|
Rho d immune globulin inj
|
$394.20 |
$394.20 |
$394.20 |
$217.71
|
|
Risankizumab-rzaa 60 mg/ml intravenous solution
|
$36,988.20 |
$36,988.20 |
$36,988.20 |
$30,071.50
|
|
Risperidone microspheres 12.5 mg/2 ml inj
|
$1,512.00 |
$1,512.00 |
$1,512.00 |
$2,429.37
|
|
Rituximab 10 mg/ml concentrate,intravenous
|
$15,661.80 |
$15,661.80 |
$15,661.80 |
$9,301.22
|
|
Rituximab-abbs 10 mg/ml intravenous solution
|
$16,305.60 |
$16,305.60 |
$16,305.60 |
$5,343.99
|
|
Rituximab-arrx 10 mg/ml intravenous solution
|
$13,159.20 |
$13,159.20 |
$13,159.20 |
$6,287.16
|
|
Romiplostim 125 mcg subcutaneous solution
|
$10,461.60 |
$10,461.60 |
$10,461.60 |
$8,950.11
|
|
Ropivacaine 0.2 % epidural pca - 1 hour dose limit
|
$129.60 |
$129.60 |
$129.60 |
$188.50
|
|
Rubella antibody igg
|
$118.20 |
$118.20 |
$118.20 |
$77.03
|
|
Rubeola antibody igg
|
$103.20 |
$103.20 |
$103.20 |
$80.00
|
|
Russell viper venom diluted
|
$256.80 |
$256.80 |
$256.80 |
$72.54
|
|
Salmonella antibody
|
$63.60 |
$63.60 |
$63.60 |
$37.58
|
|
Scan duplex abd/pelvis/retroperitoneal complete
|
$987.00 |
$987.00 |
$987.00 |
$983.50
|
|
Scan duplex abd/pelvis/retroperitoneal limited
|
$723.00 |
$723.00 |
$723.00 |
$662.00
|
|
Scan duplex extremity veins unilateral/limited study
|
$721.20 |
$721.20 |
$721.20 |
$721.60
|
|
Scan duplex lower extremity arteries complete bilateral
|
$819.60 |
$819.60 |
$819.60 |
$985.20
|
|
Scan duplex lower extremity arteries unilateral/limited study left
|
$704.40 |
$704.40 |
$704.40 |
$660.00
|
|
Scan duplex upper extremity arteries unilateral/limited study left
|
$704.40 |
$704.40 |
$704.40 |
$595.35
|
|
Screening colorectal cancer fecal occult blood immunoassay 1-3 simultaneous determinations
|
$37.80 |
$37.80 |
$37.80 |
$57.60
|
|
Screening Mammogram
|
$238.80 |
$238.80 |
$238.80 |
$312.55
|
|
Screw cortex 2.0 x 10mm
|
$3,617.96 |
$3,617.96 |
$3,617.96 |
$29,055.00
|
|
Sedimentation rate erythrocyte automated
|
$69.60 |
$69.60 |
$69.60 |
$42.00
|
|
Semen analysis w/count
|
$102.00 |
$102.00 |
$102.00 |
$56.44
|
|
Serpina1 gene
|
$396.00 |
$396.00 |
$396.00 |
$197.00
|
|
Sevelamer carbonate 800 mg tablet
|
$3.00 |
$3.00 |
$3.00 |
$7.14
|
|
Shoulder MRI (with and without contrast)
|
$3,763.20 |
$3,763.20 |
$3,763.20 |
$2,713.80
|
|
Shoulder MRI (without contrast)
|
$3,517.20 |
$3,517.20 |
$3,517.20 |
$2,065.05
|
|
Shoulder X-ray
|
$604.80 |
$604.80 |
$604.80 |
$339.50
|
|
Shunt glaucoma baerveldt 350mm
|
$3,263.40 |
$3,263.40 |
$3,263.40 |
$4,636.80
|
|
Sickling rbc
|
$79.20 |
$79.20 |
$79.20 |
$57.92
|
|
Sincalide 5 mcg solution for injection
|
$545.40 |
$545.40 |
$545.40 |
$307.58
|
|
Sinus CT scan (with and without contrast)
|
$2,686.20 |
$2,686.20 |
$2,686.20 |
$1,790.00
|
|
Sinus CT scan (with contrast)
|
$2,361.60 |
$2,361.60 |
$2,361.60 |
$1,527.60
|
|
Sinus CT scan (without contrast)
|
$1,869.00 |
$1,869.00 |
$1,869.00 |
$1,292.04
|
|
Sleep study attended
|
$678.00 |
$678.00 |
$678.00 |
$1,329.00
|
|
Sleep Study (Polysomnography)
|
$3,430.80 |
$3,430.80 |
$3,430.80 |
$3,607.50
|
|
Sleep study unattended
|
$928.80 |
$928.80 |
$928.80 |
$580.87
|
|
Slp stdy unatnd w/anal
|
$494.40 |
$494.40 |
$494.40 |
$296.34
|
|
Smear fluorescent and/or acid fast stain
|
$175.20 |
$175.20 |
$175.20 |
$64.20
|
|
Smear gram stain
|
$37.20 |
$37.20 |
$37.20 |
$55.25
|
|
Sodium 24 hour urine
|
$98.40 |
$98.40 |
$98.40 |
$48.60
|
|
Sodium chloride 0.9 % IV bolus
|
$18.60 |
$18.60 |
$18.60 |
$46.00
|
|
Sodium ferric gluconate complex in sucrose 62.5 mg/5 ml intravenous
|
$117.60 |
$117.60 |
$117.60 |
$77.77
|
|
Sodium serum/plasma/whole blood
|
$85.20 |
$85.20 |
$85.20 |
$45.60
|
|
Spirometry bronchodilation responsiveness pre/post bronchodilator administration
|
$490.20 |
$490.20 |
$490.20 |
$543.26
|
|
St analysis behavior qualitative voice/resonance
|
$406.20 |
$406.20 |
$406.20 |
$297.60
|
|
St cognitve performance testing healthcare professional each hour
|
$230.40 |
$230.40 |
$230.40 |
$286.00
|
|
Stent bili dbl pgtl 10fx5cm
|
$390.65 |
$390.65 |
$390.65 |
$2,520.08
|
|
St evaluate speech sound production
|
$429.00 |
$429.00 |
$429.00 |
$292.95
|
|
St evaluate speech sound production comprehensive/expressive
|
$429.00 |
$429.00 |
$429.00 |
$377.00
|
|
St evaluation motion fluoroscopic swallow function cine/video
|
$738.60 |
$738.60 |
$738.60 |
$399.60
|
|
St evaluation swallow function
|
$558.60 |
$558.60 |
$558.60 |
$314.40
|
|
Strep b dna amp probe
|
$63.00 |
$63.00 |
$63.00 |
$120.90
|
|
Stress test pulmonary
|
$294.00 |
$294.00 |
$294.00 |
$322.85
|
|
St treatment speech individual
|
$265.80 |
$265.80 |
$265.80 |
$248.84
|
|
St treatment swallow dysfunction/oral
|
$219.60 |
$219.60 |
$219.60 |
$240.31
|
|
Succinylcholine chloride 20 mg/ml injection solution (wrapper)
|
$64.80 |
$64.80 |
$64.80 |
$52.31
|
|
Sugars single quant
|
$159.00 |
$159.00 |
$159.00 |
$64.28
|
|
Sulbactam 1 gram-durlobactam 1 gram (0.5 gram x2) intravenous solution
|
$5,785.80 |
$5,785.80 |
$5,785.80 |
$7,345.98
|
|
Sumatriptan 6 mg/0.5 ml subcutaneous solution
|
$247.20 |
$247.20 |
$247.20 |
$114.88
|
|
Surgical pathology level 1 gross examination only
|
$198.60 |
$198.60 |
$198.60 |
$79.50
|
|
Surgical pathology level 2 gross & microscopic examination
|
$348.00 |
$348.00 |
$348.00 |
$141.94
|
|
Surgical pathology level 3 gross & microscopic examination
|
$107.40 |
$107.40 |
$107.40 |
$181.00
|
|
Surgical pathology level 4 gross & microscopic examination
|
$110.40 |
$110.40 |
$110.40 |
$239.85
|
|
Surgical pathology level 5 gross & microscopic examination
|
$1,029.60 |
$1,029.60 |
$1,029.60 |
$480.00
|
|
Surgical pathology level 6 gross & microscopic examination
|
$3,903.00 |
$3,903.00 |
$3,903.00 |
$718.00
|
|
Susceptibility agar dilution per agent
|
$57.00 |
$57.00 |
$57.00 |
$45.45
|
|
Susceptibility mic per plate
|
$189.60 |
$189.60 |
$189.60 |
$106.00
|
|
Syphilis test non-treponemal antibody quantitative rpr
|
$35.40 |
$35.40 |
$35.40 |
$41.60
|
|
T3 (triiodothyronine) free
|
$331.80 |
$331.80 |
$331.80 |
$99.20
|
|
T3 (triiodothyronine) total
|
$189.60 |
$189.60 |
$189.60 |
$93.52
|
|
T4 (thyroxine) free
|
$175.20 |
$175.20 |
$175.20 |
$85.20
|
|
T4 (thyroxine) total
|
$189.00 |
$189.00 |
$189.00 |
$69.00
|
|
Tacrolimus 1 mg capsule, immediate-release
|
$9.60 |
$9.60 |
$9.60 |
$9.84
|
|
Tacrolimus therapeutic drug level
|
$115.20 |
$115.20 |
$115.20 |
$122.40
|
|
Talymed
|
$318.50 |
$318.50 |
$318.50 |
$3,411.49
|
|
Target gsa panel hmtlmph neop
|
$5,397.60 |
$5,397.60 |
$5,397.60 |
$2,246.30
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$132.60 |
$132.60 |
$132.60 |
$177.65
|
|
Tc-99m maa
|
$73.80 |
$73.80 |
$73.80 |
$292.80
|
|
Tc-99m mebrofenin
|
$139.20 |
$139.20 |
$139.20 |
$157.65
|
|
Tc-99m medronate
|
$116.40 |
$116.40 |
$116.40 |
$111.01
|
|
Tc-99m pentetate dtpa
|
$73.80 |
$73.80 |
$73.80 |
$222.60
|
|
Tc-99m pertechnetate per mci
|
$3.60 |
$3.60 |
$3.60 |
$22.10
|
|
Tc-99m sestamibi p study dose
|
$351.00 |
$351.00 |
$351.00 |
$274.45
|
|
Tc-99m sulfur colloid
|
$75.60 |
$75.60 |
$75.60 |
$240.50
|
|
Tc-99m tetrofosmin p study dose
|
$294.00 |
$294.00 |
$294.00 |
$190.80
|
|
T cells absolute cd4/cd8 including ratio
|
$255.60 |
$255.60 |
$255.60 |
$176.40
|
|
T cells absolute cd 4 count
|
$28.80 |
$28.80 |
$28.80 |
$111.20
|
|
T cells total count
|
$121.20 |
$121.20 |
$121.20 |
$126.90
|
|
Telehealth original site facility fee
|
$30.60 |
$30.60 |
$30.60 |
$51.00
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$21,126.00 |
$21,126.00 |
$21,126.00 |
$15,245.38
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$14.40 |
$14.40 |
$14.40 |
$39.33
|
|
Test stress cardiovascular tracing only
|
$768.60 |
$768.60 |
$768.60 |
$949.70
|
|
Tezepelumab-ekko 210 mg/1.91 ml (110 mg/ml) subcutaneous syringe
|
$14,011.20 |
$14,011.20 |
$14,011.20 |
$8,737.05
|
|
Theophylline therapeutic drug level
|
$121.80 |
$121.80 |
$121.80 |
$108.00
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$17.40 |
$17.40 |
$17.40 |
$25.54
|
|
Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides)
|
$1,504.20 |
$1,504.20 |
$1,504.20 |
$1,687.50
|
|
Thrombin time
|
$76.80 |
$76.80 |
$76.80 |
$53.76
|
|
Thromboplastin inhibition
|
$46.80 |
$46.80 |
$46.80 |
$53.30
|
|
Thromboplastin time partial (ptt) substitution fractions each
|
$186.00 |
$186.00 |
$186.00 |
$61.52
|
