|
Sock wool above knee
|
$216.33 |
$216.33 |
$216.33 |
$216.33
|
|
Sodium chloride 0.9 % intravenous solution
|
$120.12 |
$120.12 |
$120.12 |
$46.43
|
|
Sodium chloride 0.9 % IV bolus
|
$120.12 |
$120.12 |
$120.12 |
$51.51
|
|
Sodium ferric gluconate complex in sucrose 62.5 mg/5 ml intravenous
|
$545.98 |
$545.98 |
$545.98 |
$104.00
|
|
Sodium serum/plasma/whole blood
|
$785.65 |
$785.65 |
$785.65 |
$42.70
|
|
Sodium thiosulfate 12.5 gram/50 ml (250 mg/ml) intravenous solution
|
$654.75 |
$654.75 |
$654.75 |
$223.86
|
|
So neo gsap dna/dna&rna
|
$3,740.00 |
$3,740.00 |
$3,740.00 |
$2,989.55
|
|
Spirometry bronchodilation responsiveness pre/post bronchodilator administration
|
$2,215.29 |
$2,215.29 |
$2,215.29 |
$559.96
|
|
Split blood or products
|
$147.18 |
$147.18 |
$147.18 |
$148.98
|
|
St cognitve performance testing healthcare professional each hour
|
$804.13 |
$804.13 |
$804.13 |
$313.96
|
|
St evaluate speech sound production
|
$855.84 |
$855.84 |
$855.84 |
$300.00
|
|
St evaluate speech sound production comprehensive/expressive
|
$855.84 |
$855.84 |
$855.84 |
$393.00
|
|
St evaluation motion fluoroscopic swallow function cine/video
|
$1,120.69 |
$1,120.69 |
$1,120.69 |
$406.40
|
|
St evaluation swallow function
|
$1,153.26 |
$1,153.26 |
$1,153.26 |
$336.60
|
|
Streptomycin injection
|
$199.09 |
$199.09 |
$199.09 |
$100.00
|
|
Streptozocin injection
|
$3,269.19 |
$3,269.19 |
$3,269.19 |
$954.71
|
|
St treatment speech individual
|
$485.18 |
$485.18 |
$485.18 |
$254.15
|
|
Succinylcholine chloride 20 mg/ml injection solution (wrapper)
|
$19.91 |
$19.91 |
$19.91 |
$49.13
|
|
Sumatriptan 6 mg/0.5 ml subcutaneous solution
|
$1,285.87 |
$1,285.87 |
$1,285.87 |
$91.67
|
|
Surgical pathology level 1 gross examination only
|
$729.99 |
$729.99 |
$729.99 |
$92.59
|
|
Surgical pathology level 2 gross & microscopic examination
|
$831.12 |
$831.12 |
$831.12 |
$149.76
|
|
Surgical pathology level 3 gross & microscopic examination
|
$2,677.64 |
$2,677.64 |
$2,677.64 |
$192.00
|
|
Surgical pathology level 5 gross & microscopic examination
|
$5,430.03 |
$5,430.03 |
$5,430.03 |
$494.00
|
|
Surgical pathology level 6 gross & microscopic examination
|
$7,009.07 |
$7,009.07 |
$7,009.07 |
$790.00
|
|
Susceptibility agar dilution per agent
|
$763.72 |
$763.72 |
$763.72 |
$40.30
|
|
T3 (triiodothyronine) total
|
$51.69 |
$51.69 |
$51.69 |
$94.90
|
|
T4 (thyroxine) total
|
$51.69 |
$51.69 |
$51.69 |
$73.64
|
|
Tacrolimus therapeutic drug level
|
$423.20 |
$423.20 |
$423.20 |
$122.40
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$43.20 |
$43.20 |
$43.20 |
$166.46
|
|
Tc-99m exame autol wbc diag per dose
|
$22,132.13 |
$22,132.13 |
$22,132.13 |
$2,393.40
|
|
Tc-99m exametazime diag
|
$22,132.13 |
$22,132.13 |
$22,132.13 |
$2,166.26
|
|
Tc-99m labeled rbc
|
$1,923.68 |
$1,923.68 |
$1,923.68 |
$323.01
|
|
Tc-99m maa
|
$3,079.70 |
$3,079.70 |
$3,079.70 |
$312.06
|
|
Tc-99m mebrofenin
|
$170.72 |
$170.72 |
$170.72 |
$169.53
|
|
Tc-99m medronate
|
$252.00 |
$252.00 |
$252.00 |
$122.46
|
|
Tc-99m mertiatide
|
$4,621.31 |
$4,621.31 |
$4,621.31 |
$757.25
|
|
Tc-99m oxidronate
|
$252.00 |
$252.00 |
$252.00 |
$124.23
|
|
Tc-99m pertechnetate per mci
|
$146.31 |
$146.31 |
$146.31 |
$28.08
|
|
Tc-99m pyroph diag per dose up to 25 mci
|
$284.69 |
$284.69 |
$284.69 |
$147.24
|
|
Tc-99m sestamibi p study dose
|
$4,103.96 |
$4,103.96 |
$4,103.96 |
$221.60
|
|
Tc-99m sulfur colloid
|
$1,016.13 |
$1,016.13 |
$1,016.13 |
$245.70
|
|
Tc-99m tetrofosmin p study dose
|
$847.73 |
$847.73 |
$847.73 |
$198.05
|
|
T cells absolute cd 4 count
|
$132.20 |
$132.20 |
$132.20 |
$120.25
|
|
T cells total count
|
$16.39 |
$16.39 |
$16.39 |
$124.11
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$68.76 |
$68.76 |
$68.76 |
$44.49
|
|
Test for urine cystines
|
$40.73 |
$40.73 |
$40.73 |
$26.00
|
|
Testicular imaging w/vasc flow
|
$6,693.74 |
$6,693.74 |
$6,693.74 |
$780.48
|
|
Tetanus immune globulin inj
|
$1,741.49 |
$1,741.49 |
$1,741.49 |
$1,395.20
|
|
Theophylline therapeutic drug level
|
$1,036.98 |
$1,036.98 |
$1,036.98 |
$108.00
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$36.78 |
$36.78 |
$36.78 |
$38.64
|
|
Thrombin time
|
$8.64 |
$8.64 |
$8.64 |
$48.75
|
|
Thyroid mets imag whole body
|
$14,764.42 |
$14,764.42 |
$14,764.42 |
$1,524.99
|
|
Thyroid Ultrasound
|
$4,899.90 |
$4,899.90 |
$4,899.90 |
$589.96
|
|
Thyroid uptake measurement
|
$13,786.06 |
$13,786.06 |
$13,786.06 |
$653.60
|
|
Thyroxine binding globulin (tbg)
|
$9.37 |
$9.37 |
$9.37 |
$63.60
|
|
Tigecycline injection
|
$1,053.45 |
$1,053.45 |
$1,053.45 |
$308.75
|
|
Tilt table study
|
$4,582.72 |
$4,582.72 |
$4,582.72 |
$1,495.00
|
|
Tl-201 thallium diag per mci
|
$222.40 |
$222.40 |
$222.40 |
$77.22
|
|
Tomosynthesis breast diagnostic left
|
$68.37 |
$68.37 |
$68.37 |
$63.70
|
|
Tomosynthesis breast screen bilateral
|
$78.98 |
$78.98 |
$78.98 |
$73.45
|
|
Total tau
|
$332.00 |
$332.00 |
$332.00 |
$293.00
|
|
Tpmt gene com vrnts
|
$200.00 |
$200.00 |
$200.00 |
$381.55
|
|
Tranexamic acid 1,000 mg/10 ml (100 mg/ml) intravenous solution
|
$299.57 |
$299.57 |
$299.57 |
$82.60
|
|
Transferrin
|
$80.50 |
$80.50 |
$80.50 |
$87.30
|
|
Trastuzumab 150 mg intravenous solution
|
$5,844.07 |
$5,844.07 |
$5,844.07 |
$3,401.26
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$1,001.00 |
$1,001.00 |
$1,001.00 |
$149.00
|
|
Treponema pallidum antibody
|
$14.89 |
$14.89 |
$14.89 |
$72.80
|
|
Trg gene rearrangement anal
|
$174.92 |
$174.92 |
$174.92 |
$455.70
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$346.88 |
$346.88 |
$346.88 |
$48.22
|
|
Trichomonas assay w/optic
|
$185.01 |
$185.01 |
$185.01 |
$66.00
|
|
Troponin quantitative
|
$1,871.06 |
$1,871.06 |
$1,871.06 |
$123.75
|
|
Tx atrial fib pulm vein isol
|
$113,057.80 |
$113,057.80 |
$113,057.80 |
$32,426.20
|
|
Tx l/r atrial fib addl
|
$31,308.31 |
$31,308.31 |
$31,308.31 |
$7,717.80
|
|
Ugt1a1 gene analy common variants
|
$263.52 |
$263.52 |
$263.52 |
$438.75
|
|
Ultrasound chest
|
$1,379.75 |
$1,379.75 |
$1,379.75 |
$459.55
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$2,465.01 |
$2,465.01 |
$2,465.01 |
$340.14
|
|
Ultrasound encephalogram
|
$2,301.28 |
$2,301.28 |
$2,301.28 |
$481.60
|
|
Ultrasound exam k transpl w/doppler
|
$3,458.08 |
$3,458.08 |
$3,458.08 |
$570.44
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$3,422.55 |
$3,422.55 |
$3,422.55 |
$477.88
|
|
Ultrasound guide intraoperative
|
$2,837.33 |
$2,837.33 |
$2,837.33 |
$632.90
|
|
Ultrasound infant hips ltd without stress
|
$2,160.18 |
$2,160.18 |
$2,160.18 |
$321.35
|
|
Ultrasound ob >=14wks ea addl gest
|
$5,068.06 |
$5,068.06 |
$5,068.06 |
$454.11
|
|
Ultrasound pregnant uterus follow up per fetus
|
$2,420.89 |
$2,420.89 |
$2,420.89 |
$450.75
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$2,925.38 |
$2,925.38 |
$2,925.38 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$2,301.28 |
$2,301.28 |
$2,301.28 |
$485.48
|
|
Ultrasound prostate/transrectal
|
$35,041.31 |
$35,041.31 |
$35,041.31 |
$545.16
|
|
Ultrasound retroperitoneal limited
|
$3,900.51 |
$3,900.51 |
$3,900.51 |
$498.00
|
|
Ultrasound scrotum and contents
|
$6,248.02 |
$6,248.02 |
$6,248.02 |
$617.28
|
|
Ultrasound spinal canal and contents
|
$2,564.79 |
$2,564.79 |
$2,564.79 |
$450.60
|
|
Ultrasound transvaginal non obstetric
|
$2,252.72 |
$2,252.72 |
$2,252.72 |
$567.44
|
|
Unit mobile power mpu
|
$42,656.80 |
$42,656.80 |
$42,656.80 |
$17,052.34
|
|
Unlisted dx gi procedure
|
$2,006.29 |
$2,006.29 |
$2,006.29 |
$482.90
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$9,492.53 |
$9,492.53 |
$9,492.53 |
$2,916.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$9,192.63 |
$9,192.63 |
$9,192.63 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$8,714.32 |
$8,714.32 |
$8,714.32 |
$2,013.08
|
|
Urea nitrogen 24 hour urine
|
$2.00 |
$2.00 |
$2.00 |
$50.00
|
|
Urethrcystgrphy rtrgrde s&i
|
$6,758.92 |
$6,758.92 |
$6,758.92 |
$574.40
|
|
Urethrocystography void s&i
|
$6,758.92 |
$6,758.92 |
$6,758.92 |
$634.50
|
|
Uric acid blood
|
$1,428.26 |
$1,428.26 |
$1,428.26 |
$46.64
|
|
Uric acid urine
|
$12.00 |
$12.00 |
$12.00 |
$46.75
|
