|
Screening prostate cancer PSA
|
$178.00 |
$178.00 |
$178.00 |
$98.28
|
|
Sedimentation rate erythrocyte automated
|
$233.99 |
$233.99 |
$233.99 |
$44.20
|
|
Sickling rbc
|
$501.71 |
$501.71 |
$501.71 |
$54.00
|
|
Sinus CT scan (with and without contrast)
|
$4,615.61 |
$4,615.61 |
$4,615.61 |
$1,800.90
|
|
Sinus CT scan (with contrast)
|
$3,901.37 |
$3,901.37 |
$3,901.37 |
$1,562.50
|
|
Sinus CT scan (without contrast)
|
$3,901.37 |
$3,901.37 |
$3,901.37 |
$1,281.80
|
|
Smear special stain inclusion bodies/parasites
|
$103.12 |
$103.12 |
$103.12 |
$68.85
|
|
Sodium 24 hour urine
|
$108.00 |
$108.00 |
$108.00 |
$48.60
|
|
Sodium chloride 0.9 % intravenous solution
|
$109.12 |
$109.12 |
$109.12 |
$48.00
|
|
Sodium ferric gluconate complex in sucrose 62.5 mg/5 ml intravenous
|
$550.39 |
$550.39 |
$550.39 |
$77.77
|
|
Sodium serum/plasma/whole blood
|
$214.16 |
$214.16 |
$214.16 |
$45.00
|
|
St analysis behavior qualitative voice/resonance
|
$535.56 |
$535.56 |
$535.56 |
$295.10
|
|
St cognitve performance testing healthcare professional each hour
|
$1,402.03 |
$1,402.03 |
$1,402.03 |
$284.65
|
|
St evaluate speech sound production
|
$535.56 |
$535.56 |
$535.56 |
$288.75
|
|
St evaluate speech sound production comprehensive/expressive
|
$535.56 |
$535.56 |
$535.56 |
$376.84
|
|
St evaluation motion fluoroscopic swallow function cine/video
|
$1,429.30 |
$1,429.30 |
$1,429.30 |
$373.50
|
|
St evaluation swallow function
|
$544.09 |
$544.09 |
$544.09 |
$311.36
|
|
Strep a ag ia
|
$347.04 |
$347.04 |
$347.04 |
$75.40
|
|
Strep b dna amp probe
|
$174.98 |
$174.98 |
$174.98 |
$122.43
|
|
St treatment speech individual
|
$711.25 |
$711.25 |
$711.25 |
$253.80
|
|
St treatment swallow dysfunction/oral
|
$936.38 |
$936.38 |
$936.38 |
$245.50
|
|
Succinylcholine chloride 20 mg/ml injection solution (wrapper)
|
$112.24 |
$112.24 |
$112.24 |
$50.22
|
|
Sumatriptan 6 mg/0.5 ml subcutaneous solution
|
$421.95 |
$421.95 |
$421.95 |
$123.58
|
|
Surgical pathology level 1 gross examination only
|
$235.99 |
$235.99 |
$235.99 |
$80.60
|
|
Surgical pathology level 2 gross & microscopic examination
|
$485.85 |
$485.85 |
$485.85 |
$146.30
|
|
Surgical pathology level 3 gross & microscopic examination
|
$499.75 |
$499.75 |
$499.75 |
$184.50
|
|
Surgical pathology level 4 gross & microscopic examination
|
$696.06 |
$696.06 |
$696.06 |
$250.20
|
|
Surgical pathology level 5 gross & microscopic examination
|
$1,556.71 |
$1,556.71 |
$1,556.71 |
$489.00
|
|
Surgical pathology level 6 gross & microscopic examination
|
$3,216.53 |
$3,216.53 |
$3,216.53 |
$730.20
|
|
Susceptibility enzyme detection per enzyme
|
$16.63 |
$16.63 |
$16.63 |
$35.10
|
|
Suscept studies macrobroth dilution ea
|
$2,063.91 |
$2,063.91 |
$2,063.91 |
$59.28
|
|
T3 (triiodothyronine) free
|
$255.82 |
$255.82 |
$255.82 |
$99.20
|
|
T3 (triiodothyronine) total
|
$997.48 |
$997.48 |
$997.48 |
$93.52
|
|
T4 (thyroxine) free
|
$366.00 |
$366.00 |
$366.00 |
$85.20
|
|
T4 (thyroxine) total
|
$160.64 |
$160.64 |
$160.64 |
$67.80
|
|
Tacrolimus therapeutic drug level
|
$832.90 |
$832.90 |
$832.90 |
$120.60
|
|
Tamoxifen 10 mg tabs 60 each bottle
|
$35.33 |
$35.33 |
$35.33 |
$14.62
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$789.25 |
$789.25 |
$789.25 |
$175.00
|
|
Tc-99m labeled rbc
|
$169.89 |
$169.89 |
$169.89 |
$302.40
|
|
Tc-99m maa
|
$99.44 |
$99.44 |
$99.44 |
$283.41
|
|
Tc-99m mebrofenin
|
$218.22 |
$218.22 |
$218.22 |
$160.58
|
|
Tc-99m medronate
|
$145.02 |
$145.02 |
$145.02 |
$109.50
|
|
Tc-99m mertiatide
|
$1,682.21 |
$1,682.21 |
$1,682.21 |
$756.00
|
|
Tc-99m pentetate dtpa
|
$473.74 |
$473.74 |
$473.74 |
$222.60
|
|
Tc-99m pentetate dtpa aerosol
|
$730.00 |
$730.00 |
$730.00 |
$181.37
|
|
Tc-99m sestamibi p study dose
|
$1,218.15 |
$1,218.15 |
$1,218.15 |
$293.73
|
|
Tc-99m sulfur colloid
|
$218.22 |
$218.22 |
$218.22 |
$239.40
|
|
Tc-99m tilmanocept diag
|
$1,646.31 |
$1,646.31 |
$1,646.31 |
$930.54
|
|
T cells absolute cd4/cd8 including ratio
|
$1,005.43 |
$1,005.43 |
$1,005.43 |
$175.00
|
|
T cells absolute cd 4 count
|
$1,005.43 |
$1,005.43 |
$1,005.43 |
$110.00
|
|
T cells total count
|
$912.60 |
$912.60 |
$912.60 |
$123.00
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$89.38 |
$89.38 |
$89.38 |
$39.18
|
|
Test pathogen(s) for platelets reference
|
$4,288.89 |
$4,288.89 |
$4,288.89 |
$66.00
|
|
Test stress cardiovascular tracing only
|
$4,152.87 |
$4,152.87 |
$4,152.87 |
$953.40
|
|
Theophylline therapeutic drug level
|
$750.87 |
$750.87 |
$750.87 |
$108.00
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$49.75 |
$49.75 |
$49.75 |
$25.54
|
|
Thrombin time
|
$533.44 |
$533.44 |
$533.44 |
$53.60
|
|
Thyroglobulin antibody
|
$333.15 |
$333.15 |
$333.15 |
$81.90
|
|
Thyroid imaging
|
$4,553.46 |
$4,553.46 |
$4,553.46 |
$673.01
|
|
Thyroid (TSH) Test
|
$349.00 |
$349.00 |
$349.00 |
$112.00
|
|
Thyroid Ultrasound
|
$1,059.33 |
$1,059.33 |
$1,059.33 |
$589.96
|
|
Tissue exam koh skin/hair/nails
|
$85.27 |
$85.27 |
$85.27 |
$47.40
|
|
Tomosynthesis breast diagnostic left
|
$228.19 |
$228.19 |
$228.19 |
$74.10
|
|
Tomosynthesis breast screen bilateral
|
$228.19 |
$228.19 |
$228.19 |
$70.89
|
|
Toxoplasma antibody igg
|
$1,563.33 |
$1,563.33 |
$1,563.33 |
$89.57
|
|
Toxoplasma antibody igm
|
$1,043.51 |
$1,043.51 |
$1,043.51 |
$87.00
|
|
Tranexamic acid 1,000 mg/10 ml (100 mg/ml) intravenous solution
|
$1,102.96 |
$1,102.96 |
$1,102.96 |
$55.69
|
|
Transferrin
|
$278.00 |
$278.00 |
$278.00 |
$81.60
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$1,230.49 |
$1,230.49 |
$1,230.49 |
$224.90
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$164.20 |
$164.20 |
$164.20 |
$141.00
|
|
Treatment inhalation pressurized/nonpressurized acute airway obstruction
|
$1,213.34 |
$1,213.34 |
$1,213.34 |
$203.35
|
|
Treponema pallidum antibody
|
$283.58 |
$283.58 |
$283.58 |
$70.85
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$84.68 |
$84.68 |
$84.68 |
$43.80
|
|
Troponin quantitative
|
$208.22 |
$208.22 |
$208.22 |
$128.80
|
|
Ultrasound abdomen aorta screening study aaa
|
$734.76 |
$734.76 |
$734.76 |
$394.20
|
|
Ultrasound chest
|
$1,059.33 |
$1,059.33 |
$1,059.33 |
$451.52
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$726.47 |
$726.47 |
$726.47 |
$338.00
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$785.11 |
$785.11 |
$785.11 |
$469.50
|
|
Ultrasound guidance for vascular access
|
$301.08 |
$301.08 |
$301.08 |
$379.36
|
|
Ultrasound guided needle placement supervision & interpretation
|
$3,186.26 |
$3,186.26 |
$3,186.26 |
$720.00
|
|
Ultrasound joint complete left
|
$1,059.33 |
$1,059.33 |
$1,059.33 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$1,059.33 |
$1,059.33 |
$1,059.33 |
$418.80
|
|
Ultrasound ob >=14wks ea addl gest
|
$1,080.04 |
$1,080.04 |
$1,080.04 |
$397.15
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$1,760.95 |
$1,760.95 |
$1,760.95 |
$323.40
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$3,041.04 |
$3,041.04 |
$3,041.04 |
$693.00
|
|
Ultrasound pregnant uterus follow up per fetus
|
$685.04 |
$685.04 |
$685.04 |
$420.80
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$1,707.08 |
$1,707.08 |
$1,707.08 |
$442.80
|
|
Ultrasound pregnant uterus transvaginal
|
$1,059.33 |
$1,059.33 |
$1,059.33 |
$484.52
|
|
Ultrasound retroperitoneal limited
|
$1,059.33 |
$1,059.33 |
$1,059.33 |
$477.10
|
|
Ultrasound scrotum and contents
|
$1,059.33 |
$1,059.33 |
$1,059.33 |
$606.60
|
|
Ultrasound transvaginal non obstetric
|
$2,155.94 |
$2,155.94 |
$2,155.94 |
$549.75
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$6,273.48 |
$6,273.48 |
$6,273.48 |
$3,039.60
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$4,317.01 |
$4,317.01 |
$4,317.01 |
$2,034.41
|
|
Urea nitrogen
|
$178.47 |
$178.47 |
$178.47 |
$39.90
|
|
Urea nitrogen 24 hour urine
|
$63.46 |
$63.46 |
$63.46 |
$52.00
|
|
Urethrcystgrphy rtrgrde s&i
|
$2,734.02 |
$2,734.02 |
$2,734.02 |
$584.00
|
|
Urethrocystography void s&i
|
$1,767.85 |
$1,767.85 |
$1,767.85 |
$622.35
|
|
Uric acid blood
|
$321.26 |
$321.26 |
$321.26 |
$49.32
|
|
Uric acid urine
|
$299.45 |
$299.45 |
$299.45 |
$44.14
|
|
Urinalysis (with microscopy)
|
$132.87 |
$132.87 |
$132.87 |
$55.00
|
