|
Romiplostim 125 mcg subcutaneous solution
|
$30,294.20 |
$30,294.20 |
$30,294.20 |
$8,779.01
|
|
Rotavirus antibody
|
$3,678.00 |
$3,678.00 |
$3,678.00 |
$38.40
|
|
Rp loclzj tum 2+area 1+d img
|
$6,257.00 |
$6,257.00 |
$6,257.00 |
$1,458.95
|
|
Rsv assay w/optic
|
$335.50 |
$335.50 |
$335.50 |
$73.80
|
|
Rubeola antibody igg
|
$327.50 |
$327.50 |
$327.50 |
$79.68
|
|
Salmonella antibody
|
$228.75 |
$228.75 |
$228.75 |
$37.58
|
|
Sargramostim injection
|
$2,082.00 |
$2,082.00 |
$2,082.00 |
$451.34
|
|
Sarscov coronavirus ag ia
|
$36.25 |
$36.25 |
$36.25 |
$60.40
|
|
Scan duplex abd/pelvis/retroperitoneal complete
|
$1,154.25 |
$1,154.25 |
$1,154.25 |
$1,012.55
|
|
Scan duplex abd/pelvis/retroperitoneal limited
|
$1,209.50 |
$1,209.50 |
$1,209.50 |
$670.00
|
|
Scan duplex aorta/ivc/iliac or bypass grafts complete
|
$1,697.00 |
$1,697.00 |
$1,697.00 |
$815.66
|
|
Scan duplex extracranial arteries unilateral/limited study
|
$4,048.75 |
$4,048.75 |
$4,048.75 |
$589.60
|
|
Scan duplex lower extremity arteries complete bilateral
|
$4,106.50 |
$4,106.50 |
$4,106.50 |
$1,006.85
|
|
Scan duplex lower extremity arteries unilateral/limited study left
|
$3,280.25 |
$3,280.25 |
$3,280.25 |
$660.00
|
|
Scan duplex upper extremity arteries unilateral/limited study left
|
$3,382.25 |
$3,382.25 |
$3,382.25 |
$601.70
|
|
Screening Mammogram
|
$1,483.50 |
$1,483.50 |
$1,483.50 |
$303.55
|
|
Sevelamer carbonate pdr 20mg
|
$172.26 |
$172.26 |
$172.26 |
$40.33
|
|
Sialography s&i
|
$3,834.25 |
$3,834.25 |
$3,834.25 |
$462.40
|
|
Sickling rbc
|
$109.00 |
$109.00 |
$109.00 |
$53.55
|
|
Sincalide 5 mcg solution for injection
|
$432.00 |
$432.00 |
$432.00 |
$409.96
|
|
Sinus CT scan (with and without contrast)
|
$20,101.25 |
$20,101.25 |
$20,101.25 |
$1,815.00
|
|
Sinus CT scan (with contrast)
|
$16,755.50 |
$16,755.50 |
$16,755.50 |
$1,519.50
|
|
Sinus CT scan (without contrast)
|
$16,755.50 |
$16,755.50 |
$16,755.50 |
$1,279.50
|
|
Sirolimus, oral
|
$127.00 |
$127.00 |
$127.00 |
$31.60
|
|
Sleep Study (Polysomnography)
|
$14,624.75 |
$14,624.75 |
$14,624.75 |
$3,936.80
|
|
Smear fluorescent and/or acid fast stain
|
$421.75 |
$421.75 |
$421.75 |
$64.20
|
|
Sodium 24 hour urine
|
$471.00 |
$471.00 |
$471.00 |
$48.50
|
|
Sodium ferric gluconate complex in sucrose 62.5 mg/5 ml intravenous
|
$395.00 |
$395.00 |
$395.00 |
$104.00
|
|
Sodium serum/plasma/whole blood
|
$358.25 |
$358.25 |
$358.25 |
$42.70
|
|
Sodium thiosulfate 12.5 gram/50 ml (250 mg/ml) intravenous solution
|
$514.10 |
$514.10 |
$514.10 |
$223.86
|
|
Specimen fat stain
|
$775.00 |
$775.00 |
$775.00 |
$32.76
|
|
Spirometry bronchodilation responsiveness pre/post bronchodilator administration
|
$8,820.50 |
$8,820.50 |
$8,820.50 |
$559.96
|
|
Spleen imaging
|
$7,831.25 |
$7,831.25 |
$7,831.25 |
$539.70
|
|
St evaluation motion fluoroscopic swallow function cine/video
|
$2,422.75 |
$2,422.75 |
$2,422.75 |
$406.40
|
|
St evaluation swallow function
|
$2,422.75 |
$2,422.75 |
$2,422.75 |
$336.60
|
|
Strep a ag ia
|
$217.50 |
$217.50 |
$217.50 |
$75.40
|
|
Streptomycin injection
|
$129.00 |
$129.00 |
$129.00 |
$100.00
|
|
Stress test pulmonary
|
$474.00 |
$474.00 |
$474.00 |
$327.20
|
|
St treatment speech individual
|
$826.75 |
$826.75 |
$826.75 |
$254.15
|
|
St treatment swallow dysfunction/oral
|
$826.75 |
$826.75 |
$826.75 |
$261.60
|
|
Succinylcholine chloride 20 mg/ml injection solution (wrapper)
|
$246.00 |
$246.00 |
$246.00 |
$49.13
|
|
Surgical pathology level 1 gross examination only
|
$1,635.75 |
$1,635.75 |
$1,635.75 |
$92.59
|
|
Surgical pathology level 2 gross & microscopic examination
|
$2,830.50 |
$2,830.50 |
$2,830.50 |
$149.76
|
|
Surgical pathology level 3 gross & microscopic examination
|
$2,830.50 |
$2,830.50 |
$2,830.50 |
$192.00
|
|
Surgical pathology level 5 gross & microscopic examination
|
$4,637.50 |
$4,637.50 |
$4,637.50 |
$494.00
|
|
Susceptibility agar dilution per agent
|
$20.25 |
$20.25 |
$20.25 |
$40.30
|
|
Susceptibility mic per plate
|
$321.75 |
$321.75 |
$321.75 |
$94.38
|
|
Svc venogram s&i
|
$8,087.75 |
$8,087.75 |
$8,087.75 |
$1,908.00
|
|
Syphilis test non-treponemal antibody quantitative rpr
|
$1,155.50 |
$1,155.50 |
$1,155.50 |
$44.85
|
|
T3 (triiodothyronine) free
|
$370.00 |
$370.00 |
$370.00 |
$89.82
|
|
T3 (triiodothyronine) total
|
$632.75 |
$632.75 |
$632.75 |
$94.90
|
|
T4 (thyroxine) free
|
$558.25 |
$558.25 |
$558.25 |
$81.60
|
|
T4 (thyroxine) total
|
$1,618.75 |
$1,618.75 |
$1,618.75 |
$73.64
|
|
Tacrolimus 5 mg/ml intravenous solution
|
$2,669.00 |
$2,669.00 |
$2,669.00 |
$612.11
|
|
Tacrolimus therapeutic drug level
|
$261.00 |
$261.00 |
$261.00 |
$122.40
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$801.75 |
$801.75 |
$801.75 |
$166.46
|
|
Tc-99m apcitide diag
|
$6,408.75 |
$6,408.75 |
$6,408.75 |
$1,765.30
|
|
Tc-99m depreotide
|
$6,903.75 |
$6,903.75 |
$6,903.75 |
$1,937.35
|
|
Tc-99m exametazime diag
|
$24,541.25 |
$24,541.25 |
$24,541.25 |
$2,166.26
|
|
Tc-99m labeled rbc
|
$2,317.00 |
$2,317.00 |
$2,317.00 |
$323.01
|
|
Tc-99m maa
|
$8,588.50 |
$8,588.50 |
$8,588.50 |
$312.06
|
|
Tc-99m mebrofenin
|
$502.75 |
$502.75 |
$502.75 |
$169.53
|
|
Tc-99m medronate
|
$265.50 |
$265.50 |
$265.50 |
$122.46
|
|
Tc-99m mertiatide
|
$5,126.25 |
$5,126.25 |
$5,126.25 |
$757.25
|
|
Tc-99m pentetate dtpa
|
$849.50 |
$849.50 |
$849.50 |
$245.85
|
|
Tc-99m pertechnetate per mci
|
$244.50 |
$244.50 |
$244.50 |
$28.08
|
|
Tc-99m pyroph diag per dose up to 25 mci
|
$228.25 |
$228.25 |
$228.25 |
$147.24
|
|
Tc-99m sestamibi p study dose
|
$419.50 |
$419.50 |
$419.50 |
$221.60
|
|
Tc-99m sulfur colloid
|
$2,315.75 |
$2,315.75 |
$2,315.75 |
$245.70
|
|
Tc-99m tetrofosmin p study dose
|
$1,205.25 |
$1,205.25 |
$1,205.25 |
$198.05
|
|
Telavancin injection
|
$4,051.00 |
$4,051.00 |
$4,051.00 |
$1,216.45
|
|
Temsirolimus 30 mg/3 ml (10 mg/ml) (first dilution) intravenous soln
|
$14,143.00 |
$14,143.00 |
$14,143.00 |
$2,791.41
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$91,303.03 |
$91,303.03 |
$91,303.03 |
$17,652.73
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$421.00 |
$421.00 |
$421.00 |
$44.49
|
|
Test for porphobilinogen
|
$23.00 |
$23.00 |
$23.00 |
$33.57
|
|
Test for urine cystines
|
$880.50 |
$880.50 |
$880.50 |
$26.00
|
|
Testicular imaging w/vasc flow
|
$6,128.75 |
$6,128.75 |
$6,128.75 |
$780.48
|
|
Test stress cardiovascular tracing only
|
$6,498.50 |
$6,498.50 |
$6,498.50 |
$1,001.55
|
|
Tetanus immune globulin inj
|
$1,354.00 |
$1,354.00 |
$1,354.00 |
$1,395.20
|
|
Theophylline therapeutic drug level
|
$1,888.25 |
$1,888.25 |
$1,888.25 |
$108.00
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$79.00 |
$79.00 |
$79.00 |
$38.64
|
|
Thrombin time
|
$383.50 |
$383.50 |
$383.50 |
$48.75
|
|
Thyroglobulin antibody
|
$1,016.00 |
$1,016.00 |
$1,016.00 |
$84.00
|
|
Thyroid mets imag whole body
|
$10,372.75 |
$10,372.75 |
$10,372.75 |
$1,524.99
|
|
Thyroid (TSH) Test
|
$1,710.50 |
$1,710.50 |
$1,710.50 |
$120.00
|
|
Thyroid Ultrasound
|
$2,106.00 |
$2,106.00 |
$2,106.00 |
$589.96
|
|
Thyroid uptake measurement
|
$5,474.00 |
$5,474.00 |
$5,474.00 |
$653.60
|
|
Thyroxine binding globulin (tbg)
|
$464.00 |
$464.00 |
$464.00 |
$63.60
|
|
Tilt table study
|
$3,491.50 |
$3,491.50 |
$3,491.50 |
$1,495.00
|
|
Tissue culture tumor
|
$1,610.50 |
$1,610.50 |
$1,610.50 |
$529.23
|
|
Tissue exam koh skin/hair/nails
|
$249.75 |
$249.75 |
$249.75 |
$47.40
|
|
Tl-201 thallium diag per mci
|
$2,721.25 |
$2,721.25 |
$2,721.25 |
$77.22
|
|
Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr
|
$25.00 |
$25.00 |
$25.00 |
$125.87
|
|
Toxoplasma antibody igg
|
$683.50 |
$683.50 |
$683.50 |
$84.35
|
|
Toxoplasma antibody igm
|
$509.00 |
$509.00 |
$509.00 |
$83.20
|
|
Transcatheter bx s&i
|
$18,144.00 |
$18,144.00 |
$18,144.00 |
$1,875.96
|
|
Transferrin
|
$421.75 |
$421.75 |
$421.75 |
$87.30
|
|
Trichinella antibody
|
$151.25 |
$151.25 |
$151.25 |
$70.65
|
|
Triglycerides
|
$567.00 |
$567.00 |
$567.00 |
$54.60
|
|
Trimethobenzamide hcl inj
|
$291.00 |
$291.00 |
$291.00 |
$154.09
|
