m disofenin
|
$131.20 |
$131.20 |
$131.20 |
$151.32
|
|
Tc-99m exame autol wbc diag per dose
|
$5,628.40 |
$5,628.40 |
$5,628.40 |
$2,393.40
|
|
Tc-99m exametazime diag
|
$3,630.80 |
$3,630.80 |
$3,630.80 |
$2,166.26
|
|
Tc-99m labeled rbc
|
$388.40 |
$388.40 |
$388.40 |
$323.01
|
|
Tc-99m maa
|
$60.40 |
$60.40 |
$60.40 |
$312.06
|
|
Tc-99m mebrofenin
|
$232.40 |
$232.40 |
$232.40 |
$169.53
|
|
Tc-99m medronate
|
$127.20 |
$127.20 |
$127.20 |
$122.46
|
|
Tc-99m mertiatide
|
$784.80 |
$784.80 |
$784.80 |
$757.25
|
|
Tc-99m non-heu per study dose
|
$15.88 |
$15.88 |
$15.88 |
$8.00
|
|
Tc-99m oxidronate
|
$49.60 |
$49.60 |
$49.60 |
$124.23
|
|
Tc-99m pentetate dtpa
|
$101.20 |
$101.20 |
$101.20 |
$245.85
|
|
Tc-99m pentetate dtpa aerosol
|
$380.00 |
$380.00 |
$380.00 |
$244.02
|
|
Tc-99m pertechnetate per mci
|
$3.20 |
$3.20 |
$3.20 |
$28.08
|
|
Tc-99m pyroph diag per dose up to 25 mci
|
$220.00 |
$220.00 |
$220.00 |
$147.24
|
|
Tc-99m sestamibi p study dose
|
$477.60 |
$477.60 |
$477.60 |
$221.60
|
|
Tc-99m succimer (dmsa)
|
$3,749.60 |
$3,749.60 |
$3,749.60 |
$1,578.33
|
|
Tc-99m tetrofosmin p study dose
|
$737.60 |
$737.60 |
$737.60 |
$198.05
|
|
T cells absolute cd4/cd8 including ratio
|
$32.84 |
$32.84 |
$32.84 |
$186.00
|
|
T cells absolute cd 4 count
|
$21.04 |
$21.04 |
$21.04 |
$120.25
|
|
T cells total count
|
$95.48 |
$95.48 |
$95.48 |
$124.11
|
|
Telethx isodose plan cplx
|
$390.80 |
$390.80 |
$390.80 |
$1,617.00
|
|
Telethx isodose plan simple
|
$390.80 |
$390.80 |
$390.80 |
$848.72
|
