|
Smear wet mount
|
$400.70 |
$400.70 |
$400.70 |
$68.63
|
|
Sodium 24 hour urine
|
$211.39 |
$211.39 |
$211.39 |
$48.50
|
|
Sodium chloride 0.9 % intravenous solution
|
$319.58 |
$319.58 |
$319.58 |
$46.43
|
|
Sodium chloride 0.9 % IV bolus
|
$319.58 |
$319.58 |
$319.58 |
$47.27
|
|
Sodium ferric gluconate complex in sucrose 62.5 mg/5 ml intravenous
|
$300.30 |
$300.30 |
$300.30 |
$84.80
|
|
Sodium serum/plasma/whole blood
|
$211.39 |
$211.39 |
$211.39 |
$42.70
|
|
Sodium thiosulfate 12.5 gram/50 ml (250 mg/ml) intravenous solution
|
$469.88 |
$469.88 |
$469.88 |
$195.48
|
|
Split blood or products
|
$670.38 |
$670.38 |
$670.38 |
$148.98
|
|
St evaluate speech sound production comprehensive/expressive
|
$924.21 |
$924.21 |
$924.21 |
$393.00
|
|
St evaluation motion fluoroscopic swallow function cine/video
|
$617.48 |
$617.48 |
$617.48 |
$406.40
|
|
St evaluation swallow function
|
$833.11 |
$833.11 |
$833.11 |
$336.60
|
|
St treatment speech individual
|
$590.66 |
$590.66 |
$590.66 |
$254.15
|
|
St treatment swallow dysfunction/oral
|
$590.66 |
$590.66 |
$590.66 |
$261.60
|
|
Succinylcholine chloride 20 mg/ml injection solution (wrapper)
|
$126.41 |
$126.41 |
$126.41 |
$49.13
|
|
Sulfamethoxazole 400 mg-trimethoprim 80 mg/5 ml intravenous solution
|
$471.57 |
$471.57 |
$471.57 |
$74.79
|
|
Sumatriptan 6 mg/0.5 ml subcutaneous solution
|
$919.79 |
$919.79 |
$919.79 |
$151.29
|
|
Surgical pathology level 1 gross examination only
|
$246.56 |
$246.56 |
$246.56 |
$92.59
|
|
Surgical pathology level 2 gross & microscopic examination
|
$575.42 |
$575.42 |
$575.42 |
$149.76
|
|
Surgical pathology level 3 gross & microscopic examination
|
$1,130.63 |
$1,130.63 |
$1,130.63 |
$192.00
|
|
Surgical pathology level 4 gross & microscopic examination
|
$1,325.57 |
$1,325.57 |
$1,325.57 |
$253.75
|
|
Surgical pathology level 5 gross & microscopic examination
|
$1,567.25 |
$1,567.25 |
$1,567.25 |
$494.00
|
|
Surgical pathology level 6 gross & microscopic examination
|
$2,192.81 |
$2,192.81 |
$2,192.81 |
$790.00
|
|
Susceptibility agar dilution per agent
|
$245.38 |
$245.38 |
$245.38 |
$40.30
|
|
Susceptibility enzyme detection per enzyme
|
$245.43 |
$245.43 |
$245.43 |
$34.48
|
|
Suscept studies macrobroth dilution ea
|
$197.55 |
$197.55 |
$197.55 |
$48.30
|
|
Svc venogram s&i
|
$8,675.81 |
$8,675.81 |
$8,675.81 |
$1,908.00
|
|
Syphilis test non-treponemal antibody quantitative rpr
|
$156.39 |
$156.39 |
$156.39 |
$44.85
|
|
T3 (triiodothyronine) free
|
$269.75 |
$269.75 |
$269.75 |
$89.82
|
|
T3 (triiodothyronine) total
|
$224.49 |
$224.49 |
$224.49 |
$94.90
|
|
T4 (thyroxine) free
|
$563.44 |
$563.44 |
$563.44 |
$81.60
|
|
T4 (thyroxine) total
|
$190.81 |
$190.81 |
$190.81 |
$73.64
|
|
Tacrolimus 5 mg/ml intravenous solution
|
$1,562.28 |
$1,562.28 |
$1,562.28 |
$612.11
|
|
Tacrolimus therapeutic drug level
|
$1,097.71 |
$1,097.71 |
$1,097.71 |
$122.40
|
|
Tamoxifen 10 mg tabs 60 each bottle
|
$30.03 |
$30.03 |
$30.03 |
$32.40
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$1,775.64 |
$1,775.64 |
$1,775.64 |
$166.46
|
|
Tc-99m bicisate
|
$3,288.01 |
$3,288.01 |
$3,288.01 |
$1,969.45
|
|
Tc-99m disofenin
|
$132.74 |
$132.74 |
$132.74 |
$151.32
|
|
Tc-99m exametazime diag
|
$4,318.82 |
$4,318.82 |
$4,318.82 |
$2,166.26
|
|
Tc-99m labeled rbc
|
$3,467.57 |
$3,467.57 |
$3,467.57 |
$323.01
|
|
Tc-99m maa
|
$501.51 |
$501.51 |
$501.51 |
$312.06
|
|
Tc-99m mebrofenin
|
$783.24 |
$783.24 |
$783.24 |
$169.53
|
|
Tc-99m medronate
|
$258.88 |
$258.88 |
$258.88 |
$122.46
|
|
Tc-99m mertiatide
|
$3,026.10 |
$3,026.10 |
$3,026.10 |
$757.25
|
|
Tc-99m oxidronate
|
$767.26 |
$767.26 |
$767.26 |
$124.23
|
|
Tc-99m pentetate dtpa
|
$501.51 |
$501.51 |
$501.51 |
$245.85
|
|
Tc-99m pentetate dtpa aerosol
|
$501.51 |
$501.51 |
$501.51 |
$244.02
|
|
Tc-99m pertechnetate per mci
|
$34.70 |
$34.70 |
$34.70 |
$28.08
|
|
Tc-99m pyroph diag per dose up to 25 mci
|
$610.84 |
$610.84 |
$610.84 |
$147.24
|
|
Tc-99m sestamibi p study dose
|
$1,097.74 |
$1,097.74 |
$1,097.74 |
$221.60
|
|
Tc-99m succimer (dmsa)
|
$1,418.86 |
$1,418.86 |
$1,418.86 |
$1,578.33
|
|
Tc-99m sulfur colloid
|
$1,290.52 |
$1,290.52 |
$1,290.52 |
$245.70
|
|
Tc-99m tetrofosmin p study dose
|
$754.60 |
$754.60 |
$754.60 |
$198.05
|
|
T cells absolute cd 4 count
|
$72.36 |
$72.36 |
$72.36 |
$120.25
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$167.56 |
$167.56 |
$167.56 |
$46.10
|
|
Test pathogen(s) for platelets reference
|
$183.06 |
$183.06 |
$183.06 |
$73.45
|
|
Test stress cardiovascular tracing only
|
$3,045.92 |
$3,045.92 |
$3,045.92 |
$1,001.55
|
|
Tetanus immune globulin inj
|
$1,013.95 |
$1,013.95 |
$1,013.95 |
$1,204.50
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$183.51 |
$183.51 |
$183.51 |
$35.72
|
|
Thyroglobulin antibody
|
$676.06 |
$676.06 |
$676.06 |
$84.00
|
|
Thyroid (TSH) Test
|
$1,032.61 |
$1,032.61 |
$1,032.61 |
$120.00
|
|
Thyroid Ultrasound
|
$1,612.29 |
$1,612.29 |
$1,612.29 |
$589.96
|
|
Tissue culture skin/biopsy
|
$642.39 |
$642.39 |
$642.39 |
$558.87
|
|
Tl-201 thallium diag per mci
|
$485.25 |
$485.25 |
$485.25 |
$77.22
|
|
Tomosynthesis breast diagnostic left
|
$69.94 |
$69.94 |
$69.94 |
$78.80
|
|
Tomosynthesis breast screen bilateral
|
$64.55 |
$64.55 |
$64.55 |
$73.45
|
|
Tranexamic acid 1,000 mg/10 ml (100 mg/ml) intravenous solution
|
$624.41 |
$624.41 |
$624.41 |
$77.65
|
|
Transferrin
|
$352.83 |
$352.83 |
$352.83 |
$87.30
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$411.79 |
$411.79 |
$411.79 |
$241.15
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$325.63 |
$325.63 |
$325.63 |
$149.00
|
|
Treatment inhalation pressurized/nonpressurized acute airway obstruction
|
$245.68 |
$245.68 |
$245.68 |
$210.00
|
|
Treponema pallidum antibody
|
$145.17 |
$145.17 |
$145.17 |
$72.80
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$137.18 |
$137.18 |
$137.18 |
$55.80
|
|
Troponin quantitative
|
$590.77 |
$590.77 |
$590.77 |
$123.75
|
|
Ultrasound abdomen aorta screening study aaa
|
$730.07 |
$730.07 |
$730.07 |
$403.26
|
|
Ultrasound chest
|
$1,938.57 |
$1,938.57 |
$1,938.57 |
$459.55
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$639.59 |
$639.59 |
$639.59 |
$340.14
|
|
Ultrasound encephalogram
|
$2,392.47 |
$2,392.47 |
$2,392.47 |
$481.60
|
|
Ultrasound exam k transpl w/doppler
|
$2,300.90 |
$2,300.90 |
$2,300.90 |
$570.44
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$607.13 |
$607.13 |
$607.13 |
$477.88
|
|
Ultrasound hips infant dynamic
|
$2,098.27 |
$2,098.27 |
$2,098.27 |
$403.00
|
|
Ultrasound joint complete left
|
$798.94 |
$798.94 |
$798.94 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$457.87 |
$457.87 |
$457.87 |
$448.50
|
|
Ultrasound ob >=14wks ea addl gest
|
$3,590.29 |
$3,590.29 |
$3,590.29 |
$454.11
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$1,131.35 |
$1,131.35 |
$1,131.35 |
$326.54
|
|
Ultrasound pregnant uterus follow up per fetus
|
$1,400.30 |
$1,400.30 |
$1,400.30 |
$450.75
|
|
Ultrasound pregnant uterus transvaginal
|
$748.45 |
$748.45 |
$748.45 |
$485.48
|
|
Ultrasound retroperitoneal limited
|
$1,458.33 |
$1,458.33 |
$1,458.33 |
$498.00
|
|
Ultrasound scrotum and contents
|
$2,098.27 |
$2,098.27 |
$2,098.27 |
$617.28
|
|
Ultrasound spinal canal and contents
|
$2,126.77 |
$2,126.77 |
$2,126.77 |
$450.60
|
|
Ultrasound transvaginal non obstetric
|
$1,275.19 |
$1,275.19 |
$1,275.19 |
$567.44
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$11,569.87 |
$11,569.87 |
$11,569.87 |
$2,916.00
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$7,242.86 |
$7,242.86 |
$7,242.86 |
$2,013.08
|
|
Urea nitrogen
|
$425.40 |
$425.40 |
$425.40 |
$45.10
|
|
Urea nitrogen 24 hour urine
|
$651.38 |
$651.38 |
$651.38 |
$50.00
|
|
Urethrcystgrphy rtrgrde s&i
|
$2,331.60 |
$2,331.60 |
$2,331.60 |
$574.40
|
|
Urethrocystography void s&i
|
$1,657.79 |
$1,657.79 |
$1,657.79 |
$634.50
|
|
Uric acid blood
|
$219.24 |
$219.24 |
$219.24 |
$46.64
|
|
Urinalysis (with microscopy)
|
$331.12 |
$331.12 |
$331.12 |
$48.14
|
|
Urinalysis (without microscopy)
|
$166.11 |
$166.11 |
$166.11 |
$38.99
|
|
Urine Culture Test
|
$744.52 |
$744.52 |
$744.52 |
$84.81
|