|
Sildenafil citrate, 25 mg
|
$6.80 |
$6.80 |
$6.80 |
$168.00
|
|
Sincalide 5 mcg solution for injection
|
$912.87 |
$912.87 |
$912.87 |
$409.96
|
|
Sinus CT scan (with and without contrast)
|
$11,770.34 |
$11,770.34 |
$11,770.34 |
$1,815.00
|
|
Sinus CT scan (with contrast)
|
$11,007.79 |
$11,007.79 |
$11,007.79 |
$1,519.50
|
|
Sinus CT scan (without contrast)
|
$9,049.60 |
$9,049.60 |
$9,049.60 |
$1,279.50
|
|
Sleep study attended
|
$4,340.48 |
$4,340.48 |
$4,340.48 |
$1,237.08
|
|
Sleep Study (Polysomnography)
|
$32,754.74 |
$32,754.74 |
$32,754.74 |
$3,936.80
|
|
Sleep study unattended
|
$1,006.93 |
$1,006.93 |
$1,006.93 |
$595.50
|
|
Sm-153 lexidron ther
|
$30,877.91 |
$30,877.91 |
$30,877.91 |
$11,563.30
|
|
Smear nasal eosinophil
|
$565.71 |
$565.71 |
$565.71 |
$49.50
|
|
Smear special stain inclusion bodies/parasites
|
$325.44 |
$325.44 |
$325.44 |
$64.35
|
|
Smear wet mount
|
$687.75 |
$687.75 |
$687.75 |
$68.63
|
|
Sodium 24 hour urine
|
$753.86 |
$753.86 |
$753.86 |
$48.50
|
|
Sodium chloride 0.9 % IV bolus
|
$51.84 |
$51.84 |
$51.84 |
$51.51
|
|
Sodium chloride 0.9 % IV bolus
|
$85.05 |
$85.05 |
$85.05 |
$46.35
|
|
Sodium chloride 3 % ivpb
|
$146.29 |
$146.29 |
$146.29 |
$65.33
|
|
Sodium ferric gluconate complex in sucrose 62.5 mg/5 ml intravenous
|
$900.40 |
$900.40 |
$900.40 |
$104.00
|
|
Sodium thiosulfate 12.5 gram/50 ml (250 mg/ml) intravenous solution
|
$339.44 |
$339.44 |
$339.44 |
$223.86
|
|
Somatropin injection
|
$379.89 |
$379.89 |
$379.89 |
$339.59
|
|
Spinal puncture lumbar diagnostic w/fluoroscopic or CT guidance
|
$4,918.97 |
$4,918.97 |
$4,918.97 |
$1,502.08
|
|
Splint finger 4 prong foam sm
|
$57.00 |
$57.00 |
$57.00 |
$22.62
|
|
Split blood or products
|
$216.13 |
$216.13 |
$216.13 |
$148.98
|
|
Sr-89 stront chlor ther / mci
|
$24,705.38 |
$24,705.38 |
$24,705.38 |
$4,588.65
|
|
Strep a ag ia
|
$620.38 |
$620.38 |
$620.38 |
$75.40
|
|
Strep b assay w/optic
|
$723.35 |
$723.35 |
$723.35 |
$32.00
|
|
Succinylcholine chloride 20 mg/ml injection solution (wrapper)
|
$2.30 |
$2.30 |
$2.30 |
$49.13
|
|
Sulfamethoxazole 400 mg-trimethoprim 80 mg/5 ml intravenous solution
|
$37.58 |
$37.58 |
$37.58 |
$71.09
|
|
Sulfonylurea screen qn-sendout
|
$288.58 |
$288.58 |
$288.58 |
$184.60
|
|
Sumatriptan 6 mg/0.5 ml subcutaneous solution
|
$1,763.37 |
$1,763.37 |
$1,763.37 |
$91.67
|
|
Surgical pathology level 1 gross examination only
|
$961.07 |
$961.07 |
$961.07 |
$92.59
|
|
Surgical pathology level 2 gross & microscopic examination
|
$1,153.04 |
$1,153.04 |
$1,153.04 |
$149.76
|
|
Surgical pathology level 3 gross & microscopic examination
|
$1,389.49 |
$1,389.49 |
$1,389.49 |
$192.00
|
|
Surgical pathology level 4 gross & microscopic examination
|
$1,699.68 |
$1,699.68 |
$1,699.68 |
$253.75
|
|
Surgical pathology level 5 gross & microscopic examination
|
$3,721.00 |
$3,721.00 |
$3,721.00 |
$494.00
|
|
Surgical pathology level 6 gross & microscopic examination
|
$8,929.37 |
$8,929.37 |
$8,929.37 |
$790.00
|
|
Susceptibility agar dilution per agent
|
$309.07 |
$309.07 |
$309.07 |
$40.30
|
|
Sweat collection by iontophoresis
|
$2,653.13 |
$2,653.13 |
$2,653.13 |
$105.21
|
|
Synvisc or synvisc-one
|
$7,840.48 |
$7,840.48 |
$7,840.48 |
$1,415.99
|
|
T3 (triiodothyronine) free
|
$954.72 |
$954.72 |
$954.72 |
$89.82
|
|
T3 (triiodothyronine) total
|
$1,578.91 |
$1,578.91 |
$1,578.91 |
$94.90
|
|
T4 (thyroxine) free
|
$1,735.28 |
$1,735.28 |
$1,735.28 |
$81.60
|
|
T4 (thyroxine) total
|
$1,578.91 |
$1,578.91 |
$1,578.91 |
$73.64
|
|
Tacrolimus therapeutic drug level
|
$1,430.17 |
$1,430.17 |
$1,430.17 |
$122.40
|
|
Tamoxifen 10 mg tabs 60 each bottle
|
$6.80 |
$6.80 |
$6.80 |
$35.75
|
|
Target gsa panel hmtlmph neop
|
$424.61 |
$424.61 |
$424.61 |
$1,928.40
|
|
Target gsa panel organ/hmtlmph neop
|
$424.61 |
$424.61 |
$424.61 |
$3,385.00
|
|
Target gsa panel organ neop
|
$424.61 |
$424.61 |
$424.61 |
$1,913.00
|
|
Tavr perq femoral
|
$122,042.61 |
$122,042.61 |
$122,042.61 |
$16,357.00
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$1,156.85 |
$1,156.85 |
$1,156.85 |
$166.46
|
|
Tc-99m apcitide diag
|
$3,437.80 |
$3,437.80 |
$3,437.80 |
$1,765.30
|
|
Tc-99m arcitumomab
|
$12,806.58 |
$12,806.58 |
$12,806.58 |
$2,159.40
|
|
Tc-99m disofenin
|
$893.78 |
$893.78 |
$893.78 |
$151.32
|
|
Tc-99m exame autol wbc diag per dose
|
$137.31 |
$137.31 |
$137.31 |
$2,393.40
|
|
Tc-99m exametazime diag
|
$9,053.47 |
$9,053.47 |
$9,053.47 |
$2,166.26
|
|
Tc-99m fanolesomab diag
|
$18,850.69 |
$18,850.69 |
$18,850.69 |
$2,860.65
|
|
Tc-99m labeled rbc
|
$1,694.75 |
$1,694.75 |
$1,694.75 |
$323.01
|
|
Tc-99m maa
|
$766.64 |
$766.64 |
$766.64 |
$312.06
|
|
Tc-99m mebrofenin
|
$893.78 |
$893.78 |
$893.78 |
$169.53
|
|
Tc-99m medronate
|
$1,048.89 |
$1,048.89 |
$1,048.89 |
$122.46
|
|
Tc-99m mertiatide
|
$3,133.94 |
$3,133.94 |
$3,133.94 |
$757.25
|
|
Tc-99m oxidronate
|
$766.64 |
$766.64 |
$766.64 |
$124.23
|
|
Tc-99m pentetate dtpa
|
$893.78 |
$893.78 |
$893.78 |
$245.85
|
|
Tc-99m pertechnetate per mci
|
$191.98 |
$191.98 |
$191.98 |
$28.08
|
|
Tc-99m pyroph diag per dose up to 25 mci
|
$300.05 |
$300.05 |
$300.05 |
$147.24
|
|
Tc-99m sestamibi p study dose
|
$2,560.55 |
$2,560.55 |
$2,560.55 |
$221.60
|
|
Tc-99m sulfur colloid
|
$574.66 |
$574.66 |
$574.66 |
$245.70
|
|
Tc-99m tetrofosmin p study dose
|
$531.44 |
$531.44 |
$531.44 |
$198.05
|
|
T cells absolute cd 4 count
|
$910.23 |
$910.23 |
$910.23 |
$120.25
|
|
T cells total count
|
$4,768.52 |
$4,768.52 |
$4,768.52 |
$124.11
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$77.11 |
$77.11 |
$77.11 |
$44.49
|
|
Testicular imaging w/vasc flow
|
$8,363.11 |
$8,363.11 |
$8,363.11 |
$780.48
|
|
Test stress cardiovascular tracing only
|
$6,073.18 |
$6,073.18 |
$6,073.18 |
$1,001.55
|
|
Tetanus immune globulin inj
|
$2,906.44 |
$2,906.44 |
$2,906.44 |
$1,395.20
|
|
Theophylline therapeutic drug level
|
$1,389.49 |
$1,389.49 |
$1,389.49 |
$108.00
|
|
Therapeutic procd strg endur
|
$487.56 |
$487.56 |
$487.56 |
$81.36
|
|
Therapy nutrition individual initial f2f w/patient each 15 minutes
|
$148.50 |
$148.50 |
$148.50 |
$55.00
|
|
Therapy nutrition individual reassessment/intervention f2f w/patient each 15 minutes
|
$69.88 |
$69.88 |
$69.88 |
$50.40
|
|
Ther/proph/diag inj ia
|
$2,501.73 |
$2,501.73 |
$2,501.73 |
$247.33
|
|
Thrombectomy/inf pq dialysis circuit
|
$24,017.25 |
$24,017.25 |
$24,017.25 |
$7,828.60
|
|
Thrombectomy/inf pq dialysis circuit w/pta
|
$24,018.58 |
$24,018.58 |
$24,018.58 |
$15,185.00
|
|
Thrombin time
|
$1,153.04 |
$1,153.04 |
$1,153.04 |
$48.75
|
|
Thyroglobulin antibody
|
$1,230.59 |
$1,230.59 |
$1,230.59 |
$84.00
|
|
Thyroid imaging
|
$6,909.93 |
$6,909.93 |
$6,909.93 |
$670.80
|
|
Thyroid mets imag whole body
|
$14,697.10 |
$14,697.10 |
$14,697.10 |
$1,524.99
|
|
Thyroid (TSH) Test
|
$2,306.07 |
$2,306.07 |
$2,306.07 |
$120.00
|
|
Thyroid Ultrasound
|
$5,650.03 |
$5,650.03 |
$5,650.03 |
$589.96
|
|
Thyroid uptake measurement
|
$12,506.53 |
$12,506.53 |
$12,506.53 |
$653.60
|
|
Thyrotropin alfa 0.9 mg intramuscular solution
|
$9,577.76 |
$9,577.76 |
$9,577.76 |
$4,886.55
|
|
Thyroxine binding globulin (tbg)
|
$1,319.58 |
$1,319.58 |
$1,319.58 |
$63.60
|
|
Tilt table study
|
$3,852.39 |
$3,852.39 |
$3,852.39 |
$1,495.00
|
|
Tissue transglutaminase iga
|
$164.78 |
$164.78 |
$164.78 |
$48.57
|
|
Tl-201 thallium diag per mci
|
$1,294.26 |
$1,294.26 |
$1,294.26 |
$77.22
|
|
Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr
|
$308.45 |
$308.45 |
$308.45 |
$125.87
|
|
Tobramycin peak therapeutic drug level
|
$1,230.59 |
$1,230.59 |
$1,230.59 |
$121.55
|
|
Tomosynthesis breast screen bilateral
|
$135.96 |
$135.96 |
$135.96 |
$73.45
|
|
Toxoplasma antibody igg
|
$1,936.14 |
$1,936.14 |
$1,936.14 |
$84.35
|
|
Tp53 gene trgt sequence alys
|
$931.87 |
$931.87 |
$931.87 |
$919.10
|
|
Training self management diabetes individual outpatient department per 30 minutes
|
$350.64 |
$350.64 |
$350.64 |
$93.75
|
|
Transcath closure of asd
|
$55,134.12 |
$55,134.12 |
$55,134.12 |
$18,772.00
|
|
Transcath closure of vsd
|
$112,256.62 |
$112,256.62 |
$112,256.62 |
$18,837.00
|
