|
Shoulder MRI (with and without contrast)
|
$1,520.40 |
$1,520.40 |
$1,520.40 |
$2,739.30
|
|
Shoulder MRI (with contrast)
|
$995.12 |
$995.12 |
$995.12 |
$2,449.80
|
|
Shoulder MRI (without contrast)
|
$990.64 |
$990.64 |
$990.64 |
$2,088.20
|
|
Shoulder X-ray
|
$122.36 |
$122.36 |
$122.36 |
$340.10
|
|
Sickling rbc
|
$15.40 |
$15.40 |
$15.40 |
$56.00
|
|
Sincalide 5 mcg solution for injection
|
$33.60 |
$33.60 |
$33.60 |
$309.14
|
|
Sinus CT scan (with and without contrast)
|
$484.40 |
$484.40 |
$484.40 |
$1,796.50
|
|
Sinus CT scan (with contrast)
|
$323.40 |
$323.40 |
$323.40 |
$1,527.60
|
|
Sinus CT scan (without contrast)
|
$323.40 |
$323.40 |
$323.40 |
$1,292.04
|
|
Smear fluorescent and/or acid fast stain
|
$12.32 |
$12.32 |
$12.32 |
$64.00
|
|
Smear gram stain
|
$8.68 |
$8.68 |
$8.68 |
$54.03
|
|
Smear nasal eosinophil
|
$8.40 |
$8.40 |
$8.40 |
$46.20
|
|
Smear special stain inclusion bodies/parasites
|
$19.60 |
$19.60 |
$19.60 |
$71.40
|
|
Smear wet mount
|
$13.72 |
$13.72 |
$13.72 |
$66.30
|
|
Sodium 24 hour urine
|
$3.64 |
$3.64 |
$3.64 |
$48.60
|
|
Sodium ferric gluconate complex in sucrose 62.5 mg/5 ml intravenous
|
$3.25 |
$3.25 |
$3.25 |
$77.77
|
|
Sodium serum/plasma/whole blood
|
$9.80 |
$9.80 |
$9.80 |
$45.50
|
|
Specific gravity body fluid
|
$4.76 |
$4.76 |
$4.76 |
$21.60
|
|
Spirometry bronchodilation responsiveness pre/post bronchodilator administration
|
$160.16 |
$160.16 |
$160.16 |
$543.26
|
|
St analysis behavior qualitative voice/resonance
|
$50.96 |
$50.96 |
$50.96 |
$295.10
|
|
Stent bili dbl pgtl 10fx5cm
|
$390.50 |
$390.50 |
$390.50 |
$2,301.33
|
|
St evaluate speech sound production
|
$50.96 |
$50.96 |
$50.96 |
$289.20
|
|
St evaluate speech sound production comprehensive/expressive
|
$50.96 |
$50.96 |
$50.96 |
$376.23
|
|
St evaluation motion fluoroscopic swallow function cine/video
|
$84.28 |
$84.28 |
$84.28 |
$370.50
|
|
St evaluation swallow function
|
$50.96 |
$50.96 |
$50.96 |
$309.60
|
|
Streptomycin injection
|
$26.60 |
$26.60 |
$26.60 |
$143.00
|
|
Stress test pulmonary
|
$61.32 |
$61.32 |
$61.32 |
$322.85
|
|
Stress tte complete
|
$376.60 |
$376.60 |
$376.60 |
$1,797.59
|
|
St treatment speech individual
|
$46.76 |
$46.76 |
$46.76 |
$249.00
|
|
St treatment swallow dysfunction/oral
|
$46.76 |
$46.76 |
$46.76 |
$243.99
|
|
Sugars single quant
|
$32.20 |
$32.20 |
$32.20 |
$58.80
|
|
Sumatriptan 6 mg/0.5 ml subcutaneous solution
|
$16.24 |
$16.24 |
$16.24 |
$122.16
|
|
Support clav 29.6-40.5in med
|
$17.36 |
$17.36 |
$17.36 |
$94.19
|
|
Surgical pathology level 1 gross examination only
|
$10.36 |
$10.36 |
$10.36 |
$79.20
|
|
Surgical pathology level 2 gross & microscopic examination
|
$22.96 |
$22.96 |
$22.96 |
$143.65
|
|
Surgical pathology level 3 gross & microscopic examination
|
$27.44 |
$27.44 |
$27.44 |
$182.25
|
|
Surgical pathology level 4 gross & microscopic examination
|
$30.52 |
$30.52 |
$30.52 |
$252.60
|
|
Surgical pathology level 5 gross & microscopic examination
|
$179.76 |
$179.76 |
$179.76 |
$480.00
|
|
Surgical pathology level 6 gross & microscopic examination
|
$252.00 |
$252.00 |
$252.00 |
$720.75
|
|
Susceptibility mic per plate
|
$17.36 |
$17.36 |
$17.36 |
$104.58
|
|
T3 (triiodothyronine) free
|
$14.00 |
$14.00 |
$14.00 |
$99.00
|
|
T3 (triiodothyronine) total
|
$7.84 |
$7.84 |
$7.84 |
$93.52
|
|
T4 (thyroxine) free
|
$18.20 |
$18.20 |
$18.20 |
$84.15
|
|
T4 (thyroxine) total
|
$6.72 |
$6.72 |
$6.72 |
$67.10
|
|
Tacrolimus therapeutic drug level
|
$34.16 |
$34.16 |
$34.16 |
$120.60
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$36.68 |
$36.68 |
$36.68 |
$175.92
|
|
Tc-99m exame autol wbc diag per dose
|
$1,373.11 |
$1,373.11 |
$1,373.11 |
$2,431.95
|
|
Tc-99m exametazime diag
|
$1,086.94 |
$1,086.94 |
$1,086.94 |
$2,033.20
|
|
Tc-99m labeled rbc
|
$93.55 |
$93.55 |
$93.55 |
$302.40
|
|
Tc-99m maa
|
$83.65 |
$83.65 |
$83.65 |
$288.75
|
|
Tc-99m mebrofenin
|
$35.30 |
$35.30 |
$35.30 |
$157.65
|
|
Tc-99m medronate
|
$38.31 |
$38.31 |
$38.31 |
$111.01
|
|
Tc-99m mertiatide
|
$171.19 |
$171.19 |
$171.19 |
$756.00
|
|
Tc-99m pentetate dtpa
|
$131.75 |
$131.75 |
$131.75 |
$222.60
|
|
Tc-99m pentetate dtpa aerosol
|
$80.72 |
$80.72 |
$80.72 |
$190.80
|
|
Tc-99m pertechnetate per mci
|
$29.53 |
$29.53 |
$29.53 |
$22.10
|
|
Tc-99m pyroph diag per dose up to 25 mci
|
$49.94 |
$49.94 |
$49.94 |
$136.40
|
|
Tc-99m sestamibi p study dose
|
$28.85 |
$28.85 |
$28.85 |
$288.90
|
|
Tc-99m sulfur colloid
|
$97.35 |
$97.35 |
$97.35 |
$240.50
|
|
Tc-99m tilmanocept diag
|
$454.50 |
$454.50 |
$454.50 |
$946.50
|
|
T cells absolute cd4/cd8 including ratio
|
$95.20 |
$95.20 |
$95.20 |
$175.00
|
|
T cells absolute cd 4 count
|
$68.32 |
$68.32 |
$68.32 |
$110.72
|
|
Telehealth original site facility fee
|
$13.44 |
$13.44 |
$13.44 |
$51.85
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$57.54 |
$57.54 |
$57.54 |
$15,245.38
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$9.80 |
$9.80 |
$9.80 |
$37.76
|
|
Test pathogen(s) for platelets reference
|
$29.40 |
$29.40 |
$29.40 |
$69.95
|
|
Test stress cardiovascular tracing only
|
$136.36 |
$136.36 |
$136.36 |
$949.92
|
|
Tetanus immune globulin inj
|
$141.96 |
$141.96 |
$141.96 |
$1,210.21
|
|
Theophylline therapeutic drug level
|
$28.56 |
$28.56 |
$28.56 |
$108.00
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$9.80 |
$9.80 |
$9.80 |
$25.54
|
|
Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides)
|
$826.56 |
$826.56 |
$826.56 |
$1,687.50
|
|
Thrombin time
|
$2.80 |
$2.80 |
$2.80 |
$53.76
|
|
Thromboplastin time partial (ptt) substitution fractions each
|
$3.64 |
$3.64 |
$3.64 |
$61.50
|
|
Thyroglobulin antibody
|
$12.88 |
$12.88 |
$12.88 |
$81.90
|
|
Thyroid imaging
|
$171.64 |
$171.64 |
$171.64 |
$695.02
|
|
Thyroid (TSH) Test
|
$33.88 |
$33.88 |
$33.88 |
$112.00
|
|
Thyroid Ultrasound
|
$128.80 |
$128.80 |
$128.80 |
$588.50
|
|
Thyroid uptake measurement
|
$171.64 |
$171.64 |
$171.64 |
$590.05
|
|
Thyroxine binding globulin (tbg)
|
$13.16 |
$13.16 |
$13.16 |
$64.35
|
|
Tirofiban 12.5 mg/50 ml
|
$5.04 |
$5.04 |
$5.04 |
$456.00
|
|
Tissue transglutaminase iga
|
$8.96 |
$8.96 |
$8.96 |
$44.25
|
|
Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr
|
$13.72 |
$13.72 |
$13.72 |
$152.36
|
|
Tobramycin peak therapeutic drug level
|
$11.48 |
$11.48 |
$11.48 |
$121.55
|
|
Toxoplasma antibody igg
|
$12.32 |
$12.32 |
$12.32 |
$89.24
|
|
Toxoplasma antibody igm
|
$18.48 |
$18.48 |
$18.48 |
$87.00
|
|
Transferrin
|
$6.16 |
$6.16 |
$6.16 |
$81.60
|
|
Transfusion blood/blood component(s)
|
$100.52 |
$100.52 |
$100.52 |
$936.80
|
|
Treatment inhalation pressurized/nonpressurized acute airway obstruction
|
$94.08 |
$94.08 |
$94.08 |
$203.49
|
|
Treponema pallidum antibody
|
$7.28 |
$7.28 |
$7.28 |
$69.60
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$5.60 |
$5.60 |
$5.60 |
$43.05
|
|
Trichinella antibody
|
$40.60 |
$40.60 |
$40.60 |
$72.00
|
|
Triglycerides
|
$11.48 |
$11.48 |
$11.48 |
$56.94
|
|
Troponin quantitative
|
$19.88 |
$19.88 |
$19.88 |
$125.00
|
|
Tte w or without contr, cont ecg
|
$376.60 |
$376.60 |
$376.60 |
$1,974.24
|
|
Ugt1a1 gene analy common variants
|
$148.40 |
$148.40 |
$148.40 |
$423.54
|
|
Ultrasound abdomen aorta screening study aaa
|
$46.76 |
$46.76 |
$46.76 |
$394.20
|
|
Ultrasound breast complete
|
$265.44 |
$265.44 |
$265.44 |
$530.00
|
|
Ultrasound breast unilateral limited (both sides)
|
$176.96 |
$176.96 |
$176.96 |
$455.25
|
|
Ultrasound chest
|
$112.00 |
$112.00 |
$112.00 |
$458.44
|
|
Ultrasound guided needle placement supervision & interpretation
|
$117.60 |
$117.60 |
$117.60 |
$720.00
|
