|
Shoulder MRI (with and without contrast)
|
$1,475.60 |
$1,475.60 |
$1,475.60 |
$2,628.75
|
|
Shoulder MRI (with contrast)
|
$1,290.80 |
$1,290.80 |
$1,290.80 |
$2,353.60
|
|
Shoulder MRI (without contrast)
|
$2,257.92 |
$2,257.92 |
$2,257.92 |
$1,938.28
|
|
Shoulder X-ray
|
$86.24 |
$86.24 |
$86.24 |
$307.20
|
|
Shunt glaucoma baerveldt 350mm
|
$2,016.00 |
$2,016.00 |
$2,016.00 |
$4,050.00
|
|
Sialidase enzyme assay
|
$14.00 |
$14.00 |
$14.00 |
$54.60
|
|
Sickling rbc
|
$11.22 |
$11.22 |
$11.22 |
$53.40
|
|
Sinus CT scan (with and without contrast)
|
$557.20 |
$557.20 |
$557.20 |
$1,610.70
|
|
Sinus CT scan (with contrast)
|
$490.56 |
$490.56 |
$490.56 |
$1,419.18
|
|
Sinus CT scan (without contrast)
|
$421.68 |
$421.68 |
$421.68 |
$1,151.00
|
|
Sling arm deluxe w/pad xs
|
$87.36 |
$87.36 |
$87.36 |
$37.80
|
|
Sling suprapubic suburetheral
|
$7,022.96 |
$7,022.96 |
$7,022.96 |
$7,586.40
|
|
Smear fluorescent and/or acid fast stain
|
$40.16 |
$40.16 |
$40.16 |
$50.70
|
|
Smear gram stain
|
$18.31 |
$18.31 |
$18.31 |
$48.00
|
|
Smear nasal eosinophil
|
$24.21 |
$24.21 |
$24.21 |
$50.00
|
|
Smear special stain inclusion bodies/parasites
|
$30.70 |
$30.70 |
$30.70 |
$60.00
|
|
Smear wet mount
|
$24.21 |
$24.21 |
$24.21 |
$56.13
|
|
Smpd1 gene common variants
|
$55.44 |
$55.44 |
$55.44 |
$127.86
|
|
Sodium 24 hour urine
|
$18.89 |
$18.89 |
$18.89 |
$47.25
|
|
Sodium serum/plasma/whole blood
|
$14.76 |
$14.76 |
$14.76 |
$42.43
|
|
Specific gravity body fluid
|
$11.22 |
$11.22 |
$11.22 |
$21.55
|
|
Specimen fat stain
|
$25.39 |
$25.39 |
$25.39 |
$40.00
|
|
Spirometry bronchodilation responsiveness pre/post bronchodilator administration
|
$180.88 |
$180.88 |
$180.88 |
$526.80
|
|
Split blood or products
|
$42.00 |
$42.00 |
$42.00 |
$143.64
|
|
St analysis behavior qualitative voice/resonance
|
$143.36 |
$143.36 |
$143.36 |
$295.10
|
|
Staph a dna amp probe
|
$41.93 |
$41.93 |
$41.93 |
$116.39
|
|
Stent axios caut enh 15x10mm electrocaut
|
$17,814.16 |
$17,814.16 |
$17,814.16 |
$30,010.80
|
|
Stent bili dbl pgtl 10fx5cm
|
$1,512.00 |
$1,512.00 |
$1,512.00 |
$1,512.00
|
|
Stent bili rx wallflx 10x80 uncvr
|
$15,394.96 |
$15,394.96 |
$15,394.96 |
$23,887.50
|
|
St evaluate speech sound production
|
$137.76 |
$137.76 |
$137.76 |
$298.41
|
|
St evaluate speech sound production comprehensive/expressive
|
$246.40 |
$246.40 |
$246.40 |
$387.00
|
|
St evaluation motion fluoroscopic swallow function cine/video
|
$293.44 |
$293.44 |
$293.44 |
$336.00
|
|
St evaluation swallow function
|
$145.04 |
$145.04 |
$145.04 |
$323.72
|
|
Stress tte complete
|
$777.84 |
$777.84 |
$777.84 |
$1,989.60
|
|
St treatment speech individual
|
$87.92 |
$87.92 |
$87.92 |
$246.87
|
|
St treatment swallow dysfunction/oral
|
$119.84 |
$119.84 |
$119.84 |
$221.00
|
|
Sugars single quant
|
$13.44 |
$13.44 |
$13.44 |
$64.28
|
|
Sumatriptan 6 mg/0.5 ml subcutaneous solution
|
$27.34 |
$27.34 |
$27.34 |
$52.49
|
|
Surgical pathology level 1 gross examination only
|
$15.12 |
$15.12 |
$15.12 |
$81.00
|
|
Surgical pathology level 2 gross & microscopic examination
|
$31.92 |
$31.92 |
$31.92 |
$138.00
|
|
Surgical pathology level 3 gross & microscopic examination
|
$38.64 |
$38.64 |
$38.64 |
$181.00
|
|
Surgical pathology level 4 gross & microscopic examination
|
$68.32 |
$68.32 |
$68.32 |
$239.85
|
|
Surgical pathology level 5 gross & microscopic examination
|
$96.88 |
$96.88 |
$96.88 |
$489.00
|
|
Surgical pathology level 6 gross & microscopic examination
|
$140.56 |
$140.56 |
$140.56 |
$720.75
|
|
Susceptibility agar dilution per agent
|
$10.04 |
$10.04 |
$10.04 |
$38.58
|
|
Susceptibility mic per plate
|
$18.89 |
$18.89 |
$18.89 |
$89.70
|
|
Sweat collection by iontophoresis
|
$37.20 |
$37.20 |
$37.20 |
$100.20
|
|
Syphilis test non-treponemal antibody quantitative rpr
|
$25.98 |
$25.98 |
$25.98 |
$45.70
|
|
System pacing micra av
|
$13,720.00 |
$13,720.00 |
$13,720.00 |
$22,146.00
|
|
System pcmkr dual chamber leadless micra av2 intrdcr cath
|
$4,480.00 |
$4,480.00 |
$4,480.00 |
$11,441.25
|
|
T3 (triiodothyronine) free
|
$29.53 |
$29.53 |
$29.53 |
$91.20
|
|
T3 (triiodothyronine) total
|
$36.02 |
$36.02 |
$36.02 |
$88.00
|
|
T4 (thyroxine) free
|
$37.20 |
$37.20 |
$37.20 |
$65.00
|
|
T4 (thyroxine) total
|
$15.36 |
$15.36 |
$15.36 |
$62.40
|
|
Tacrolimus therapeutic drug level
|
$63.78 |
$63.78 |
$63.78 |
$137.15
|
|
Tbo-filgrastim 300 mcg/0.5 ml subcutaneous syringe
|
$1.58 |
$1.58 |
$1.58 |
$760.95
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$26.42 |
$26.42 |
$26.42 |
$178.40
|
|
Tc-99m exametazime diag
|
$944.72 |
$944.72 |
$944.72 |
$2,236.65
|
|
Tc-99m labeled rbc
|
$202.16 |
$202.16 |
$202.16 |
$312.70
|
|
Tc-99m maa
|
$49.84 |
$49.84 |
$49.84 |
$306.60
|
|
Tc-99m mebrofenin
|
$82.88 |
$82.88 |
$82.88 |
$169.53
|
|
Tc-99m medronate
|
$26.88 |
$26.88 |
$26.88 |
$120.35
|
|
Tc-99m mertiatide
|
$238.56 |
$238.56 |
$238.56 |
$757.25
|
|
Tc-99m pertechnetate per mci
|
$2.24 |
$2.24 |
$2.24 |
$22.10
|
|
Tc-99m sestamibi p study dose
|
$366.80 |
$366.80 |
$366.80 |
$221.60
|
|
Tc-99m sulfur colloid
|
$72.80 |
$72.80 |
$72.80 |
$240.50
|
|
Tc-99m tilmanocept diag
|
$370.72 |
$370.72 |
$370.72 |
$1,007.79
|
|
T cells absolute cd4/cd8 including ratio
|
$109.24 |
$109.24 |
$109.24 |
$189.60
|
|
T cells absolute cd 4 count
|
$38.98 |
$38.98 |
$38.98 |
$120.25
|
|
T cells total count
|
$86.22 |
$86.22 |
$86.22 |
$126.90
|
|
Test for porphobilinogen
|
$34.84 |
$34.84 |
$34.84 |
$33.57
|
|
Test stress cardiovascular tracing only
|
$326.48 |
$326.48 |
$326.48 |
$1,016.00
|
|
Tetanus immune globulin inj
|
$171.44 |
$171.44 |
$171.44 |
$1,073.02
|
|
Theophylline therapeutic drug level
|
$41.34 |
$41.34 |
$41.34 |
$101.40
|
|
Ther/proph/diag inj ia
|
$94.08 |
$94.08 |
$94.08 |
$247.33
|
|
Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides)
|
$2,086.00 |
$2,086.00 |
$2,086.00 |
$1,658.70
|
|
Thrombin time
|
$21.85 |
$21.85 |
$21.85 |
$53.50
|
|
Thromboplastin time partial (ptt) substitution fractions each
|
$64.40 |
$64.40 |
$64.40 |
$56.93
|
|
Thyroglobulin antibody
|
$31.89 |
$31.89 |
$31.89 |
$86.40
|
|
Thyroid imaging
|
$215.60 |
$215.60 |
$215.60 |
$577.80
|
|
Thyroid (TSH) Test
|
$31.30 |
$31.30 |
$31.30 |
$101.40
|
|
Thyroid Ultrasound
|
$143.36 |
$143.36 |
$143.36 |
$553.80
|
|
Thyroid uptake measurement
|
$164.08 |
$164.08 |
$164.08 |
$580.20
|
|
Tissue culture placenta
|
$318.64 |
$318.64 |
$318.64 |
$470.00
|
|
Tissue culture skin/biopsy
|
$318.64 |
$318.64 |
$318.64 |
$626.77
|
|
Tissue culture tumor
|
$453.04 |
$453.04 |
$453.04 |
$605.60
|
|
Tissue exam koh skin/hair/nails
|
$14.17 |
$14.17 |
$14.17 |
$45.23
|
|
Tissue matrix 1.8x1.8cm collagen dermacell porous 4sq cm cost per sq cm
|
$96.88 |
$96.88 |
$96.88 |
$2,516.07
|
|
Tissue surgimend prs meshed 20 cm x 10 cm - cost per 0.5cm
|
$13,052.48 |
$13,052.48 |
$13,052.48 |
$6,727.80
|
|
Tobramycin peak therapeutic drug level
|
$35.43 |
$35.43 |
$35.43 |
$117.00
|
|
Tocilizumab 162 mg/0.9 ml subcutaneous pen injector
|
$3.89 |
$3.89 |
$3.89 |
$2,743.02
|
|
Tomosynthesis breast diagnostic left
|
$19.60 |
$19.60 |
$19.60 |
$53.92
|
|
Tomosynthesis breast screen bilateral
|
$19.60 |
$19.60 |
$19.60 |
$77.46
|
|
Toxoplasma antibody igg
|
$95.76 |
$95.76 |
$95.76 |
$83.20
|
|
Toxoplasma antibody igm
|
$95.82 |
$95.82 |
$95.82 |
$85.80
|
|
Tpmt gene com vrnts
|
$133.84 |
$133.84 |
$133.84 |
$402.35
|
|
Transferrin
|
$42.52 |
$42.52 |
$42.52 |
$83.07
|
|
Transfusion blood/blood component(s)
|
$652.40 |
$652.40 |
$652.40 |
$988.24
|
|
Trauma partial team response w/critical care services level 4
|
$4,760.00 |
$4,760.00 |
$4,760.00 |
$4,523.04
|
|
Treatment inhalation pressurized/nonpressurized acute airway obstruction
|
$64.40 |
$64.40 |
$64.40 |
$197.60
|