|
Smear nasal eosinophil
|
$24.00 |
$24.00 |
$24.00 |
$46.20
|
|
Smear special stain inclusion bodies/parasites
|
$29.60 |
$29.60 |
$29.60 |
$73.15
|
|
Sodium 24 hour urine
|
$20.80 |
$20.80 |
$20.80 |
$48.60
|
|
Sodium chloride 0.9 % intravenous solution
|
$16.00 |
$16.00 |
$16.00 |
$48.11
|
|
Sodium chloride 3 % ivpb
|
$22.00 |
$22.00 |
$22.00 |
$40.61
|
|
Sodium serum/plasma/whole blood
|
$25.60 |
$25.60 |
$25.60 |
$45.60
|
|
Spinal puncture lumbar diagnostic w/fluoroscopic or CT guidance
|
$1,758.40 |
$1,758.40 |
$1,758.40 |
$1,439.40
|
|
Spirometry bronchodilation responsiveness pre/post bronchodilator administration
|
$841.60 |
$841.60 |
$841.60 |
$543.26
|
|
Splint dorsal bloc wh med perf 3.2mm lf polyflex ii
|
$552.00 |
$552.00 |
$552.00 |
$392.09
|
|
Splint extn xsm w sof-stretch rolyan
|
$67.20 |
$67.20 |
$67.20 |
$68.25
|
|
Splint finger frog med
|
$79.20 |
$79.20 |
$79.20 |
$38.08
|
|
Split blood or products
|
$653.60 |
$653.60 |
$653.60 |
$127.48
|
|
Staph a dna amp probe
|
$175.20 |
$175.20 |
$175.20 |
$125.00
|
|
St cognitve performance testing healthcare professional each hour
|
$424.80 |
$424.80 |
$424.80 |
$286.00
|
|
Sterile water/saline, 10 ml
|
$36.80 |
$36.80 |
$36.80 |
$13.32
|
|
St evaluate speech sound production
|
$380.00 |
$380.00 |
$380.00 |
$292.95
|
|
St evaluate speech sound production comprehensive/expressive
|
$380.00 |
$380.00 |
$380.00 |
$377.00
|
|
St evaluation motion fluoroscopic swallow function cine/video
|
$429.60 |
$429.60 |
$429.60 |
$399.60
|
|
St evaluation swallow function
|
$380.00 |
$380.00 |
$380.00 |
$314.40
|
|
Stress test pulmonary
|
$455.20 |
$455.20 |
$455.20 |
$322.85
|
|
St treatment speech individual
|
$304.80 |
$304.80 |
$304.80 |
$248.84
|
|
St treatment swallow dysfunction/oral
|
$296.80 |
$296.80 |
$296.80 |
$240.31
|
|
Succinylcholine chloride 20 mg/ml injection solution (wrapper)
|
$15.00 |
$15.00 |
$15.00 |
$52.31
|
|
Sugars single quant
|
$48.00 |
$48.00 |
$48.00 |
$64.28
|
|
Sulfamethoxazole 400 mg-trimethoprim 80 mg/5 ml intravenous solution
|
$22.00 |
$22.00 |
$22.00 |
$82.43
|
|
Sumatriptan 6 mg/0.5 ml subcutaneous solution
|
$5.60 |
$5.60 |
$5.60 |
$114.88
|
|
Surgical pathology level 1 gross examination only
|
$126.40 |
$126.40 |
$126.40 |
$79.50
|
|
Surgical pathology level 2 gross & microscopic examination
|
$126.40 |
$126.40 |
$126.40 |
$141.94
|
|
Surgical pathology level 3 gross & microscopic examination
|
$252.80 |
$252.80 |
$252.80 |
$181.00
|
|
Surgical pathology level 4 gross & microscopic examination
|
$218.40 |
$218.40 |
$218.40 |
$239.85
|
|
Surgical pathology level 5 gross & microscopic examination
|
$1,124.00 |
$1,124.00 |
$1,124.00 |
$480.00
|
|
Susceptibility enzyme detection per enzyme
|
$20.00 |
$20.00 |
$20.00 |
$35.70
|
|
Susceptibility mic per plate
|
$52.80 |
$52.80 |
$52.80 |
$106.00
|
|
Syphilis test non-treponemal antibody quantitative rpr
|
$18.40 |
$18.40 |
$18.40 |
$41.60
|
|
T3 (triiodothyronine) free
|
$70.40 |
$70.40 |
$70.40 |
$99.20
|
|
T3 (triiodothyronine) total
|
$59.20 |
$59.20 |
$59.20 |
$93.52
|
|
T4 (thyroxine) free
|
$35.00 |
$35.00 |
$35.00 |
$85.20
|
|
T4 (thyroxine) total
|
$28.00 |
$28.00 |
$28.00 |
$69.00
|
|
Tacrolimus 1 mg capsule, immediate-release
|
$2.20 |
$2.20 |
$2.20 |
$9.84
|
|
Tacrolimus therapeutic drug level
|
$50.00 |
$50.00 |
$50.00 |
$122.40
|
|
Target gsa panel hmtlmph neop
|
$3,160.00 |
$3,160.00 |
$3,160.00 |
$2,246.30
|
|
Tbo-filgrastim 300 mcg/0.5 ml subcutaneous syringe
|
$327.60 |
$327.60 |
$327.60 |
$937.50
|
|
Tbs techl calculation only
|
$398.40 |
$398.40 |
$398.40 |
$153.60
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$309.60 |
$309.60 |
$309.60 |
$177.65
|
|
Tc-99m labeled rbc
|
$363.20 |
$363.20 |
$363.20 |
$302.40
|
|
Tc-99m maa
|
$320.80 |
$320.80 |
$320.80 |
$292.80
|
|
Tc-99m mebrofenin
|
$94.40 |
$94.40 |
$94.40 |
$157.65
|
|
Tc-99m medronate
|
$52.80 |
$52.80 |
$52.80 |
$111.01
|
|
Tc-99m mertiatide
|
$824.80 |
$824.80 |
$824.80 |
$756.00
|
|
Tc-99m non-heu per study dose
|
$17.60 |
$17.60 |
$17.60 |
$6.60
|
|
Tc-99m pentetate dtpa aerosol
|
$321.60 |
$321.60 |
$321.60 |
$190.80
|
|
Tc-99m pertechnetate per mci
|
$68.80 |
$68.80 |
$68.80 |
$22.10
|
|
Tc-99m sestamibi p study dose
|
$94.40 |
$94.40 |
$94.40 |
$274.45
|
|
Tc-99m sulfur colloid
|
$146.40 |
$146.40 |
$146.40 |
$240.50
|
|
T cells absolute cd4/cd8 including ratio
|
$195.20 |
$195.20 |
$195.20 |
$176.40
|
|
T cells absolute cd 4 count
|
$111.20 |
$111.20 |
$111.20 |
$111.20
|
|
T cells total count
|
$157.60 |
$157.60 |
$157.60 |
$126.90
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$26,651.20 |
$26,651.20 |
$26,651.20 |
$15,245.38
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$5.20 |
$5.20 |
$5.20 |
$39.33
|
|
Test stress cardiovascular tracing only
|
$1,102.40 |
$1,102.40 |
$1,102.40 |
$949.70
|
|
Tetanus immune globulin inj
|
$1,468.40 |
$1,468.40 |
$1,468.40 |
$1,285.36
|
|
Theophylline therapeutic drug level
|
$59.20 |
$59.20 |
$59.20 |
$108.00
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$31.80 |
$31.80 |
$31.80 |
$25.54
|
|
Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides)
|
$2,428.00 |
$2,428.00 |
$2,428.00 |
$1,687.50
|
|
Thrombin time
|
$40.80 |
$40.80 |
$40.80 |
$53.76
|
|
Thyroglobulin antibody
|
$66.40 |
$66.40 |
$66.40 |
$82.00
|
|
Thyroid (TSH) Test
|
$40.00 |
$40.00 |
$40.00 |
$111.00
|
|
Thyroid Ultrasound
|
$635.20 |
$635.20 |
$635.20 |
$588.50
|
|
Thyroxine binding globulin (tbg)
|
$61.60 |
$61.60 |
$61.60 |
$64.35
|
|
Tissue exam koh skin/hair/nails
|
$17.60 |
$17.60 |
$17.60 |
$47.20
|
|
Tissue transglutaminase iga
|
$57.60 |
$57.60 |
$57.60 |
$44.16
|
|
Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr
|
$17.00 |
$17.00 |
$17.00 |
$152.36
|
|
Tobramycin peak therapeutic drug level
|
$67.20 |
$67.20 |
$67.20 |
$120.60
|
|
Tocilizumab 162 mg/0.9 ml subcutaneous pen injector
|
$6,214.80 |
$6,214.80 |
$6,214.80 |
$5,258.52
|
|
Tomosynthesis breast screen bilateral
|
$157.60 |
$157.60 |
$157.60 |
$72.68
|
|
Toxoplasma antibody igg
|
$60.00 |
$60.00 |
$60.00 |
$89.40
|
|
Toxoplasma antibody igm
|
$60.00 |
$60.00 |
$60.00 |
$87.00
|
|
Tranexamic acid 1,000 mg/10 ml (100 mg/ml) intravenous solution
|
$16.20 |
$16.20 |
$16.20 |
$56.38
|
|
Transferrin
|
$50.00 |
$50.00 |
$50.00 |
$82.00
|
|
Transfusion blood/blood component(s)
|
$1,714.40 |
$1,714.40 |
$1,714.40 |
$983.00
|
|
Treat humerus fracture
|
$849.60 |
$849.60 |
$849.60 |
$1,771.43
|
|
Treat knee fracture 27530
|
$1,445.60 |
$1,445.60 |
$1,445.60 |
$550.00
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$549.60 |
$549.60 |
$549.60 |
$224.90
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$255.20 |
$255.20 |
$255.20 |
$145.51
|
|
Treatment inhalation pressurized/nonpressurized acute airway obstruction
|
$252.00 |
$252.00 |
$252.00 |
$203.35
|
|
Treatment of ankle fracture 27786
|
$518.40 |
$518.40 |
$518.40 |
$520.80
|
|
Treatment of fibula fracture 27780
|
$593.60 |
$593.60 |
$593.60 |
$491.50
|
|
Treatment of heel fracture 28400
|
$513.60 |
$513.60 |
$513.60 |
$473.00
|
|
Treatment of toe fracture 28510
|
$752.00 |
$752.00 |
$752.00 |
$369.70
|
|
Treponema pallidum antibody
|
$65.60 |
$65.60 |
$65.60 |
$70.40
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$35.60 |
$35.60 |
$35.60 |
$43.21
|
|
Triglycerides
|
$28.00 |
$28.00 |
$28.00 |
$58.05
|
|
Troponin quantitative
|
$118.40 |
$118.40 |
$118.40 |
$127.20
|
|
Ultrasound abdomen aorta screening study aaa
|
$300.80 |
$300.80 |
$300.80 |
$394.20
|
|
Ultrasound breast complete
|
$540.80 |
$540.80 |
$540.80 |
$528.41
|
|
Ultrasound breast unilateral limited (both sides)
|
$492.00 |
$492.00 |
$492.00 |
$449.35
|
|
Ultrasound chest
|
$724.00 |
$724.00 |
$724.00 |
$460.85
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$329.60 |
$329.60 |
$329.60 |
$338.00
|
|
Ultrasound encephalogram
|
$588.80 |
$588.80 |
$588.80 |
$488.80
|
|
Ultrasound exam k transpl w/doppler
|
$544.00 |
$544.00 |
$544.00 |
$573.54
|
