|
#resp virpnl dfa-parainfluenza
|
$238.00 |
$238.00 |
$238.00 |
$35.20
|
|
Reticulocyte automated
|
$233.00 |
$233.00 |
$233.00 |
$54.60
|
|
Rheumatoid factor qualitative
|
$489.00 |
$489.00 |
$489.00 |
$54.60
|
|
Rheumatoid factor quantitative
|
$489.00 |
$489.00 |
$489.00 |
$58.00
|
|
Rho d immune globulin inj
|
$2,143.00 |
$2,143.00 |
$2,143.00 |
$287.82
|
|
Rifampin in ns IV syringe 3 mg/ml (neo/ped) - cnr
|
$3,853.00 |
$3,853.00 |
$3,853.00 |
$462.44
|
|
Risperidone microspheres 12.5 mg/2 ml inj
|
$9,568.00 |
$9,568.00 |
$9,568.00 |
$2,453.83
|
|
Romidepsin 10 mg/2 ml intravenous powder for solution
|
$189.00 |
$189.00 |
$189.00 |
$7,626.51
|
|
Rotavirus antibody
|
$384.00 |
$384.00 |
$384.00 |
$38.40
|
|
Rp loclzj tum 2+area 1+d img
|
$4,941.00 |
$4,941.00 |
$4,941.00 |
$1,458.95
|
|
Rp loclzj tum spect w/ct 1
|
$5,617.00 |
$5,617.00 |
$5,617.00 |
$2,531.25
|
|
Rsv assay w/optic
|
$737.00 |
$737.00 |
$737.00 |
$73.80
|
|
Sacituzumab govitecan-hziy 180 mg intravenous solution
|
$11,434.00 |
$11,434.00 |
$11,434.00 |
$6,466.16
|
|
Salmonella antibody
|
$1,289.00 |
$1,289.00 |
$1,289.00 |
$37.58
|
|
Sargramostim injection
|
$896.00 |
$896.00 |
$896.00 |
$708.27
|
|
Screening prostate cancer PSA
|
$315.00 |
$315.00 |
$315.00 |
$100.80
|
|
Sedimentation rate erythrocyte automated
|
$78.00 |
$78.00 |
$78.00 |
$44.20
|
|
Semen analysis presence/motility
|
$171.00 |
$171.00 |
$171.00 |
$70.85
|
|
Semen analysis w/count
|
$518.00 |
$518.00 |
$518.00 |
$56.44
|
|
Serpina1 gene
|
$632.00 |
$632.00 |
$632.00 |
$191.73
|
|
Sex chromatin identification
|
$48.00 |
$48.00 |
$48.00 |
$25.35
|
|
Shuntogram nonvascular supervision & interpretation
|
$957.00 |
$957.00 |
$957.00 |
$345.00
|
|
Sincalide 5 mcg solution for injection
|
$1,384.00 |
$1,384.00 |
$1,384.00 |
$354.67
|
|
Sinus CT scan (with and without contrast)
|
$10,127.00 |
$10,127.00 |
$10,127.00 |
$1,815.00
|
|
Sinus CT scan (with contrast)
|
$7,971.00 |
$7,971.00 |
$7,971.00 |
$1,519.50
|
|
Sinus CT scan (without contrast)
|
$6,673.00 |
$6,673.00 |
$6,673.00 |
$1,279.50
|
|
Sinus/juglr venogram s&i
|
$4,639.00 |
$4,639.00 |
$4,639.00 |
$2,489.25
|
|
Smear nasal eosinophil
|
$201.00 |
$201.00 |
$201.00 |
$49.50
|
|
Smpd1 gene common variants
|
$734.00 |
$734.00 |
$734.00 |
$140.00
|
|
Sodium 24 hour urine
|
$184.00 |
$184.00 |
$184.00 |
$48.50
|
|
Sodium chloride 0.9 % intravenous solution
|
$506.00 |
$506.00 |
$506.00 |
$46.43
|
|
Sodium chloride 0.9 % IV bolus
|
$442.00 |
$442.00 |
$442.00 |
$47.27
|
|
Sodium ferric gluconate complex in sucrose 62.5 mg/5 ml intravenous
|
$1,339.00 |
$1,339.00 |
$1,339.00 |
$84.80
|
|
Sodium thiosulfate 12.5 gram/50 ml (250 mg/ml) intravenous solution
|
$1,137.00 |
$1,137.00 |
$1,137.00 |
$195.48
|
|
Specific gravity body fluid
|
$73.00 |
$73.00 |
$73.00 |
$23.63
|
|
Specimen fat stain
|
$193.00 |
$193.00 |
$193.00 |
$32.76
|
|
Staph a dna amp probe
|
$439.00 |
$439.00 |
$439.00 |
$116.39
|
|
Strep b assay w/optic
|
$386.00 |
$386.00 |
$386.00 |
$32.00
|
|
Sugars single quant
|
$196.00 |
$196.00 |
$196.00 |
$52.47
|
|
Sulfamethoxazole 400 mg-trimethoprim 80 mg/5 ml intravenous solution
|
$162.00 |
$162.00 |
$162.00 |
$74.79
|
|
Surgical pathology level 1 gross examination only
|
$439.00 |
$439.00 |
$439.00 |
$92.59
|
|
Surgical pathology level 2 gross & microscopic examination
|
$862.00 |
$862.00 |
$862.00 |
$149.76
|
|
Surgical pathology level 3 gross & microscopic examination
|
$1,220.00 |
$1,220.00 |
$1,220.00 |
$192.00
|
|
Surgical pathology level 4 gross & microscopic examination
|
$1,378.00 |
$1,378.00 |
$1,378.00 |
$253.75
|
|
Surgical pathology level 5 gross & microscopic examination
|
$1,673.00 |
$1,673.00 |
$1,673.00 |
$494.00
|
|
Surgical pathology level 6 gross & microscopic examination
|
$2,019.00 |
$2,019.00 |
$2,019.00 |
$790.00
|
|
Susceptibility enzyme detection per enzyme
|
$85.00 |
$85.00 |
$85.00 |
$34.48
|
|
Suscept studies macrobroth dilution ea
|
$342.00 |
$342.00 |
$342.00 |
$48.30
|
|
T3 (triiodothyronine) free
|
$235.00 |
$235.00 |
$235.00 |
$89.82
|
|
T3 (triiodothyronine) total
|
$889.00 |
$889.00 |
$889.00 |
$94.90
|
|
T4 (thyroxine) free
|
$365.00 |
$365.00 |
$365.00 |
$81.60
|
|
T4 (thyroxine) total
|
$303.00 |
$303.00 |
$303.00 |
$73.64
|
|
Tacrolimus 5 mg/ml intravenous solution
|
$4,509.00 |
$4,509.00 |
$4,509.00 |
$612.11
|
|
Tacrolimus therapeutic drug level
|
$792.00 |
$792.00 |
$792.00 |
$122.40
|
|
Target gsa panel hmtlmph neop
|
$2,048.00 |
$2,048.00 |
$2,048.00 |
$1,928.40
|
|
Target gsa panel organ/hmtlmph neop
|
$6,316.00 |
$6,316.00 |
$6,316.00 |
$3,385.00
|
|
Target gsa panel organ neop
|
$3,444.00 |
$3,444.00 |
$3,444.00 |
$1,913.00
|
|
Tb test cell mediated immunity antigen response enumeration gamma interferon t-cells
|
$309.00 |
$309.00 |
$309.00 |
$200.00
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$973.00 |
$973.00 |
$973.00 |
$166.46
|
|
Tc-99m disofenin
|
$281.00 |
$281.00 |
$281.00 |
$151.32
|
|
Tc-99m exametazime diag
|
$2,751.00 |
$2,751.00 |
$2,751.00 |
$2,166.26
|
|
Tc-99m labeled rbc
|
$1,277.00 |
$1,277.00 |
$1,277.00 |
$323.01
|
|
Tc-99m maa
|
$120.00 |
$120.00 |
$120.00 |
$312.06
|
|
Tc-99m mebrofenin
|
$228.00 |
$228.00 |
$228.00 |
$169.53
|
|
Tc-99m medronate
|
$686.00 |
$686.00 |
$686.00 |
$122.46
|
|
Tc-99m mertiatide
|
$1,104.00 |
$1,104.00 |
$1,104.00 |
$757.25
|
|
Tc-99m pentetate dtpa
|
$595.00 |
$595.00 |
$595.00 |
$245.85
|
|
Tc-99m pentetate dtpa aerosol
|
$154.00 |
$154.00 |
$154.00 |
$244.02
|
|
Tc-99m pertechnetate per mci
|
$76.00 |
$76.00 |
$76.00 |
$28.08
|
|
Tc-99m pyroph diag per dose up to 25 mci
|
$154.00 |
$154.00 |
$154.00 |
$147.24
|
|
Tc-99m succimer (dmsa)
|
$11,143.00 |
$11,143.00 |
$11,143.00 |
$1,578.33
|
|
Tc-99m sulfur colloid
|
$254.00 |
$254.00 |
$254.00 |
$245.70
|
|
T cells absolute cd4/cd8 including ratio
|
$1,488.00 |
$1,488.00 |
$1,488.00 |
$186.00
|
|
T cells absolute cd 4 count
|
$1,488.00 |
$1,488.00 |
$1,488.00 |
$120.25
|
|
T cells total count
|
$523.00 |
$523.00 |
$523.00 |
$124.11
|
|
Telehealth original site facility fee
|
$68.00 |
$68.00 |
$68.00 |
$60.80
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$357.00 |
$357.00 |
$357.00 |
$46.10
|
|
Tert gene targeted seq alys
|
$215.00 |
$215.00 |
$215.00 |
$304.59
|
|
Test for porphobilinogen
|
$307.00 |
$307.00 |
$307.00 |
$33.57
|
|
Test urine for porphyrins
|
$596.00 |
$596.00 |
$596.00 |
$27.30
|
|
Tetanus immune globulin inj
|
$3,203.00 |
$3,203.00 |
$3,203.00 |
$1,204.50
|
|
Tgsap so neo 5-50 rna alys
|
$1,605.00 |
$1,605.00 |
$1,605.00 |
$816.27
|
|
Theophylline therapeutic drug level
|
$601.00 |
$601.00 |
$601.00 |
$108.00
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$393.00 |
$393.00 |
$393.00 |
$35.72
|
|
Thrombin time
|
$255.00 |
$255.00 |
$255.00 |
$48.75
|
|
Thromboplastin inhibition
|
$378.00 |
$378.00 |
$378.00 |
$52.00
|
|
Thyroglobulin antibody
|
$351.00 |
$351.00 |
$351.00 |
$84.00
|
|
Thyroid imaging
|
$4,237.00 |
$4,237.00 |
$4,237.00 |
$670.80
|
|
Thyroid mets imag whole body
|
$6,606.00 |
$6,606.00 |
$6,606.00 |
$1,524.99
|
|
Thyroid Ultrasound
|
$2,470.00 |
$2,470.00 |
$2,470.00 |
$589.96
|
|
Thyroid uptake measurement
|
$5,918.00 |
$5,918.00 |
$5,918.00 |
$653.60
|
|
Thyrotropin alfa 0.9 mg intramuscular solution
|
$18,422.00 |
$18,422.00 |
$18,422.00 |
$4,319.71
|
|
Thyroxine binding globulin (tbg)
|
$211.00 |
$211.00 |
$211.00 |
$63.60
|
|
Tigecycline injection
|
$2,142.00 |
$2,142.00 |
$2,142.00 |
$277.31
|
|
Tissue culture placenta
|
$737.00 |
$737.00 |
$737.00 |
$520.91
|
|
Tissue culture tumor
|
$1,854.00 |
$1,854.00 |
$1,854.00 |
$529.23
|
|
Tissue exam koh skin/hair/nails
|
$119.00 |
$119.00 |
$119.00 |
$47.40
|
|
Tl-201 thallium diag per mci
|
$603.00 |
$603.00 |
$603.00 |
$77.22
|
|
Tomosynthesis breast diagnostic left
|
$102.00 |
$102.00 |
$102.00 |
$78.80
|
|
Tomosynthesis breast screen bilateral
|
$102.00 |
$102.00 |
$102.00 |
$73.45
|
