|
Sodium 24 hour urine
|
$172.00 |
$172.00 |
$172.00 |
$48.50
|
|
Sodium chloride 0.9 % intravenous solution
|
$54.00 |
$54.00 |
$54.00 |
$46.43
|
|
Sodium chloride 0.9 % IV bolus
|
$54.00 |
$54.00 |
$54.00 |
$47.27
|
|
Sodium ferric gluconate complex in sucrose 62.5 mg/5 ml intravenous
|
$1,033.00 |
$1,033.00 |
$1,033.00 |
$84.80
|
|
Sodium serum/plasma/whole blood
|
$172.00 |
$172.00 |
$172.00 |
$42.70
|
|
Sodium thiosulfate 12.5 gram/50 ml (250 mg/ml) intravenous solution
|
$459.00 |
$459.00 |
$459.00 |
$195.48
|
|
Specific gravity body fluid
|
$149.00 |
$149.00 |
$149.00 |
$23.63
|
|
St analysis behavior qualitative voice/resonance
|
$302.00 |
$302.00 |
$302.00 |
$300.00
|
|
Staph a dna amp probe
|
$240.00 |
$240.00 |
$240.00 |
$116.39
|
|
St evaluate speech sound production
|
$288.00 |
$288.00 |
$288.00 |
$300.00
|
|
St evaluate speech sound production comprehensive/expressive
|
$596.00 |
$596.00 |
$596.00 |
$393.00
|
|
St evaluation motion fluoroscopic swallow function cine/video
|
$874.00 |
$874.00 |
$874.00 |
$406.40
|
|
St evaluation swallow function
|
$380.00 |
$380.00 |
$380.00 |
$336.60
|
|
Strep a ag ia
|
$418.00 |
$418.00 |
$418.00 |
$75.40
|
|
Strep b assay w/optic
|
$230.00 |
$230.00 |
$230.00 |
$32.00
|
|
St treatment speech individual
|
$212.00 |
$212.00 |
$212.00 |
$254.15
|
|
St treatment swallow dysfunction/oral
|
$333.00 |
$333.00 |
$333.00 |
$261.60
|
|
Sulfamethoxazole 400 mg-trimethoprim 80 mg/5 ml intravenous solution
|
$195.00 |
$195.00 |
$195.00 |
$74.79
|
|
Surgical pathology level 1 gross examination only
|
$36.00 |
$36.00 |
$36.00 |
$92.59
|
|
Surgical pathology level 2 gross & microscopic examination
|
$103.00 |
$103.00 |
$103.00 |
$149.76
|
|
Surgical pathology level 3 gross & microscopic examination
|
$105.00 |
$105.00 |
$105.00 |
$192.00
|
|
Surgical pathology level 4 gross & microscopic examination
|
$154.00 |
$154.00 |
$154.00 |
$253.75
|
|
Surgical pathology level 5 gross & microscopic examination
|
$223.00 |
$223.00 |
$223.00 |
$494.00
|
|
Surgical pathology level 6 gross & microscopic examination
|
$316.00 |
$316.00 |
$316.00 |
$790.00
|
|
Susceptibility enzyme detection per enzyme
|
$124.00 |
$124.00 |
$124.00 |
$34.48
|
|
Suscept studies macrobroth dilution ea
|
$17.00 |
$17.00 |
$17.00 |
$48.30
|
|
Syphilis test non-treponemal antibody quantitative rpr
|
$114.00 |
$114.00 |
$114.00 |
$44.85
|
|
T3 (triiodothyronine) free
|
$317.00 |
$317.00 |
$317.00 |
$89.82
|
|
T3 (triiodothyronine) total
|
$266.00 |
$266.00 |
$266.00 |
$94.90
|
|
T4 (thyroxine) free
|
$445.00 |
$445.00 |
$445.00 |
$81.60
|
|
T4 (thyroxine) total
|
$414.00 |
$414.00 |
$414.00 |
$73.64
|
|
Tacrolimus therapeutic drug level
|
$1,396.00 |
$1,396.00 |
$1,396.00 |
$122.40
|
|
Target gsa panel hmtlmph neop
|
$3,326.00 |
$3,326.00 |
$3,326.00 |
$1,928.40
|
|
Target gsa panel organ/hmtlmph neop
|
$6,434.00 |
$6,434.00 |
$6,434.00 |
$3,385.00
|
|
Tb test cell mediated immunity antigen response enumeration gamma interferon t-cells
|
$121.00 |
$121.00 |
$121.00 |
$200.00
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$576.00 |
$576.00 |
$576.00 |
$166.46
|
|
Tc-99m depreotide
|
$5,384.00 |
$5,384.00 |
$5,384.00 |
$1,937.35
|
|
Tc-99m exametazime diag
|
$6,224.00 |
$6,224.00 |
$6,224.00 |
$2,166.26
|
|
Tc-99m labeled rbc
|
$2,561.00 |
$2,561.00 |
$2,561.00 |
$323.01
|
|
Tc-99m maa
|
$2,332.00 |
$2,332.00 |
$2,332.00 |
$312.06
|
|
Tc-99m mebrofenin
|
$2,561.00 |
$2,561.00 |
$2,561.00 |
$169.53
|
|
Tc-99m medronate
|
$1,881.00 |
$1,881.00 |
$1,881.00 |
$122.46
|
|
Tc-99m mertiatide
|
$2,561.00 |
$2,561.00 |
$2,561.00 |
$757.25
|
|
Tc-99m pentetate dtpa
|
$2,561.00 |
$2,561.00 |
$2,561.00 |
$245.85
|
|
Tc-99m pentetate dtpa aerosol
|
$2,561.00 |
$2,561.00 |
$2,561.00 |
$244.02
|
|
Tc-99m pertechnetate per mci
|
$3.00 |
$3.00 |
$3.00 |
$28.08
|
|
Tc-99m pyroph diag per dose up to 25 mci
|
$2,561.00 |
$2,561.00 |
$2,561.00 |
$147.24
|
|
Tc-99m sestamibi p study dose
|
$2,718.00 |
$2,718.00 |
$2,718.00 |
$221.60
|
|
Tc-99m sulfur colloid
|
$2,561.00 |
$2,561.00 |
$2,561.00 |
$245.70
|
|
T cells absolute cd4/cd8 including ratio
|
$862.00 |
$862.00 |
$862.00 |
$186.00
|
|
T cells total count
|
$549.00 |
$549.00 |
$549.00 |
$124.11
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$93.00 |
$93.00 |
$93.00 |
$46.10
|
|
Tetanus immune globulin inj
|
$1,663.00 |
$1,663.00 |
$1,663.00 |
$1,204.50
|
|
Theophylline therapeutic drug level
|
$469.00 |
$469.00 |
$469.00 |
$108.00
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$35.00 |
$35.00 |
$35.00 |
$35.72
|
|
Thrombin time
|
$391.00 |
$391.00 |
$391.00 |
$48.75
|
|
Thromboplastin inhibition
|
$211.00 |
$211.00 |
$211.00 |
$52.00
|
|
Thyroglobulin antibody
|
$457.00 |
$457.00 |
$457.00 |
$84.00
|
|
Thyroid (TSH) Test
|
$552.00 |
$552.00 |
$552.00 |
$120.00
|
|
Thyroid Ultrasound
|
$1,812.00 |
$1,812.00 |
$1,812.00 |
$589.96
|
|
Thyroid uptake measurement
|
$5,184.00 |
$5,184.00 |
$5,184.00 |
$653.60
|
|
Thyroxine binding globulin (tbg)
|
$279.00 |
$279.00 |
$279.00 |
$63.60
|
|
Tissue exam koh skin/hair/nails
|
$266.00 |
$266.00 |
$266.00 |
$47.40
|
|
Tl-201 thallium diag per mci
|
$2,463.00 |
$2,463.00 |
$2,463.00 |
$77.22
|
|
Tomosynthesis breast diagnostic left
|
$82.00 |
$82.00 |
$82.00 |
$78.80
|
|
Tomosynthesis breast screen bilateral
|
$82.00 |
$82.00 |
$82.00 |
$73.45
|
|
Toxoplasma antibody igg
|
$434.00 |
$434.00 |
$434.00 |
$84.35
|
|
Toxoplasma antibody igm
|
$380.00 |
$380.00 |
$380.00 |
$83.20
|
|
Tranexamic acid 1,000 mg/10 ml (100 mg/ml) intravenous solution
|
$305.00 |
$305.00 |
$305.00 |
$77.65
|
|
Transferrin
|
$247.00 |
$247.00 |
$247.00 |
$87.30
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$274.00 |
$274.00 |
$274.00 |
$55.80
|
|
Trichinella antibody
|
$541.00 |
$541.00 |
$541.00 |
$70.65
|
|
Troponin quantitative
|
$418.00 |
$418.00 |
$418.00 |
$123.75
|
|
Ultrasound abdomen aorta screening study aaa
|
$576.00 |
$576.00 |
$576.00 |
$403.26
|
|
Ultrasound chest
|
$1,737.68 |
$1,737.68 |
$1,737.68 |
$459.55
|
|
Ultrasound elastography parenchyma
|
$600.00 |
$600.00 |
$600.00 |
$284.25
|
|
Ultrasound guidance for vascular access
|
$36.00 |
$36.00 |
$36.00 |
$340.22
|
|
Ultrasound joint complete left
|
$1,573.00 |
$1,573.00 |
$1,573.00 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$256.00 |
$256.00 |
$256.00 |
$448.50
|
|
Ultrasound ob >=14wks ea addl gest
|
$2,944.00 |
$2,944.00 |
$2,944.00 |
$454.11
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$1,545.00 |
$1,545.00 |
$1,545.00 |
$459.00
|
|
Ultrasound retroperitoneal limited
|
$1,944.00 |
$1,944.00 |
$1,944.00 |
$498.00
|
|
Ultrasound scrotum and contents
|
$1,997.00 |
$1,997.00 |
$1,997.00 |
$617.28
|
|
Ultrasound transvaginal non obstetric
|
$2,070.00 |
$2,070.00 |
$2,070.00 |
$567.44
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$17,753.00 |
$17,753.00 |
$17,753.00 |
$2,916.00
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$11,850.00 |
$11,850.00 |
$11,850.00 |
$2,013.08
|
|
Urea nitrogen 24 hour urine
|
$154.00 |
$154.00 |
$154.00 |
$50.00
|
|
Urea nitrogen clearance
|
$129.00 |
$129.00 |
$129.00 |
$33.57
|
|
Urethrocystography void s&i
|
$1,170.00 |
$1,170.00 |
$1,170.00 |
$634.50
|
|
Uric acid blood
|
$356.00 |
$356.00 |
$356.00 |
$46.64
|
|
Urinalysis (with microscopy)
|
$229.00 |
$229.00 |
$229.00 |
$48.14
|
|
Urine Culture Test
|
$418.00 |
$418.00 |
$418.00 |
$84.81
|
|
Urine pregnancy test
|
$515.00 |
$515.00 |
$515.00 |
$66.40
|
|
Urography, antegrade
|
$1,170.00 |
$1,170.00 |
$1,170.00 |
$593.37
|
|
Vaccine dtap < 7 years im
|
$149.48 |
$149.48 |
$149.48 |
$87.80
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$353.00 |
$353.00 |
$353.00 |
$173.98
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$143.00 |
$143.00 |
$143.00 |
$79.04
|
|
Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im
|
$1,579.04 |
$1,579.04 |
$1,579.04 |
$686.67
|
|
Vaccine influenza (iiv) preservative free antigen content im
|
$323.00 |
$323.00 |
$323.00 |
$157.41
|
|
Vaccine influenza nos 0.5ml dose im
|
$81.00 |
$81.00 |
$81.00 |
$36.80
|
