|
Shrinker prosth above knee
|
$1,502.00 |
$1,502.00 |
$1,502.00 |
$168.89
|
|
Shrinker prosth below knee
|
$488.00 |
$488.00 |
$488.00 |
$105.12
|
|
Shuntogram nonvascular supervision & interpretation
|
$855.99 |
$855.99 |
$855.99 |
$349.20
|
|
Sialidase enzyme assay
|
$53.28 |
$53.28 |
$53.28 |
$54.60
|
|
Sickling rbc
|
$433.17 |
$433.17 |
$433.17 |
$57.92
|
|
Sincalide 5 mcg solution for injection
|
$254.00 |
$254.00 |
$254.00 |
$307.58
|
|
Sirolimus, oral
|
$10.67 |
$10.67 |
$10.67 |
$41.25
|
|
Skeletal muscle relaxant 1/2
|
$370.50 |
$370.50 |
$370.50 |
$83.85
|
|
Smear nasal eosinophil
|
$520.90 |
$520.90 |
$520.90 |
$46.20
|
|
Smear wet mount
|
$409.87 |
$409.87 |
$409.87 |
$67.49
|
|
Socket insert without lock mech
|
$3,837.00 |
$3,837.00 |
$3,837.00 |
$1,192.50
|
|
Sock fracture or equal each
|
$277.00 |
$277.00 |
$277.00 |
$74.51
|
|
Sodium 24 hour urine
|
$220.02 |
$220.02 |
$220.02 |
$48.60
|
|
Sodium chloride 0.9 % intravenous solution
|
$130.00 |
$130.00 |
$130.00 |
$48.11
|
|
Sodium ferric gluconate complex in sucrose 62.5 mg/5 ml intravenous
|
$103.22 |
$103.22 |
$103.22 |
$77.77
|
|
Sodium serum/plasma/whole blood
|
$293.87 |
$293.87 |
$293.87 |
$45.60
|
|
Solid skin barrier
|
$3.00 |
$3.00 |
$3.00 |
$2.84
|
|
Somatosensory testing
|
$5,666.49 |
$5,666.49 |
$5,666.49 |
$816.00
|
|
Special radiation dosimetry
|
$1,057.56 |
$1,057.56 |
$1,057.56 |
$392.50
|
|
Special teletx port plan
|
$2,873.05 |
$2,873.05 |
$2,873.05 |
$1,086.99
|
|
Specific gravity body fluid
|
$337.02 |
$337.02 |
$337.02 |
$22.00
|
|
Specimen fat stain
|
$529.28 |
$529.28 |
$529.28 |
$35.10
|
|
Split blood or products
|
$350.15 |
$350.15 |
$350.15 |
$127.48
|
|
Srs linear based
|
$73,387.57 |
$73,387.57 |
$73,387.57 |
$13,585.00
|
|
Srs multisource
|
$38,196.05 |
$38,196.05 |
$38,196.05 |
$34,165.20
|
|
Staph a dna amp probe
|
$676.06 |
$676.06 |
$676.06 |
$125.00
|
|
St cognitve performance testing healthcare professional each hour
|
$662.25 |
$662.25 |
$662.25 |
$286.00
|
|
St evaluation motion fluoroscopic swallow function cine/video
|
$2,529.39 |
$2,529.39 |
$2,529.39 |
$399.60
|
|
St treatment speech individual
|
$1,203.35 |
$1,203.35 |
$1,203.35 |
$248.84
|
|
St treatment swallow dysfunction/oral
|
$1,607.29 |
$1,607.29 |
$1,607.29 |
$240.31
|
|
Sulfamethoxazole 400 mg-trimethoprim 80 mg/5 ml intravenous solution
|
$104.19 |
$104.19 |
$104.19 |
$82.43
|
|
Sumatriptan 6 mg/0.5 ml subcutaneous solution
|
$387.52 |
$387.52 |
$387.52 |
$114.88
|
|
Surgical pathology level 1 gross examination only
|
$274.43 |
$274.43 |
$274.43 |
$79.50
|
|
Surgical pathology level 2 gross & microscopic examination
|
$903.93 |
$903.93 |
$903.93 |
$141.94
|
|
Surgical pathology level 3 gross & microscopic examination
|
$1,120.27 |
$1,120.27 |
$1,120.27 |
$181.00
|
|
Surgical pathology level 5 gross & microscopic examination
|
$1,383.22 |
$1,383.22 |
$1,383.22 |
$480.00
|
|
Surgical pathology level 6 gross & microscopic examination
|
$4,718.82 |
$4,718.82 |
$4,718.82 |
$718.00
|
|
Susceptibility mic per plate
|
$603.20 |
$603.20 |
$603.20 |
$106.00
|
|
T3 (triiodothyronine) free
|
$952.76 |
$952.76 |
$952.76 |
$99.20
|
|
T3 (triiodothyronine) total
|
$887.33 |
$887.33 |
$887.33 |
$93.52
|
|
T4 (thyroxine) free
|
$969.37 |
$969.37 |
$969.37 |
$85.20
|
|
T4 (thyroxine) total
|
$619.83 |
$619.83 |
$619.83 |
$69.00
|
|
Tacrolimus 1 mg capsule, immediate-release
|
$4.50 |
$4.50 |
$4.50 |
$9.84
|
|
Tacrolimus 5 mg/ml intravenous solution
|
$228.45 |
$228.45 |
$228.45 |
$601.95
|
|
Tacrolimus therapeutic drug level
|
$945.74 |
$945.74 |
$945.74 |
$122.40
|
|
Target gsa panel organ neop
|
$5,787.06 |
$5,787.06 |
$5,787.06 |
$1,655.52
|
|
Tbs techl calculation only
|
$731.06 |
$731.06 |
$731.06 |
$153.60
|
|
Tbs techl prep&transmis data
|
$731.06 |
$731.06 |
$731.06 |
$119.66
|
|
Tb test cell mediated immunity antigen response enumeration gamma interferon t-cells
|
$1,447.23 |
$1,447.23 |
$1,447.23 |
$194.35
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$1,447.23 |
$1,447.23 |
$1,447.23 |
$177.65
|
|
Tc-99m maa
|
$255.18 |
$255.18 |
$255.18 |
$292.80
|
|
Tc-99m mertiatide
|
$2,709.81 |
$2,709.81 |
$2,709.81 |
$756.00
|
|
Tc-99m oxidronate
|
$169.48 |
$169.48 |
$169.48 |
$105.60
|
|
Tc-99m pentetate dtpa aerosol
|
$445.56 |
$445.56 |
$445.56 |
$190.80
|
|
Tc-99m pyroph diag per dose up to 25 mci
|
$345.88 |
$345.88 |
$345.88 |
$136.40
|
|
Tc-99m tetrofosmin p study dose
|
$1,564.51 |
$1,564.51 |
$1,564.51 |
$190.80
|
|
T cells absolute cd4/cd8 including ratio
|
$473.52 |
$473.52 |
$473.52 |
$176.40
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$22,364.51 |
$22,364.51 |
$22,364.51 |
$15,245.38
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$127.49 |
$127.49 |
$127.49 |
$39.33
|
|
Test for chlorohydrocarbons
|
$1,175.51 |
$1,175.51 |
$1,175.51 |
$65.00
|
|
Tetanus immune globulin inj
|
$1,573.18 |
$1,573.18 |
$1,573.18 |
$1,285.36
|
|
Theophylline therapeutic drug level
|
$722.89 |
$722.89 |
$722.89 |
$108.00
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$39.50 |
$39.50 |
$39.50 |
$25.54
|
|
Thiotepa injection
|
$1,942.29 |
$1,942.29 |
$1,942.29 |
$1,485.00
|
|
Thrombin time
|
$534.83 |
$534.83 |
$534.83 |
$53.76
|
|
Thromboplastin time partial (ptt) substitution fractions each
|
$619.83 |
$619.83 |
$619.83 |
$61.52
|
|
Thromboxane urine
|
$423.35 |
$423.35 |
$423.35 |
$95.00
|
|
Thyroglobulin antibody
|
$1,202.03 |
$1,202.03 |
$1,202.03 |
$82.00
|
|
Thyrotropin alfa 0.9 mg intramuscular solution
|
$6,523.23 |
$6,523.23 |
$6,523.23 |
$4,112.43
|
|
Thyroxine binding globulin (tbg)
|
$853.82 |
$853.82 |
$853.82 |
$64.35
|
|
Tibial length sock fx or equ
|
$605.00 |
$605.00 |
$605.00 |
$88.92
|
|
Tigecycline injection
|
$131.00 |
$131.00 |
$131.00 |
$234.00
|
|
Tissue culture placenta
|
$3,438.68 |
$3,438.68 |
$3,438.68 |
$457.00
|
|
Tissue culture skin/biopsy
|
$3,286.38 |
$3,286.38 |
$3,286.38 |
$484.00
|
|
Tissue culture tumor
|
$3,445.01 |
$3,445.01 |
$3,445.01 |
$483.36
|
|
Tissue matrix 1.8x1.8cm collagen dermacell porous 4sq cm cost per sq cm
|
$80.33 |
$80.33 |
$80.33 |
$1,134.00
|
|
Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr
|
$4.36 |
$4.36 |
$4.36 |
$152.36
|
|
Tobramycin non-comp unit
|
$362.25 |
$362.25 |
$362.25 |
$108.42
|
|
Tobramycin peak therapeutic drug level
|
$984.72 |
$984.72 |
$984.72 |
$120.60
|
|
Topotecan 4 mg/4 ml (1 mg/ml) intravenous solution
|
$169.60 |
$169.60 |
$169.60 |
$325.00
|
|
Toxoplasma antibody igg
|
$1,011.17 |
$1,011.17 |
$1,011.17 |
$89.40
|
|
Toxoplasma antibody igm
|
$1,403.93 |
$1,403.93 |
$1,403.93 |
$87.00
|
|
Transferrin
|
$220.14 |
$220.14 |
$220.14 |
$82.00
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$727.98 |
$727.98 |
$727.98 |
$224.90
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$777.19 |
$777.19 |
$777.19 |
$145.51
|
|
Treatment inhalation pressurized/nonpressurized acute airway obstruction
|
$696.05 |
$696.05 |
$696.05 |
$203.35
|
|
Trg gene rearrangement anal
|
$877.17 |
$877.17 |
$877.17 |
$455.70
|
|
Trh stimulation panel
|
$1,569.08 |
$1,569.08 |
$1,569.08 |
$117.75
|
|
Trichinella antibody
|
$1,281.33 |
$1,281.33 |
$1,281.33 |
$70.20
|
|
Trichomonas assay w/optic
|
$66.66 |
$66.66 |
$66.66 |
$55.50
|
|
Trilaciclib 300 mg intravenous solution
|
$5,036.50 |
$5,036.50 |
$5,036.50 |
$4,043.12
|
|
Trimethobenzamide hcl inj
|
$102.40 |
$102.40 |
$102.40 |
$117.49
|
|
Tube drain vert dev st 5-40f
|
$73.00 |
$73.00 |
$73.00 |
$29.40
|
|
Ultrasound guide tissue ablation
|
$3,388.31 |
$3,388.31 |
$3,388.31 |
$560.00
|
|
Ultrasound infant hips ltd without stress
|
$3,967.77 |
$3,967.77 |
$3,967.77 |
$311.25
|
|
Ultrasound prostate/transrectal
|
$4,084.63 |
$4,084.63 |
$4,084.63 |
$557.40
|
|
Unlisted fluoroscopic px
|
$457.64 |
$457.64 |
$457.64 |
$305.76
|
|
Unlisted neurological dx px
|
$930.80 |
$930.80 |
$930.80 |
$242.50
|
|
Urea nitrogen 24 hour urine
|
$349.57 |
$349.57 |
$349.57 |
$51.75
|
|
Uric acid blood
|
$885.86 |
$885.86 |
$885.86 |
$48.75
|
