|
Strep b assay w/optic
|
$6.00 |
$6.00 |
$6.00 |
$32.00
|
|
St treatment speech individual
|
$380.67 |
$380.67 |
$380.67 |
$254.15
|
|
St treatment swallow dysfunction/oral
|
$355.75 |
$355.75 |
$355.75 |
$261.60
|
|
Succinylcholine chloride 20 mg/ml injection solution (wrapper)
|
$71.40 |
$71.40 |
$71.40 |
$49.13
|
|
Sulfamethoxazole 400 mg-trimethoprim 80 mg/5 ml intravenous solution
|
$62.03 |
$62.03 |
$62.03 |
$71.09
|
|
Sumatriptan 6 mg/0.5 ml subcutaneous solution
|
$183.75 |
$183.75 |
$183.75 |
$91.67
|
|
Support clav 29.6-40.5in med
|
$49.87 |
$49.87 |
$49.87 |
$68.54
|
|
Surgical pathology level 1 gross examination only
|
$81.68 |
$81.68 |
$81.68 |
$92.59
|
|
Surgical pathology level 5 gross & microscopic examination
|
$1,643.92 |
$1,643.92 |
$1,643.92 |
$494.00
|
|
Surgical pathology level 6 gross & microscopic examination
|
$2,333.83 |
$2,333.83 |
$2,333.83 |
$790.00
|
|
Susceptibility agar dilution per agent
|
$10.42 |
$10.42 |
$10.42 |
$40.30
|
|
Syphilis test non-treponemal antibody quantitative rpr
|
$1,424.97 |
$1,424.97 |
$1,424.97 |
$44.85
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$41.00 |
$41.00 |
$41.00 |
$166.46
|
|
Tc-99m apcitide diag
|
$5,622.10 |
$5,622.10 |
$5,622.10 |
$1,765.30
|
|
Tc-99m disofenin
|
$1,141.44 |
$1,141.44 |
$1,141.44 |
$151.32
|
|
Tc-99m exame autol wbc diag per dose
|
$2,464.79 |
$2,464.79 |
$2,464.79 |
$2,393.40
|
|
Tc-99m exametazime diag
|
$8,968.65 |
$8,968.65 |
$8,968.65 |
$2,166.26
|
|
Tc-99m labeled rbc
|
$887.62 |
$887.62 |
$887.62 |
$323.01
|
|
Tc-99m maa
|
$930.16 |
$930.16 |
$930.16 |
$312.06
|
|
Tc-99m mebrofenin
|
$513.50 |
$513.50 |
$513.50 |
$169.53
|
|
Tc-99m medronate
|
$306.63 |
$306.63 |
$306.63 |
$122.46
|
|
Tc-99m mertiatide
|
$1,965.99 |
$1,965.99 |
$1,965.99 |
$757.25
|
|
Tc-99m oxidronate
|
$24.94 |
$24.94 |
$24.94 |
$124.23
|
|
Tc-99m pentetate dtpa
|
$4,618.58 |
$4,618.58 |
$4,618.58 |
$245.85
|
|
Tc-99m pertechnetate per mci
|
$2.93 |
$2.93 |
$2.93 |
$28.08
|
|
Tc-99m pyroph diag per dose up to 25 mci
|
$2,388.52 |
$2,388.52 |
$2,388.52 |
$147.24
|
|
Tc-99m sestamibi p study dose
|
$990.33 |
$990.33 |
$990.33 |
$221.60
|
|
Tc-99m sulfur colloid
|
$159.92 |
$159.92 |
$159.92 |
$245.70
|
|
Tc-99m tetrofosmin p study dose
|
$2,652.60 |
$2,652.60 |
$2,652.60 |
$198.05
|
|
T cells absolute cd4/cd8 including ratio
|
$27.50 |
$27.50 |
$27.50 |
$186.00
|
|
T cells total count
|
$27.50 |
$27.50 |
$27.50 |
$124.11
|
|
Temozolomide 100 mg intravenous solution
|
$4,029.83 |
$4,029.83 |
$4,029.83 |
$2,851.96
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$5.25 |
$5.25 |
$5.25 |
$44.49
|
|
Test for porphobilinogen
|
$63.80 |
$63.80 |
$63.80 |
$33.57
|
|
Testicular imaging w/vasc flow
|
$6,735.66 |
$6,735.66 |
$6,735.66 |
$780.48
|
|
Tetanus immune globulin inj
|
$819.00 |
$819.00 |
$819.00 |
$1,395.20
|
|
Theophylline therapeutic drug level
|
$663.84 |
$663.84 |
$663.84 |
$108.00
|
|
Therapeutic procd strg endur
|
$240.02 |
$240.02 |
$240.02 |
$81.36
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$33.60 |
$33.60 |
$33.60 |
$38.64
|
|
Thrombin time
|
$47.30 |
$47.30 |
$47.30 |
$48.75
|
|
Thromboplastin time partial (ptt) substitution fractions each
|
$79.94 |
$79.94 |
$79.94 |
$56.93
|
|
Thyroid imaging
|
$2,589.52 |
$2,589.52 |
$2,589.52 |
$670.80
|
|
Thyroid mets imag whole body
|
$9,916.42 |
$9,916.42 |
$9,916.42 |
$1,524.99
|
|
Thyroid (TSH) Test
|
$3,440.78 |
$3,440.78 |
$3,440.78 |
$120.00
|
|
Thyroid Ultrasound
|
$4,040.11 |
$4,040.11 |
$4,040.11 |
$589.96
|
|
Thyroxine binding globulin (tbg)
|
$31.90 |
$31.90 |
$31.90 |
$63.60
|
|
Tigecycline injection
|
$906.15 |
$906.15 |
$906.15 |
$308.75
|
|
Tissue culture skin/biopsy
|
$520.30 |
$520.30 |
$520.30 |
$558.87
|
|
Tissue exam koh skin/hair/nails
|
$907.12 |
$907.12 |
$907.12 |
$47.40
|
|
Tl-201 thallium diag per mci
|
$274.35 |
$274.35 |
$274.35 |
$77.22
|
|
Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr
|
$4.20 |
$4.20 |
$4.20 |
$125.87
|
|
Topotecan 4 mg/4 ml (1 mg/ml) intravenous solution
|
$2,533.65 |
$2,533.65 |
$2,533.65 |
$303.88
|
|
Toxoplasma antibody igg
|
$9.90 |
$9.90 |
$9.90 |
$84.35
|
|
Toxoplasma antibody igm
|
$28.88 |
$28.88 |
$28.88 |
$83.20
|
|
Training self management diabetes individual outpatient department per 30 minutes
|
$150.93 |
$150.93 |
$150.93 |
$93.75
|
|
Tranexamic acid 1,000 mg/10 ml (100 mg/ml) intravenous solution
|
$19.00 |
$19.00 |
$19.00 |
$82.60
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$789.60 |
$789.60 |
$789.60 |
$48.22
|
|
Triamcinolone a inj prs-free
|
$710.68 |
$710.68 |
$710.68 |
$225.43
|
|
Trichinella antibody
|
$101.20 |
$101.20 |
$101.20 |
$70.65
|
|
Trimethobenzamide hcl inj
|
$28.35 |
$28.35 |
$28.35 |
$154.09
|
|
Tube drain vert dev st 5-40f
|
$59.87 |
$59.87 |
$59.87 |
$72.21
|
|
Tx atrial fib pulm vein isol
|
$198,832.39 |
$198,832.39 |
$198,832.39 |
$32,426.20
|
|
Tx l/r atrial fib addl
|
$73,078.84 |
$73,078.84 |
$73,078.84 |
$7,717.80
|
|
Ultrasound chest
|
$1,191.84 |
$1,191.84 |
$1,191.84 |
$459.55
|
|
Ultrasound guide intraoperative
|
$3,376.23 |
$3,376.23 |
$3,376.23 |
$632.90
|
|
Ultrasound ob >=14wks ea addl gest
|
$3,184.84 |
$3,184.84 |
$3,184.84 |
$454.11
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$2,136.87 |
$2,136.87 |
$2,136.87 |
$326.54
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$4,424.20 |
$4,424.20 |
$4,424.20 |
$690.48
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$1,682.84 |
$1,682.84 |
$1,682.84 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$7,267.18 |
$7,267.18 |
$7,267.18 |
$485.48
|
|
Ultrasound prostate/transrectal
|
$3,640.20 |
$3,640.20 |
$3,640.20 |
$545.16
|
|
Ultrasound retroperitoneal limited
|
$4,603.70 |
$4,603.70 |
$4,603.70 |
$498.00
|
|
Ultrasound scrotum and contents
|
$4,034.84 |
$4,034.84 |
$4,034.84 |
$617.28
|
|
Ultrasound transabd ea addl gest
|
$2,214.74 |
$2,214.74 |
$2,214.74 |
$425.10
|
|
Ultrasound transvaginal non obstetric
|
$3,640.20 |
$3,640.20 |
$3,640.20 |
$567.44
|
|
Unit mobile power mpu
|
$39,218.26 |
$39,218.26 |
$39,218.26 |
$17,052.34
|
|
Unlisted chemotherapy px
|
$339.00 |
$339.00 |
$339.00 |
$153.85
|
|
Unlisted mr procedure
|
$8,012.91 |
$8,012.91 |
$8,012.91 |
$1,032.20
|
|
Unlisted ultrasound procedure
|
$2,679.33 |
$2,679.33 |
$2,679.33 |
$321.20
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$32,546.91 |
$32,546.91 |
$32,546.91 |
$2,916.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$24,523.42 |
$24,523.42 |
$24,523.42 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$8,012.91 |
$8,012.91 |
$8,012.91 |
$2,013.08
|
|
Urea nitrogen
|
$881.07 |
$881.07 |
$881.07 |
$45.10
|
|
Urethrcystgrphy rtrgrde s&i
|
$5,878.00 |
$5,878.00 |
$5,878.00 |
$574.40
|
|
Urethrocystography void s&i
|
$15,622.29 |
$15,622.29 |
$15,622.29 |
$634.50
|
|
Uric acid blood
|
$1,343.30 |
$1,343.30 |
$1,343.30 |
$46.64
|
|
Urine Culture Test
|
$733.35 |
$733.35 |
$733.35 |
$84.81
|
|
Vaccine hepatitis a (hepa) adult im
|
$82.50 |
$82.50 |
$82.50 |
$178.07
|
|
Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im
|
$154.35 |
$154.35 |
$154.35 |
$218.40
|
|
Vaccine influenza quadrivalent (riv4) rdna antibiotic/preservative free im
|
$320.29 |
$320.29 |
$320.29 |
$72.00
|
|
Vaccine menigococcal serogroups a/c/w/y quadrivalent tetanus toxoid(menacwy-tt) im
|
$1,370.00 |
$1,370.00 |
$1,370.00 |
$349.15
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$815.85 |
$815.85 |
$815.85 |
$408.70
|
|
Vaccine mmr live subcutaneous
|
$104.50 |
$104.50 |
$104.50 |
$224.04
|
|
Vaccine pneumonococcal conjugate 15 valent (pcv15) im
|
$745.86 |
$745.86 |
$745.86 |
$385.45
|
|
Vaccine rabies im
|
$1,244.25 |
$1,244.25 |
$1,244.25 |
$945.46
|
|
Vaccine tdap >=7 years im
|
$174.00 |
$174.00 |
$174.00 |
$150.76
|
|
Vaccine td preservative free >= 7 years im
|
$90.30 |
$90.30 |
$90.30 |
$131.77
|
|
Vaccine varicella live subcutaneous
|
$95.00 |
$95.00 |
$95.00 |
$447.80
|
|
Vad battery clip set hmii 14-v li-ion
|
$2,696.26 |
$2,696.26 |
$2,696.26 |
$1,683.99
|
|
Vad univ batt charger hm 1440
|
$35,296.43 |
$35,296.43 |
$35,296.43 |
$14,929.92
|
