|
Sleep study attended
|
$3,101.19 |
$3,101.19 |
$3,101.19 |
$1,237.08
|
|
Sleep Study (Polysomnography)
|
$16,470.44 |
$16,470.44 |
$16,470.44 |
$3,745.80
|
|
Sleep study unattended
|
$1,734.42 |
$1,734.42 |
$1,734.42 |
$594.00
|
|
Sm-153 lexidron ther
|
$68,634.79 |
$68,634.79 |
$68,634.79 |
$6,866.16
|
|
Sodium chloride 0.9 % IV bolus
|
$182.54 |
$182.54 |
$182.54 |
$43.45
|
|
Sodium ferric gluconate complex in sucrose 62.5 mg/5 ml intravenous
|
$51.92 |
$51.92 |
$51.92 |
$77.77
|
|
Soft interface below knee se
|
$523.00 |
$523.00 |
$523.00 |
$179.08
|
|
Special physics consult
|
$2.30 |
$2.30 |
$2.30 |
$709.00
|
|
Special radiation dosimetry
|
$2.30 |
$2.30 |
$2.30 |
$398.47
|
|
Special teletx port plan
|
$2.30 |
$2.30 |
$2.30 |
$1,056.31
|
|
Specific gravity body fluid
|
$286.84 |
$286.84 |
$286.84 |
$22.10
|
|
Specimen fat stain
|
$488.60 |
$488.60 |
$488.60 |
$37.70
|
|
Sperm antibody test
|
$125.07 |
$125.07 |
$125.07 |
$57.85
|
|
Spirometry bronchodilation responsiveness pre/post bronchodilator administration
|
$3,688.18 |
$3,688.18 |
$3,688.18 |
$543.75
|
|
Spleen imaging
|
$4,986.39 |
$4,986.39 |
$4,986.39 |
$732.60
|
|
Split blood or products
|
$278.94 |
$278.94 |
$278.94 |
$127.80
|
|
Sr-89 stront chlor ther / mci
|
$65,477.48 |
$65,477.48 |
$65,477.48 |
$2,617.05
|
|
Srs linear based
|
$2.30 |
$2.30 |
$2.30 |
$14,124.25
|
|
Srs multisource
|
$2.30 |
$2.30 |
$2.30 |
$31,800.00
|
|
St cognitve performance testing healthcare professional each hour
|
$950.35 |
$950.35 |
$950.35 |
$285.60
|
|
St evaluation motion fluoroscopic swallow function cine/video
|
$1,228.36 |
$1,228.36 |
$1,228.36 |
$373.80
|
|
Strep b assay w/optic
|
$436.90 |
$436.90 |
$436.90 |
$82.68
|
|
Streptozocin injection
|
$3,806.77 |
$3,806.77 |
$3,806.77 |
$785.95
|
|
Stress tte complete
|
$12,627.68 |
$12,627.68 |
$12,627.68 |
$1,867.55
|
|
Succinylcholine chloride 20 mg/ml injection solution (wrapper)
|
$63.26 |
$63.26 |
$63.26 |
$52.39
|
|
Sulfamethoxazole 400 mg-trimethoprim 80 mg/5 ml intravenous solution
|
$17.57 |
$17.57 |
$17.57 |
$82.43
|
|
Sulfonylurea screen qn-sendout
|
$652.03 |
$652.03 |
$652.03 |
$152.64
|
|
Sumatriptan 6 mg/0.5 ml subcutaneous solution
|
$2,849.36 |
$2,849.36 |
$2,849.36 |
$123.58
|
|
Surgical pathology level 1 gross examination only
|
$581.97 |
$581.97 |
$581.97 |
$79.20
|
|
Surgical pathology level 2 gross & microscopic examination
|
$1,619.23 |
$1,619.23 |
$1,619.23 |
$144.30
|
|
Surgical pathology level 3 gross & microscopic examination
|
$2,157.84 |
$2,157.84 |
$2,157.84 |
$184.50
|
|
Surgical pathology level 4 gross & microscopic examination
|
$3,220.10 |
$3,220.10 |
$3,220.10 |
$252.75
|
|
Surgical pathology level 5 gross & microscopic examination
|
$6,238.39 |
$6,238.39 |
$6,238.39 |
$480.00
|
|
Surgical pathology level 6 gross & microscopic examination
|
$8,521.28 |
$8,521.28 |
$8,521.28 |
$720.75
|
|
Susceptibility enzyme detection per enzyme
|
$160.09 |
$160.09 |
$160.09 |
$35.70
|
|
Suscept studies macrobroth dilution ea
|
$867.14 |
$867.14 |
$867.14 |
$59.28
|
|
Svc venogram s&i
|
$3,781.09 |
$3,781.09 |
$3,781.09 |
$1,934.62
|
|
T3 (triiodothyronine) free
|
$1,537.50 |
$1,537.50 |
$1,537.50 |
$99.82
|
|
T3 (triiodothyronine) total
|
$1,037.22 |
$1,037.22 |
$1,037.22 |
$93.52
|
|
T4 (thyroxine) free
|
$571.99 |
$571.99 |
$571.99 |
$85.20
|
|
Tacrolimus 5 mg/ml intravenous solution
|
$2,233.45 |
$2,233.45 |
$2,233.45 |
$601.95
|
|
Tacrolimus therapeutic drug level
|
$1,033.88 |
$1,033.88 |
$1,033.88 |
$121.39
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$663.70 |
$663.70 |
$663.70 |
$175.00
|
|
Tc-99m apcitide diag
|
$4,336.44 |
$4,336.44 |
$4,336.44 |
$1,181.70
|
|
Tc-99m depreotide
|
$6,764.80 |
$6,764.80 |
$6,764.80 |
$1,486.80
|
|
Tc-99m exametazime diag
|
$6,815.48 |
$6,815.48 |
$6,815.48 |
$2,033.20
|
|
Tc-99m gluceptate
|
$533.67 |
$533.67 |
$533.67 |
$31.35
|
|
Tc-99m labeled rbc
|
$1,541.38 |
$1,541.38 |
$1,541.38 |
$302.40
|
|
Tc-99m maa
|
$1,009.20 |
$1,009.20 |
$1,009.20 |
$281.40
|
|
Tc-99m medronate
|
$727.46 |
$727.46 |
$727.46 |
$109.80
|
|
Tc-99m mertiatide
|
$3,521.04 |
$3,521.04 |
$3,521.04 |
$756.00
|
|
Tc-99m pentetate dtpa
|
$1,906.61 |
$1,906.61 |
$1,906.61 |
$222.60
|
|
Tc-99m pertechnetate per mci
|
$257.90 |
$257.90 |
$257.90 |
$22.10
|
|
Tc-99m sestamibi p study dose
|
$2,085.48 |
$2,085.48 |
$2,085.48 |
$292.95
|
|
Tc-99m succimer (dmsa)
|
$4,224.65 |
$4,224.65 |
$4,224.65 |
$1,128.40
|
|
Tc-99m sulfur colloid
|
$1,647.22 |
$1,647.22 |
$1,647.22 |
$239.40
|
|
Tc-99m tetrofosmin p study dose
|
$1,217.18 |
$1,217.18 |
$1,217.18 |
$188.50
|
|
Tc-99m tilmanocept diag
|
$2,792.08 |
$2,792.08 |
$2,792.08 |
$930.54
|
|
T cells absolute cd 4 count
|
$723.73 |
$723.73 |
$723.73 |
$110.72
|
|
T cells total count
|
$1,432.43 |
$1,432.43 |
$1,432.43 |
$123.00
|
|
Telavancin injection
|
$2,936.14 |
$2,936.14 |
$2,936.14 |
$1,191.80
|
|
Temsirolimus 30 mg/3 ml (10 mg/ml) (first dilution) intravenous soln
|
$23,913.24 |
$23,913.24 |
$23,913.24 |
$3,723.60
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$29,552.73 |
$29,552.73 |
$29,552.73 |
$15,245.38
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$157.44 |
$157.44 |
$157.44 |
$39.18
|
|
Test for porphobilinogen
|
$435.25 |
$435.25 |
$435.25 |
$33.57
|
|
Testicular imaging w/vasc flow
|
$4,898.44 |
$4,898.44 |
$4,898.44 |
$879.80
|
|
Test pathogen(s) for platelets reference
|
$382.35 |
$382.35 |
$382.35 |
$66.15
|
|
Test urine for porphyrins
|
$683.69 |
$683.69 |
$683.69 |
$50.50
|
|
Tetanus immune globulin inj
|
$4,794.77 |
$4,794.77 |
$4,794.77 |
$1,210.21
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$180.31 |
$180.31 |
$180.31 |
$25.54
|
|
Thrombin time titer
|
$1,133.95 |
$1,133.95 |
$1,133.95 |
$17.60
|
|
Thromboplastin inhibition
|
$945.51 |
$945.51 |
$945.51 |
$55.20
|
|
Thyroglobulin antibody
|
$426.91 |
$426.91 |
$426.91 |
$82.00
|
|
Thyroid imaging
|
$4,080.05 |
$4,080.05 |
$4,080.05 |
$695.02
|
|
Thyroid met imaging
|
$3,676.06 |
$3,676.06 |
$3,676.06 |
$838.25
|
|
Thyroid met imaging/studies
|
$1,747.10 |
$1,747.10 |
$1,747.10 |
$763.73
|
|
Thyroid mets imag whole body
|
$7,298.45 |
$7,298.45 |
$7,298.45 |
$1,560.50
|
|
Thyroid uptake measurement
|
$4,642.04 |
$4,642.04 |
$4,642.04 |
$589.22
|
|
Thyrotropin alfa 0.9 mg intramuscular solution
|
$16,926.28 |
$16,926.28 |
$16,926.28 |
$4,044.25
|
|
Thyroxine binding globulin (tbg)
|
$555.29 |
$555.29 |
$555.29 |
$64.51
|
|
Tigecycline injection
|
$1,163.06 |
$1,163.06 |
$1,163.06 |
$234.00
|
|
Tirofiban 12.5 mg/50 ml
|
$10,735.41 |
$10,735.41 |
$10,735.41 |
$456.00
|
|
Tissue culture skin/biopsy
|
$3,165.06 |
$3,165.06 |
$3,165.06 |
$484.00
|
|
Tissue culture tumor
|
$2,124.49 |
$2,124.49 |
$2,124.49 |
$493.43
|
|
Tl-201 thallium diag per mci
|
$3,106.62 |
$3,106.62 |
$3,106.62 |
$78.40
|
|
Tlso 2mod symphis-xipho pre
|
$21,663.00 |
$21,663.00 |
$21,663.00 |
$1,874.66
|
|
Tlso 2 shl symphys-stern cst
|
$3,074.00 |
$3,074.00 |
$3,074.00 |
$1,808.59
|
|
Tlso 3mod sacro-scap pre
|
$3,823.00 |
$3,823.00 |
$3,823.00 |
$2,106.00
|
|
Tlso rig fram pelvic pre cst
|
$5,563.00 |
$5,563.00 |
$5,563.00 |
$999.43
|
|
Tlso rigid lined custom fab
|
$4,416.00 |
$4,416.00 |
$4,416.00 |
$2,831.21
|
|
Tlso rigid plastic cust fab
|
$9.00 |
$9.00 |
$9.00 |
$2,347.16
|
|
Tobramycin non-comp unit
|
$1,838.87 |
$1,838.87 |
$1,838.87 |
$105.75
|
|
Tobramycin peak therapeutic drug level
|
$925.51 |
$925.51 |
$925.51 |
$121.80
|
|
Tocilizumab for covid-19
|
$17,057.91 |
$17,057.91 |
$17,057.91 |
$21.08
|
|
Tomosynthesis breast diagnostic left
|
$260.92 |
$260.92 |
$260.92 |
$71.40
|
|
Tomosynthesis breast screen bilateral
|
$260.92 |
$260.92 |
$260.92 |
$68.43
|
|
Topotecan 4 mg/4 ml (1 mg/ml) intravenous solution
|
$571.27 |
$571.27 |
$571.27 |
$310.80
|
|
Toxoplasma antibody igg
|
$1,008.88 |
$1,008.88 |
$1,008.88 |
$90.75
|
|
Toxoplasma antibody igm
|
$1,177.31 |
$1,177.31 |
$1,177.31 |
$87.75
|
|
Training self management diabetes individual outpatient department per 30 minutes
|
$422.43 |
$422.43 |
$422.43 |
$101.25
|
