|
Sincalide 5 mcg solution for injection
|
$576.68 |
$576.68 |
$576.68 |
$307.58
|
|
Sinus CT scan (with and without contrast)
|
$8,584.00 |
$8,584.00 |
$8,584.00 |
$1,790.00
|
|
Sinus CT scan (with contrast)
|
$6,166.36 |
$6,166.36 |
$6,166.36 |
$1,527.60
|
|
Sinus CT scan (without contrast)
|
$5,841.62 |
$5,841.62 |
$5,841.62 |
$1,292.04
|
|
Skeletal muscle relaxant 1/2
|
$156.05 |
$156.05 |
$156.05 |
$83.85
|
|
Sleep study unattended
|
$710.33 |
$710.33 |
$710.33 |
$580.87
|
|
Smear nasal eosinophil
|
$114.34 |
$114.34 |
$114.34 |
$46.20
|
|
Smear special stain inclusion bodies/parasites
|
$163.78 |
$163.78 |
$163.78 |
$73.15
|
|
Smear wet mount
|
$270.38 |
$270.38 |
$270.38 |
$67.49
|
|
Sodium 24 hour urine
|
$163.78 |
$163.78 |
$163.78 |
$48.60
|
|
Sodium chloride 0.9 % intravenous solution
|
$25.00 |
$25.00 |
$25.00 |
$48.11
|
|
Sodium ferric gluconate complex in sucrose 62.5 mg/5 ml intravenous
|
$16.43 |
$16.43 |
$16.43 |
$77.77
|
|
Sodium hyaluronate 20 mg/2 ml syringe
|
$210.06 |
$210.06 |
$210.06 |
$410.40
|
|
Sodium serum/plasma/whole blood
|
$214.75 |
$214.75 |
$214.75 |
$45.60
|
|
Specific gravity body fluid
|
$145.23 |
$145.23 |
$145.23 |
$22.00
|
|
Specimen fat stain
|
$227.12 |
$227.12 |
$227.12 |
$35.10
|
|
Spirometry bronchodilation responsiveness pre/post bronchodilator administration
|
$1,528.60 |
$1,528.60 |
$1,528.60 |
$543.26
|
|
St evaluate speech sound production
|
$1,372.36 |
$1,372.36 |
$1,372.36 |
$292.95
|
|
St evaluate speech sound production comprehensive/expressive
|
$1,372.36 |
$1,372.36 |
$1,372.36 |
$377.00
|
|
St evaluation motion fluoroscopic swallow function cine/video
|
$2,477.08 |
$2,477.08 |
$2,477.08 |
$399.60
|
|
St evaluation swallow function
|
$661.86 |
$661.86 |
$661.86 |
$314.40
|
|
Strep a ag ia
|
$26.00 |
$26.00 |
$26.00 |
$75.40
|
|
St treatment swallow dysfunction/oral
|
$739.72 |
$739.72 |
$739.72 |
$240.31
|
|
Sumatriptan 6 mg/0.5 ml subcutaneous solution
|
$37.63 |
$37.63 |
$37.63 |
$114.88
|
|
Surgical pathology level 1 gross examination only
|
$154.50 |
$154.50 |
$154.50 |
$79.50
|
|
Surgical pathology level 5 gross & microscopic examination
|
$1,447.67 |
$1,447.67 |
$1,447.67 |
$480.00
|
|
Surgical pathology level 6 gross & microscopic examination
|
$1,235.99 |
$1,235.99 |
$1,235.99 |
$718.00
|
|
Susceptibility agar dilution per agent
|
$440.33 |
$440.33 |
$440.33 |
$45.45
|
|
Susceptibility mic per plate
|
$315.18 |
$315.18 |
$315.18 |
$106.00
|
|
T3 (triiodothyronine) free
|
$891.46 |
$891.46 |
$891.46 |
$99.20
|
|
T3 (triiodothyronine) total
|
$381.62 |
$381.62 |
$381.62 |
$93.52
|
|
T4 (thyroxine) free
|
$373.89 |
$373.89 |
$373.89 |
$85.20
|
|
T4 (thyroxine) total
|
$264.19 |
$264.19 |
$264.19 |
$69.00
|
|
Tacrolimus therapeutic drug level
|
$404.79 |
$404.79 |
$404.79 |
$122.40
|
|
Target gsa panel organ neop
|
$12,051.00 |
$12,051.00 |
$12,051.00 |
$1,655.52
|
|
Tb test cell mediated immunity antigen response enumeration gamma interferon t-cells
|
$1,237.56 |
$1,237.56 |
$1,237.56 |
$194.35
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$106.08 |
$106.08 |
$106.08 |
$177.65
|
|
Tc-99m exametazime diag
|
$5,683.20 |
$5,683.20 |
$5,683.20 |
$2,033.20
|
|
Tc-99m labeled rbc
|
$53.67 |
$53.67 |
$53.67 |
$302.40
|
|
Tc-99m maa
|
$737.01 |
$737.01 |
$737.01 |
$292.80
|
|
Tc-99m mebrofenin
|
$586.73 |
$586.73 |
$586.73 |
$157.65
|
|
Tc-99m medronate
|
$447.22 |
$447.22 |
$447.22 |
$111.01
|
|
Tc-99m pentetate dtpa
|
$370.29 |
$370.29 |
$370.29 |
$222.60
|
|
Tc-99m pentetate dtpa aerosol
|
$579.60 |
$579.60 |
$579.60 |
$190.80
|
|
Tc-99m pertechnetate per mci
|
$450.79 |
$450.79 |
$450.79 |
$22.10
|
|
Tc-99m sestamibi p study dose
|
$1,323.76 |
$1,323.76 |
$1,323.76 |
$274.45
|
|
Tc-99m sulfur colloid
|
$350.61 |
$350.61 |
$350.61 |
$240.50
|
|
T cells absolute cd4/cd8 including ratio
|
$1,103.13 |
$1,103.13 |
$1,103.13 |
$176.40
|
|
Telehealth original site facility fee
|
$155.04 |
$155.04 |
$155.04 |
$51.00
|
|
Temsirolimus 30 mg/3 ml (10 mg/ml) (first dilution) intravenous soln
|
$5,728.45 |
$5,728.45 |
$5,728.45 |
$3,723.60
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$67.50 |
$67.50 |
$67.50 |
$39.33
|
|
Test for chlorohydrocarbons
|
$512.94 |
$512.94 |
$512.94 |
$65.00
|
|
Tetanus immune globulin inj
|
$1,651.82 |
$1,651.82 |
$1,651.82 |
$1,285.36
|
|
Theophylline therapeutic drug level
|
$341.44 |
$341.44 |
$341.44 |
$108.00
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$5.18 |
$5.18 |
$5.18 |
$25.54
|
|
Thrombin time
|
$301.27 |
$301.27 |
$301.27 |
$53.76
|
|
Thromboplastin time partial (ptt) substitution fractions each
|
$264.19 |
$264.19 |
$264.19 |
$61.52
|
|
Thromboxane urine
|
$605.65 |
$605.65 |
$605.65 |
$95.00
|
|
Thyroglobulin antibody
|
$512.94 |
$512.94 |
$512.94 |
$82.00
|
|
Thyroid imaging
|
$2,495.47 |
$2,495.47 |
$2,495.47 |
$695.02
|
|
Thyroid mets imag whole body
|
$5,983.73 |
$5,983.73 |
$5,983.73 |
$1,524.99
|
|
Thyroid Ultrasound
|
$1,256.55 |
$1,256.55 |
$1,256.55 |
$588.50
|
|
Thyroid uptake measurement
|
$4,985.54 |
$4,985.54 |
$4,985.54 |
$591.25
|
|
Thyroxine binding globulin (tbg)
|
$366.88 |
$366.88 |
$366.88 |
$64.35
|
|
Tigecycline injection
|
$31.40 |
$31.40 |
$31.40 |
$234.00
|
|
Tl-201 thallium diag per mci
|
$4,819.16 |
$4,819.16 |
$4,819.16 |
$78.40
|
|
Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr
|
$1.46 |
$1.46 |
$1.46 |
$152.36
|
|
Tobramycin peak therapeutic drug level
|
$392.43 |
$392.43 |
$392.43 |
$120.60
|
|
Tomosynthesis breast diagnostic left
|
$92.26 |
$92.26 |
$92.26 |
$73.00
|
|
Tomosynthesis breast screen bilateral
|
$92.26 |
$92.26 |
$92.26 |
$72.68
|
|
Toxoplasma antibody igg
|
$1,049.06 |
$1,049.06 |
$1,049.06 |
$89.40
|
|
Toxoplasma antibody igm
|
$593.28 |
$593.28 |
$593.28 |
$87.00
|
|
Tranexamic acid 1,000 mg/10 ml (100 mg/ml) intravenous solution
|
$172.30 |
$172.30 |
$172.30 |
$56.38
|
|
Transferrin
|
$326.01 |
$326.01 |
$326.01 |
$82.00
|
|
Treatment inhalation pressurized/nonpressurized acute airway obstruction
|
$213.06 |
$213.06 |
$213.06 |
$203.35
|
|
Treatment of ankle fracture 27786
|
$1,213.00 |
$1,213.00 |
$1,213.00 |
$520.80
|
|
Trg gene rearrangement anal
|
$1,626.89 |
$1,626.89 |
$1,626.89 |
$455.70
|
|
Trh stimulation panel
|
$276.56 |
$276.56 |
$276.56 |
$117.75
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$100.20 |
$100.20 |
$100.20 |
$43.21
|
|
Trichinella antibody
|
$545.39 |
$545.39 |
$545.39 |
$70.20
|
|
Trimethobenzamide hcl inj
|
$85.50 |
$85.50 |
$85.50 |
$117.49
|
|
Troponin quantitative
|
$588.65 |
$588.65 |
$588.65 |
$127.20
|
|
Ultrasound abdomen aorta screening study aaa
|
$1,795.84 |
$1,795.84 |
$1,795.84 |
$394.20
|
|
Ultrasound chest
|
$1,731.79 |
$1,731.79 |
$1,731.79 |
$460.85
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$2,522.31 |
$2,522.31 |
$2,522.31 |
$469.50
|
|
Ultrasound guided needle placement supervision & interpretation
|
$2,154.73 |
$2,154.73 |
$2,154.73 |
$720.15
|
|
Ultrasound joint complete left
|
$2,062.45 |
$2,062.45 |
$2,062.45 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$1,033.53 |
$1,033.53 |
$1,033.53 |
$425.45
|
|
Ultrasound ob >=14wks ea addl gest
|
$2,917.58 |
$2,917.58 |
$2,917.58 |
$407.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$2,028.62 |
$2,028.62 |
$2,028.62 |
$331.50
|
|
Ultrasound pregnant uterus follow up per fetus
|
$1,256.55 |
$1,256.55 |
$1,256.55 |
$425.60
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$2,028.62 |
$2,028.62 |
$2,028.62 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$2,028.62 |
$2,028.62 |
$2,028.62 |
$497.12
|
|
Ultrasound prostate/transrectal
|
$2,050.15 |
$2,050.15 |
$2,050.15 |
$557.40
|
|
Ultrasound retroperitoneal limited
|
$1,241.16 |
$1,241.16 |
$1,241.16 |
$486.50
|
|
Ultrasound scrotum and contents
|
$2,497.71 |
$2,497.71 |
$2,497.71 |
$608.90
|
|
Ultrasound transvaginal non obstetric
|
$1,254.99 |
$1,254.99 |
$1,254.99 |
$558.35
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$7,446.95 |
$7,446.95 |
$7,446.95 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$10,660.89 |
$10,660.89 |
$10,660.89 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$6,892.74 |
$6,892.74 |
$6,892.74 |
$2,034.41
|
