|
Smear special stain inclusion bodies/parasites
|
$317.00 |
$317.00 |
$317.00 |
$64.35
|
|
Sodium 24 hour urine
|
$335.00 |
$335.00 |
$335.00 |
$48.50
|
|
Sodium chloride 0.9 % intravenous solution
|
$1,252.00 |
$1,252.00 |
$1,252.00 |
$46.43
|
|
Sodium chloride 0.9 % IV bolus
|
$1,154.00 |
$1,154.00 |
$1,154.00 |
$47.27
|
|
Sodium ferric gluconate complex in sucrose 62.5 mg/5 ml intravenous
|
$1,260.00 |
$1,260.00 |
$1,260.00 |
$84.80
|
|
Sodium serum/plasma/whole blood
|
$482.00 |
$482.00 |
$482.00 |
$42.70
|
|
Sodium thiosulfate 12.5 gram/50 ml (250 mg/ml) intravenous solution
|
$841.00 |
$841.00 |
$841.00 |
$195.48
|
|
St analysis behavior qualitative voice/resonance
|
$1,241.00 |
$1,241.00 |
$1,241.00 |
$300.00
|
|
St cognitve performance testing healthcare professional each hour
|
$581.00 |
$581.00 |
$581.00 |
$313.96
|
|
St evaluate speech sound production
|
$1,073.00 |
$1,073.00 |
$1,073.00 |
$300.00
|
|
St evaluate speech sound production comprehensive/expressive
|
$1,241.00 |
$1,241.00 |
$1,241.00 |
$393.00
|
|
St evaluation motion fluoroscopic swallow function cine/video
|
$1,530.00 |
$1,530.00 |
$1,530.00 |
$406.40
|
|
St evaluation swallow function
|
$1,353.00 |
$1,353.00 |
$1,353.00 |
$336.60
|
|
St treatment speech individual
|
$818.00 |
$818.00 |
$818.00 |
$254.15
|
|
St treatment swallow dysfunction/oral
|
$736.00 |
$736.00 |
$736.00 |
$261.60
|
|
Succinylcholine chloride 20 mg/ml injection solution (wrapper)
|
$90.00 |
$90.00 |
$90.00 |
$49.13
|
|
Sumatriptan 6 mg/0.5 ml subcutaneous solution
|
$2,419.00 |
$2,419.00 |
$2,419.00 |
$151.29
|
|
Surgical pathology level 1 gross examination only
|
$294.00 |
$294.00 |
$294.00 |
$92.59
|
|
Surgical pathology level 2 gross & microscopic examination
|
$423.00 |
$423.00 |
$423.00 |
$149.76
|
|
Surgical pathology level 3 gross & microscopic examination
|
$549.00 |
$549.00 |
$549.00 |
$192.00
|
|
Surgical pathology level 4 gross & microscopic examination
|
$783.00 |
$783.00 |
$783.00 |
$253.75
|
|
Surgical pathology level 5 gross & microscopic examination
|
$1,247.00 |
$1,247.00 |
$1,247.00 |
$494.00
|
|
Surgical pathology level 6 gross & microscopic examination
|
$1,727.00 |
$1,727.00 |
$1,727.00 |
$790.00
|
|
Susceptibility agar dilution per agent
|
$260.00 |
$260.00 |
$260.00 |
$40.30
|
|
Susceptibility enzyme detection per enzyme
|
$241.00 |
$241.00 |
$241.00 |
$34.48
|
|
Suscept studies macrobroth dilution ea
|
$277.00 |
$277.00 |
$277.00 |
$48.30
|
|
T3 (triiodothyronine) free
|
$794.00 |
$794.00 |
$794.00 |
$89.82
|
|
T3 (triiodothyronine) total
|
$603.00 |
$603.00 |
$603.00 |
$94.90
|
|
T4 (thyroxine) free
|
$454.00 |
$454.00 |
$454.00 |
$81.60
|
|
T4 (thyroxine) total
|
$273.00 |
$273.00 |
$273.00 |
$73.64
|
|
Tacrolimus therapeutic drug level
|
$901.00 |
$901.00 |
$901.00 |
$122.40
|
|
Tamoxifen 10 mg tabs 60 each bottle
|
$78.00 |
$78.00 |
$78.00 |
$32.40
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$710.00 |
$710.00 |
$710.00 |
$166.46
|
|
Tc-99m arcitumomab
|
$9,753.00 |
$9,753.00 |
$9,753.00 |
$2,159.40
|
|
Tc-99m bicisate
|
$3,233.00 |
$3,233.00 |
$3,233.00 |
$1,969.45
|
|
Tc-99m disofenin
|
$1,152.00 |
$1,152.00 |
$1,152.00 |
$151.32
|
|
Tc-99m exame autol wbc diag per dose
|
$4,997.00 |
$4,997.00 |
$4,997.00 |
$2,393.40
|
|
Tc-99m exametazime diag
|
$4,996.00 |
$4,996.00 |
$4,996.00 |
$2,166.26
|
|
Tc-99m labeled rbc
|
$1,603.00 |
$1,603.00 |
$1,603.00 |
$323.01
|
|
Tc-99m maa
|
$1,106.00 |
$1,106.00 |
$1,106.00 |
$312.06
|
|
Tc-99m mebrofenin
|
$1,106.00 |
$1,106.00 |
$1,106.00 |
$169.53
|
|
Tc-99m medronate
|
$1,103.00 |
$1,103.00 |
$1,103.00 |
$122.46
|
|
Tc-99m mertiatide
|
$1,730.00 |
$1,730.00 |
$1,730.00 |
$757.25
|
|
Tc-99m pentetate dtpa
|
$1,144.00 |
$1,144.00 |
$1,144.00 |
$245.85
|
|
Tc-99m pentetate dtpa aerosol
|
$1,144.00 |
$1,144.00 |
$1,144.00 |
$244.02
|
|
Tc-99m pertechnetate per mci
|
$123.00 |
$123.00 |
$123.00 |
$28.08
|
|
Tc-99m pyroph diag per dose up to 25 mci
|
$1,204.00 |
$1,204.00 |
$1,204.00 |
$147.24
|
|
Tc-99m sestamibi p study dose
|
$1,094.00 |
$1,094.00 |
$1,094.00 |
$221.60
|
|
Tc-99m succimer (dmsa)
|
$1,532.00 |
$1,532.00 |
$1,532.00 |
$1,578.33
|
|
Tc-99m sulfur colloid
|
$1,231.00 |
$1,231.00 |
$1,231.00 |
$245.70
|
|
Tc-99m tetrofosmin p study dose
|
$790.00 |
$790.00 |
$790.00 |
$198.05
|
|
Tc-99m tilmanocept diag
|
$1,523.00 |
$1,523.00 |
$1,523.00 |
$930.54
|
|
T cells absolute cd4/cd8 including ratio
|
$1,191.00 |
$1,191.00 |
$1,191.00 |
$186.00
|
|
T cells absolute cd 4 count
|
$989.00 |
$989.00 |
$989.00 |
$120.25
|
|
T cells total count
|
$790.00 |
$790.00 |
$790.00 |
$124.11
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$561.00 |
$561.00 |
$561.00 |
$46.10
|
|
Test pathogen(s) for platelets reference
|
$184.00 |
$184.00 |
$184.00 |
$73.45
|
|
Tetanus immune globulin inj
|
$3,031.00 |
$3,031.00 |
$3,031.00 |
$1,204.50
|
|
Theophylline therapeutic drug level
|
$574.00 |
$574.00 |
$574.00 |
$108.00
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$281.00 |
$281.00 |
$281.00 |
$35.72
|
|
Thrombin time
|
$288.00 |
$288.00 |
$288.00 |
$48.75
|
|
Thromboplastin inhibition
|
$457.00 |
$457.00 |
$457.00 |
$52.00
|
|
Thyroglobulin antibody
|
$516.00 |
$516.00 |
$516.00 |
$84.00
|
|
Thyroid Ultrasound
|
$1,339.00 |
$1,339.00 |
$1,339.00 |
$589.96
|
|
Thyroid uptake measurement
|
$3,884.00 |
$3,884.00 |
$3,884.00 |
$653.60
|
|
Tigecycline injection
|
$1,672.00 |
$1,672.00 |
$1,672.00 |
$277.31
|
|
Tissue matrix 1.8x1.8cm collagen dermacell porous 4sq cm cost per sq cm
|
$2,205.00 |
$2,205.00 |
$2,205.00 |
$2,516.07
|
|
Tl-201 thallium diag per mci
|
$829.00 |
$829.00 |
$829.00 |
$77.22
|
|
Tobramycin non-comp unit
|
$711.00 |
$711.00 |
$711.00 |
$143.38
|
|
Tomosynthesis breast diagnostic left
|
$43.00 |
$43.00 |
$43.00 |
$78.80
|
|
Tomosynthesis breast screen bilateral
|
$43.00 |
$43.00 |
$43.00 |
$73.45
|
|
Toxoplasma antibody igg
|
$457.00 |
$457.00 |
$457.00 |
$84.35
|
|
Toxoplasma antibody igm
|
$562.00 |
$562.00 |
$562.00 |
$83.20
|
|
Tranexamic acid 1,000 mg/10 ml (100 mg/ml) intravenous solution
|
$1,641.00 |
$1,641.00 |
$1,641.00 |
$77.65
|
|
Transferrin
|
$528.00 |
$528.00 |
$528.00 |
$87.30
|
|
Treponema pallidum antibody
|
$409.00 |
$409.00 |
$409.00 |
$72.80
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$189.00 |
$189.00 |
$189.00 |
$55.80
|
|
Ultrasound abdomen aorta screening study aaa
|
$968.00 |
$968.00 |
$968.00 |
$403.26
|
|
Ultrasound elastography parenchyma
|
$1,011.00 |
$1,011.00 |
$1,011.00 |
$284.25
|
|
Ultrasound exam k transpl w/doppler
|
$764.00 |
$764.00 |
$764.00 |
$570.44
|
|
Ultrasound guidance for vascular access
|
$891.00 |
$891.00 |
$891.00 |
$340.22
|
|
Ultrasound joint complete left
|
$1,377.00 |
$1,377.00 |
$1,377.00 |
$556.14
|
|
Ultrasound ob >=14wks ea addl gest
|
$1,458.00 |
$1,458.00 |
$1,458.00 |
$454.11
|
|
Ultrasound pregnant uterus follow up per fetus
|
$1,715.00 |
$1,715.00 |
$1,715.00 |
$450.75
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$2,557.00 |
$2,557.00 |
$2,557.00 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$1,838.00 |
$1,838.00 |
$1,838.00 |
$485.48
|
|
Ultrasound retroperitoneal limited
|
$1,474.00 |
$1,474.00 |
$1,474.00 |
$498.00
|
|
Ultrasound scrotum and contents
|
$1,775.00 |
$1,775.00 |
$1,775.00 |
$617.28
|
|
Ultrasound transvaginal non obstetric
|
$1,578.00 |
$1,578.00 |
$1,578.00 |
$567.44
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$8,058.00 |
$8,058.00 |
$8,058.00 |
$2,916.00
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$7,811.00 |
$7,811.00 |
$7,811.00 |
$2,013.08
|
|
Urea nitrogen
|
$313.00 |
$313.00 |
$313.00 |
$45.10
|
|
Urea nitrogen 24 hour urine
|
$243.00 |
$243.00 |
$243.00 |
$50.00
|
|
Urine Culture Test
|
$597.00 |
$597.00 |
$597.00 |
$84.81
|
|
Vaccine dtap < 7 years im
|
$170.00 |
$170.00 |
$170.00 |
$87.80
|
|
Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im
|
$722.00 |
$722.00 |
$722.00 |
$85.00
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$542.00 |
$542.00 |
$542.00 |
$45.33
|
|
Vaccine hepatitis a (hepa) adult im
|
$400.00 |
$400.00 |
$400.00 |
$178.07
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$93.00 |
$93.00 |
$93.00 |
$79.04
|
|
Vaccine mmr live subcutaneous
|
$2,075.00 |
$2,075.00 |
$2,075.00 |
$224.04
|
