|
Smear fluorescent and/or acid fast stain
|
$23.13 |
$23.13 |
$23.13 |
$50.70
|
|
Smear gram stain
|
$42.37 |
$42.37 |
$42.37 |
$48.00
|
|
Smear nasal eosinophil
|
$21.65 |
$21.65 |
$21.65 |
$50.00
|
|
Smear special stain inclusion bodies/parasites
|
$52.08 |
$52.08 |
$52.08 |
$60.00
|
|
Smear wet mount
|
$21.74 |
$21.74 |
$21.74 |
$56.13
|
|
Snrpn/ube3a gene
|
$479.34 |
$479.34 |
$479.34 |
$228.80
|
|
Sodium 24 hour urine
|
$47.18 |
$47.18 |
$47.18 |
$47.25
|
|
Sodium chloride 0.9 % intravenous solution
|
$48.58 |
$48.58 |
$48.58 |
$46.35
|
|
Sodium chloride 0.9 % IV bolus
|
$48.71 |
$48.71 |
$48.71 |
$42.25
|
|
Sodium chloride 0.9 % IV bolus
|
$24.18 |
$24.18 |
$24.18 |
$42.25
|
|
Sodium chloride 3 % ivpb
|
$17.39 |
$17.39 |
$17.39 |
$37.50
|
|
Sodium ferric gluconate complex in sucrose 62.5 mg/5 ml intravenous
|
$9.45 |
$9.45 |
$9.45 |
$28.46
|
|
Sodium serum/plasma/whole blood
|
$24.88 |
$24.88 |
$24.88 |
$42.43
|
|
Somatosensory testing
|
$358.35 |
$358.35 |
$358.35 |
$827.45
|
|
Somatropin injection
|
$339.59 |
$339.59 |
$339.59 |
$339.59
|
|
Special physics consult
|
$224.41 |
$224.41 |
$224.41 |
$688.05
|
|
Special radiation dosimetry
|
$138.75 |
$138.75 |
$138.75 |
$482.08
|
|
Special radiation treatment
|
$609.48 |
$609.48 |
$609.48 |
$1,945.00
|
|
Special teletx port plan
|
$389.33 |
$389.33 |
$389.33 |
$975.60
|
|
Specific gravity body fluid
|
$14.99 |
$14.99 |
$14.99 |
$21.55
|
|
Spirometry bronchodilation responsiveness pre/post bronchodilator administration
|
$159.01 |
$159.01 |
$159.01 |
$526.80
|
|
Split blood or products
|
$65.12 |
$65.12 |
$65.12 |
$143.64
|
|
Sr-89 stront chlor ther / mci
|
$10,718.35 |
$10,718.35 |
$10,718.35 |
$5,445.60
|
|
Srs linear based
|
$3,766.05 |
$3,766.05 |
$3,766.05 |
$14,124.25
|
|
St analysis behavior qualitative voice/resonance
|
$64.57 |
$64.57 |
$64.57 |
$295.10
|
|
St cognitve performance testing healthcare professional each hour
|
$106.28 |
$106.28 |
$106.28 |
$313.96
|
|
Stent/athrectomy/fem/pop/unilat 37227
|
$46,301.25 |
$46,301.25 |
$46,301.25 |
$28,126.65
|
|
Stent iliac/open or perc/uni/init 37221
|
$24,193.19 |
$24,193.19 |
$24,193.19 |
$19,385.83
|
|
Stent iliac/open/perc/ea ad/ipsila 37223
|
$20,776.24 |
$20,776.24 |
$20,776.24 |
$10,086.20
|
|
Stent/tib/peroneal/unilat/initial 37230
|
$27,143.57 |
$27,143.57 |
$27,143.57 |
$24,161.40
|
|
St evaluate speech sound production
|
$68.64 |
$68.64 |
$68.64 |
$298.41
|
|
St evaluate speech sound production comprehensive/expressive
|
$142.36 |
$142.36 |
$142.36 |
$387.00
|
|
St evaluation motion fluoroscopic swallow function cine/video
|
$134.59 |
$134.59 |
$134.59 |
$336.00
|
|
St evaluation swallow function
|
$88.43 |
$88.43 |
$88.43 |
$323.72
|
|
Strapping of ankle and/or ft 29540
|
$89.36 |
$89.36 |
$89.36 |
$185.36
|
|
Strapping of chest
|
$111.37 |
$111.37 |
$111.37 |
$196.93
|
|
Strapping of elbow or wrist 29260
|
$176.31 |
$176.31 |
$176.31 |
$176.31
|
|
Strapping of hand or finger
|
$153.74 |
$153.74 |
$153.74 |
$197.63
|
|
Strapping of hip
|
$114.33 |
$114.33 |
$114.33 |
$164.70
|
|
Strapping of knee
|
$93.52 |
$93.52 |
$93.52 |
$216.34
|
|
Strapping of toes 29550
|
$78.90 |
$78.90 |
$78.90 |
$183.30
|
|
Streptomycin injection
|
$26.21 |
$26.21 |
$26.21 |
$26.21
|
|
Streptozocin injection
|
$459.11 |
$459.11 |
$459.11 |
$400.68
|
|
Stress test pulmonary
|
$135.61 |
$135.61 |
$135.61 |
$330.63
|
|
St treatment speech individual
|
$66.05 |
$66.05 |
$66.05 |
$246.87
|
|
St treatment swallow dysfunction/oral
|
$87.32 |
$87.32 |
$87.32 |
$221.00
|
|
Succinylcholine chloride 20 mg/ml injection solution (wrapper)
|
$61.83 |
$61.83 |
$61.83 |
$22.19
|
|
Sugars single quant
|
$92.91 |
$92.91 |
$92.91 |
$64.28
|
|
Supprelin la implant
|
$25,852.66 |
$25,852.66 |
$25,852.66 |
$45,560.39
|
|
Surgical pathology level 1 gross examination only
|
$23.31 |
$23.31 |
$23.31 |
$81.00
|
|
Surgical pathology level 2 gross & microscopic examination
|
$48.56 |
$48.56 |
$48.56 |
$138.00
|
|
Surgical pathology level 3 gross & microscopic examination
|
$50.14 |
$50.14 |
$50.14 |
$181.00
|
|
Surgical pathology level 4 gross & microscopic examination
|
$68.45 |
$68.45 |
$68.45 |
$239.85
|
|
Surgical pathology level 5 gross & microscopic examination
|
$160.30 |
$160.30 |
$160.30 |
$489.00
|
|
Surgical pathology level 6 gross & microscopic examination
|
$208.22 |
$208.22 |
$208.22 |
$720.75
|
|
Susceptibility agar dilution per agent
|
$20.72 |
$20.72 |
$20.72 |
$38.58
|
|
Susceptibility enzyme detection per enzyme
|
$13.97 |
$13.97 |
$13.97 |
$31.85
|
|
Susceptibility mic per plate
|
$163.98 |
$163.98 |
$163.98 |
$89.70
|
|
Svc venogram s&i
|
$867.10 |
$867.10 |
$867.10 |
$1,908.00
|
|
Sweat collection by iontophoresis
|
$50.14 |
$50.14 |
$50.14 |
$100.20
|
|
Synvisc or synvisc-one
|
$1,242.63 |
$1,242.63 |
$1,242.63 |
$1,053.54
|
|
Syphilis test non-treponemal antibody quantitative rpr
|
$45.70 |
$45.70 |
$45.70 |
$45.70
|
|
T3 (triiodothyronine) free
|
$89.82 |
$89.82 |
$89.82 |
$91.20
|
|
T3 (triiodothyronine) total
|
$59.02 |
$59.02 |
$59.02 |
$88.00
|
|
T4 (thyroxine) free
|
$61.33 |
$61.33 |
$61.33 |
$65.00
|
|
T4 (thyroxine) total
|
$41.26 |
$41.26 |
$41.26 |
$62.40
|
|
Tacrol envarsus ex rel oral
|
$2.74 |
$2.74 |
$2.74 |
$3.20
|
|
Tacrolimus 1 mg capsule, immediate-release
|
$1.36 |
$1.36 |
$1.36 |
$4.87
|
|
Tacrolimus 5 mg/ml intravenous solution
|
$176.77 |
$176.77 |
$176.77 |
$612.11
|
|
Tacrolimus therapeutic drug level
|
$96.66 |
$96.66 |
$96.66 |
$137.15
|
|
Target gsa panel hmtlmph neop
|
$925.19 |
$925.19 |
$925.19 |
$1,928.40
|
|
Target gsa panel organ/hmtlmph neop
|
$1,259.70 |
$1,259.70 |
$1,259.70 |
$3,567.96
|
|
Target gsa panel organ neop
|
$1,426.07 |
$1,426.07 |
$1,426.07 |
$1,913.00
|
|
Tbo-filgrastim 300 mcg/0.5 ml subcutaneous syringe
|
$332.56 |
$332.56 |
$332.56 |
$760.95
|
|
Tb test cell mediated immunity antigen response enumeration gamma interferon t-cells
|
$85.93 |
$85.93 |
$85.93 |
$221.65
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$77.52 |
$77.52 |
$77.52 |
$178.40
|
|
Tc-99m bicisate
|
$2,525.34 |
$2,525.34 |
$2,525.34 |
$2,398.20
|
|
Tc-99m exametazime diag
|
$2,832.07 |
$2,832.07 |
$2,832.07 |
$2,236.65
|
|
Tc-99m labeled rbc
|
$265.66 |
$265.66 |
$265.66 |
$312.70
|
|
Tc-99m maa
|
$281.20 |
$281.20 |
$281.20 |
$306.60
|
|
Tc-99m mebrofenin
|
$111.28 |
$111.28 |
$111.28 |
$169.53
|
|
Tc-99m medronate
|
$43.11 |
$43.11 |
$43.11 |
$120.35
|
|
Tc-99m mertiatide
|
$582.84 |
$582.84 |
$582.84 |
$757.25
|
|
Tc-99m oxidronate
|
$83.99 |
$83.99 |
$83.99 |
$132.05
|
|
Tc-99m pentetate dtpa
|
$161.23 |
$161.23 |
$161.23 |
$222.60
|
|
Tc-99m pertechnetate per mci
|
$49.12 |
$49.12 |
$49.12 |
$22.10
|
|
Tc-99m pyroph diag per dose up to 25 mci
|
$130.80 |
$130.80 |
$130.80 |
$137.01
|
|
Tc-99m succimer (dmsa)
|
$373.42 |
$373.42 |
$373.42 |
$1,749.60
|
|
Tc-99m sulfur colloid
|
$199.25 |
$199.25 |
$199.25 |
$240.50
|
|
Tc-99m tetrofosmin p study dose
|
$138.29 |
$138.29 |
$138.29 |
$198.05
|
|
Tc-99m tilmanocept diag
|
$801.70 |
$801.70 |
$801.70 |
$1,007.79
|
|
T cells absolute cd4/cd8 including ratio
|
$185.28 |
$185.28 |
$185.28 |
$189.60
|
|
T cells absolute cd 4 count
|
$110.72 |
$110.72 |
$110.72 |
$120.25
|
|
T cells total count
|
$68.92 |
$68.92 |
$68.92 |
$126.90
|
|
Telavancin injection
|
$464.05 |
$464.05 |
$464.05 |
$2,428.05
|
|
Telethx isodose plan cplx
|
$277.22 |
$277.22 |
$277.22 |
$1,526.85
|
|
Telethx isodose plan simple
|
$200.36 |
$200.36 |
$200.36 |
$848.72
|
|
Temozolomide
|
$427.46 |
$427.46 |
$427.46 |
$632.98
|
|
Temozolomide 100 mg intravenous solution
|
$29.19 |
$29.19 |
$29.19 |
$601.80
|
|
Temsirolimus 30 mg/3 ml (10 mg/ml) (first dilution) intravenous soln
|
$116.48 |
$116.48 |
$116.48 |
$116.48
|
