|
Smear gram stain
|
$16.80 |
$16.80 |
$16.80 |
$55.25
|
|
Smear nasal eosinophil
|
$24.00 |
$24.00 |
$24.00 |
$46.20
|
|
Smear special stain inclusion bodies/parasites
|
$24.80 |
$24.80 |
$24.80 |
$73.15
|
|
Sodium 24 hour urine
|
$20.80 |
$20.80 |
$20.80 |
$48.60
|
|
Sodium serum/plasma/whole blood
|
$25.60 |
$25.60 |
$25.60 |
$45.60
|
|
Sodium thiosulfate 12.5 gram/50 ml (250 mg/ml) intravenous solution
|
$1,007.60 |
$1,007.60 |
$1,007.60 |
$177.52
|
|
Splint dorsal bloc wh med perf 3.2mm lf polyflex ii
|
$552.80 |
$552.80 |
$552.80 |
$392.09
|
|
Split blood or products
|
$653.60 |
$653.60 |
$653.60 |
$127.48
|
|
St analysis behavior qualitative voice/resonance
|
$384.80 |
$384.80 |
$384.80 |
$297.60
|
|
Staph a dna amp probe
|
$143.20 |
$143.20 |
$143.20 |
$125.00
|
|
St cognitve performance testing healthcare professional each hour
|
$384.80 |
$384.80 |
$384.80 |
$286.00
|
|
Sterile water/saline, 10 ml
|
$46.40 |
$46.40 |
$46.40 |
$13.32
|
|
St evaluate speech sound production
|
$384.80 |
$384.80 |
$384.80 |
$292.95
|
|
St evaluate speech sound production comprehensive/expressive
|
$384.80 |
$384.80 |
$384.80 |
$377.00
|
|
St evaluation motion fluoroscopic swallow function cine/video
|
$464.00 |
$464.00 |
$464.00 |
$399.60
|
|
St evaluation swallow function
|
$404.80 |
$404.80 |
$404.80 |
$314.40
|
|
Stress test pulmonary
|
$455.20 |
$455.20 |
$455.20 |
$322.85
|
|
St treatment speech individual
|
$270.40 |
$270.40 |
$270.40 |
$248.84
|
|
St treatment swallow dysfunction/oral
|
$296.80 |
$296.80 |
$296.80 |
$240.31
|
|
Sumatriptan 6 mg/0.5 ml subcutaneous solution
|
$55.00 |
$55.00 |
$55.00 |
$114.88
|
|
Surgical pathology level 1 gross examination only
|
$102.40 |
$102.40 |
$102.40 |
$79.50
|
|
Surgical pathology level 2 gross & microscopic examination
|
$102.40 |
$102.40 |
$102.40 |
$141.94
|
|
Surgical pathology level 3 gross & microscopic examination
|
$204.80 |
$204.80 |
$204.80 |
$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 mic per plate
|
$35.20 |
$35.20 |
$35.20 |
$106.00
|
|
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
|
|
Tacrol envarsus ex rel oral
|
$9.00 |
$9.00 |
$9.00 |
$15.60
|
|
Tacrolimus 1 mg capsule, immediate-release
|
$4.40 |
$4.40 |
$4.40 |
$9.84
|
|
Tacrolimus therapeutic drug level
|
$50.00 |
$50.00 |
$50.00 |
$122.40
|
|
Tbo-filgrastim 300 mcg/0.5 ml subcutaneous syringe
|
$815.20 |
$815.20 |
$815.20 |
$937.50
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$257.60 |
$257.60 |
$257.60 |
$177.65
|
|
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
|
|
Telethx isodose plan cplx
|
$4,604.80 |
$4,604.80 |
$4,604.80 |
$1,526.85
|
|
Test pathogen(s) for platelets reference
|
$238.40 |
$238.40 |
$238.40 |
$70.00
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$43.00 |
$43.00 |
$43.00 |
$25.54
|
|
Thyroglobulin antibody
|
$66.40 |
$66.40 |
$66.40 |
$82.00
|
|
Thyroid (TSH) Test
|
$40.00 |
$40.00 |
$40.00 |
$111.00
|
|
Tissue exam koh skin/hair/nails
|
$17.60 |
$17.60 |
$17.60 |
$47.20
|
|
Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr
|
$849.60 |
$849.60 |
$849.60 |
$152.36
|
|
Tomosynthesis breast screen bilateral
|
$88.80 |
$88.80 |
$88.80 |
$72.68
|
|
Toxoplasma antibody igg
|
$60.00 |
$60.00 |
$60.00 |
$89.40
|
|
Toxoplasma antibody igm
|
$60.00 |
$60.00 |
$60.00 |
$87.00
|
|
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
|
|
Treatment inhalation pressurized/nonpressurized acute airway obstruction
|
$239.20 |
$239.20 |
$239.20 |
$203.35
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$134.00 |
$134.00 |
$134.00 |
$43.21
|
|
Triglycerides
|
$24.00 |
$24.00 |
$24.00 |
$58.05
|
|
Troponin quantitative
|
$61.60 |
$61.60 |
$61.60 |
$127.20
|
|
Ultrasound breast unilateral limited (both sides)
|
$492.00 |
$492.00 |
$492.00 |
$449.35
|
|
Ultrasound chest
|
$480.00 |
$480.00 |
$480.00 |
$460.85
|
|
Ultrasound guidance for vascular access
|
$504.00 |
$504.00 |
$504.00 |
$400.20
|
|
Ultrasound guided needle placement supervision & interpretation
|
$780.80 |
$780.80 |
$780.80 |
$720.15
|
|
Ultrasound joint/nonvascular extremity limited left
|
$468.00 |
$468.00 |
$468.00 |
$425.45
|
|
Ultrasound scrotum and contents
|
$617.60 |
$617.60 |
$617.60 |
$608.90
|
|
Unlisted CT procedure
|
$942.40 |
$942.40 |
$942.40 |
$732.70
|
|
Unlisted mr procedure
|
$400.00 |
$400.00 |
$400.00 |
$1,163.00
|
|
Unsched dialysis esrd pt hos
|
$684.00 |
$684.00 |
$684.00 |
$1,268.17
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$454.00 |
$454.00 |
$454.00 |
$2,034.41
|
|
Urea nitrogen
|
$16.00 |
$16.00 |
$16.00 |
$41.46
|
|
Urea nitrogen 24 hour urine
|
$23.20 |
$23.20 |
$23.20 |
$51.75
|
|
Uric acid blood
|
$15.00 |
$15.00 |
$15.00 |
$48.75
|
|
Urinalysis (with microscopy)
|
$10.00 |
$10.00 |
$10.00 |
$55.00
|
|
Urinalysis (without microscopy)
|
$10.00 |
$10.00 |
$10.00 |
$35.75
|
|
Urine Culture Test
|
$25.00 |
$25.00 |
$25.00 |
$81.50
|
|
Urine pregnancy test
|
$35.20 |
$35.20 |
$35.20 |
$67.20
|
|
Vaccine influenza inactivated adjuvant im
|
$531.80 |
$531.80 |
$531.80 |
$109.50
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$119.60 |
$119.60 |
$119.60 |
$47.88
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$1,742.00 |
$1,742.00 |
$1,742.00 |
$563.36
|
|
Valproic acid total therapeutic drug level
|
$56.80 |
$56.80 |
$56.80 |
$114.72
|
|
Vancomycin 1,000 mg intravenous injection
|
$1,396.00 |
$1,396.00 |
$1,396.00 |
$251.86
|
|
Vancomycin 750 mg intravenous solution
|
$179.40 |
$179.40 |
$179.40 |
$90.33
|
|
Vancomycin peak therapeutic drug level
|
$55.20 |
$55.20 |
$55.20 |
$136.13
|
|
Ven blood coll snf/hha
|
$20.00 |
$20.00 |
$20.00 |
$15.65
|
|
Vitamin b-12
|
$40.00 |
$40.00 |
$40.00 |
$100.00
|
|
Vitamin D Test
|
$100.00 |
$100.00 |
$100.00 |
$132.00
|
|
Warde 1015200 kappa light chain free
|
$71.20 |
$71.20 |
$71.20 |
$65.20
|
|
Warde 3400652 ova & parasites direct smear concentration and id
|
$37.60 |
$37.60 |
$37.60 |
$62.50
|
|
Warde 3400652 smear complex special stain ova/parasites
|
$75.20 |
$75.20 |
$75.20 |
$72.50
|
|
Warde acetylcholine receptor blocking antibody
|
$76.80 |
$76.80 |
$76.80 |
$75.00
|
|
Warde adenosine deaminase pleural fluid
|
$33.60 |
$33.60 |
$33.60 |
$90.00
|
|
Warde adrenocorticotropic hormone (acth)
|
$160.80 |
$160.80 |
$160.80 |
$151.20
|
|
Warde aldolase
|
$40.80 |
$40.80 |
$40.80 |
$53.30
|
|
Warde collagen cross links c-telopeptide
|
$77.60 |
$77.60 |
$77.60 |
$96.85
|
|
Warde folic acid rbc
|
$73.60 |
$73.60 |
$73.60 |
$79.30
|
|
Warde g6pd (glucose 6 phosphate dehydrogenase) quantitative
|
$40.80 |
$40.80 |
$40.80 |
$43.55
|
|
Warde immunofixation electrophoresis urine
|
$122.40 |
$122.40 |
$122.40 |
$161.28
|
|
Warde pancreatic elastase fecal quantitative
|
$93.60 |
$93.60 |
$93.60 |
$94.25
|
|
Warde vitamin d (1 25 dihydroxy)
|
$160.80 |
$160.80 |
$160.80 |
$138.50
|
|
Warde zinc
|
$47.20 |
$47.20 |
$47.20 |
$62.50
|
|
Wound therapy negative pressure per session <= 50 sq cm
|
$137.60 |
$137.60 |
$137.60 |
$554.01
|
|
Wound therapy negative pressure per session > 50 sq cm
|
$296.80 |
$296.80 |
$296.80 |
$579.70
|
|
Wound therapy negative pressure per session <= 50 sq cm dme
|
$137.60 |
$137.60 |
$137.60 |
$284.70
|
|
Wound therapy negative pressure per session > 50 sq cm dme
|
$296.80 |
$296.80 |
$296.80 |
$438.75
|
|
Wrist X-ray
|
$315.20 |
$315.20 |
$315.20 |
$342.80
|
|
X-ray abdomen 1 view
|
$292.80 |
$292.80 |
$292.80 |
$258.50
|
|
X-ray abdomen 2 views
|
$482.40 |
$482.40 |
$482.40 |
$316.47
|
