|
Special radiation dosimetry
|
$53.39 |
$53.39 |
$53.39 |
$392.50
|
|
Special radiation treatment
|
$190.00 |
$190.00 |
$190.00 |
$1,986.00
|
|
Special teletx port plan
|
$142.12 |
$142.12 |
$142.12 |
$1,086.99
|
|
Spinal puncture lumbar diagnostic w/fluoroscopic or CT guidance
|
$393.30 |
$393.30 |
$393.30 |
$1,439.40
|
|
Spirometry bronchodilation responsiveness pre/post bronchodilator administration
|
$92.34 |
$92.34 |
$92.34 |
$543.26
|
|
Split blood or products
|
$39.52 |
$39.52 |
$39.52 |
$127.48
|
|
Srs linear based
|
$3,024.80 |
$3,024.80 |
$3,024.80 |
$13,585.00
|
|
St analysis behavior qualitative voice/resonance
|
$57.00 |
$57.00 |
$57.00 |
$297.60
|
|
Staph a dna amp probe
|
$28.88 |
$28.88 |
$28.88 |
$125.00
|
|
St cognitve performance testing healthcare professional each hour
|
$67.64 |
$67.64 |
$67.64 |
$286.00
|
|
Stent/athrectomy/fem/pop/unilat 37227
|
$13,765.88 |
$13,765.88 |
$13,765.88 |
$21,626.50
|
|
Stent axios caut enh 15x10mm electrocaut
|
$1,078.44 |
$1,078.44 |
$1,078.44 |
$32,403.15
|
|
Stent bili rx wallflx 10x80 uncvr
|
$519.27 |
$519.27 |
$519.27 |
$20,962.50
|
|
Stent iliac/open or perc/uni/init 37221
|
$9,519.95 |
$9,519.95 |
$9,519.95 |
$14,356.50
|
|
Stent iliac/open/perc/ea ad/ipsila 37223
|
$5,369.78 |
$5,369.78 |
$5,369.78 |
$9,008.54
|
|
Stent/tib/peroneal/unilat/initial 37230
|
$8,354.87 |
$8,354.87 |
$8,354.87 |
$17,271.50
|
|
St evaluate speech sound production
|
$55.48 |
$55.48 |
$55.48 |
$292.95
|
|
St evaluate speech sound production comprehensive/expressive
|
$114.19 |
$114.19 |
$114.19 |
$377.00
|
|
St evaluation motion fluoroscopic swallow function cine/video
|
$80.94 |
$80.94 |
$80.94 |
$399.60
|
|
St evaluation swallow function
|
$103.93 |
$103.93 |
$103.93 |
$314.40
|
|
Stimulants synthetic
|
$14.44 |
$14.44 |
$14.44 |
$80.08
|
|
Strapping of ankle and/or ft 29540
|
$35.53 |
$35.53 |
$35.53 |
$223.45
|
|
Strapping of chest
|
$41.80 |
$41.80 |
$41.80 |
$195.33
|
|
Strapping of hand or finger
|
$27.93 |
$27.93 |
$27.93 |
$174.82
|
|
Strapping of knee
|
$27.93 |
$27.93 |
$27.93 |
$205.20
|
|
Strapping of toes 29550
|
$27.93 |
$27.93 |
$27.93 |
$164.70
|
|
Strep b dna amp probe
|
$24.89 |
$24.89 |
$24.89 |
$120.90
|
|
Streptomycin injection
|
$110.56 |
$110.56 |
$110.56 |
$138.30
|
|
Stress test pulmonary
|
$42.56 |
$42.56 |
$42.56 |
$322.85
|
|
St treatment speech individual
|
$72.58 |
$72.58 |
$72.58 |
$248.84
|
|
St treatment swallow dysfunction/oral
|
$40.28 |
$40.28 |
$40.28 |
$240.31
|
|
Succinylcholine chloride 20 mg/ml injection solution (wrapper)
|
$79.51 |
$79.51 |
$79.51 |
$52.31
|
|
Sugars single quant
|
$50.35 |
$50.35 |
$50.35 |
$64.28
|
|
Sulfonylurea screen qn-sendout
|
$58.71 |
$58.71 |
$58.71 |
$156.16
|
|
Sumatriptan 6 mg/0.5 ml subcutaneous solution
|
$65.93 |
$65.93 |
$65.93 |
$114.88
|
|
Surgical pathology level 1 gross examination only
|
$7.22 |
$7.22 |
$7.22 |
$79.50
|
|
Surgical pathology level 2 gross & microscopic examination
|
$11.97 |
$11.97 |
$11.97 |
$141.94
|
|
Surgical pathology level 3 gross & microscopic examination
|
$26.41 |
$26.41 |
$26.41 |
$181.00
|
|
Surgical pathology level 4 gross & microscopic examination
|
$26.41 |
$26.41 |
$26.41 |
$239.85
|
|
Surgical pathology level 5 gross & microscopic examination
|
$99.37 |
$99.37 |
$99.37 |
$480.00
|
|
Surgical pathology level 6 gross & microscopic examination
|
$208.81 |
$208.81 |
$208.81 |
$718.00
|
|
Susceptibility enzyme detection per enzyme
|
$11.21 |
$11.21 |
$11.21 |
$35.70
|
|
Susceptibility mic per plate
|
$29.07 |
$29.07 |
$29.07 |
$106.00
|
|
Suscept studies macrobroth dilution ea
|
$3.99 |
$3.99 |
$3.99 |
$59.28
|
|
Svc venogram s&i
|
$356.63 |
$356.63 |
$356.63 |
$1,934.62
|
|
Sweat collection by iontophoresis
|
$30.78 |
$30.78 |
$30.78 |
$125.40
|
|
Syphilis test non-treponemal antibody quantitative rpr
|
$2.09 |
$2.09 |
$2.09 |
$41.60
|
|
T3 (triiodothyronine) free
|
$23.56 |
$23.56 |
$23.56 |
$99.20
|
|
T3 (triiodothyronine) total
|
$79.42 |
$79.42 |
$79.42 |
$93.52
|
|
T4 (thyroxine) free
|
$76.76 |
$76.76 |
$76.76 |
$85.20
|
|
T4 (thyroxine) total
|
$41.42 |
$41.42 |
$41.42 |
$69.00
|
|
Tacrolimus 1 mg capsule, immediate-release
|
$5.95 |
$5.95 |
$5.95 |
$9.84
|
|
Tacrolimus therapeutic drug level
|
$47.69 |
$47.69 |
$47.69 |
$122.40
|
|
Tafasitamab-cxix 200 mg intravenous solution
|
$1,300.07 |
$1,300.07 |
$1,300.07 |
$2,762.00
|
|
Target gsa panel hmtlmph neop
|
$295.26 |
$295.26 |
$295.26 |
$2,246.30
|
|
Tavr perq femoral
|
$4,843.29 |
$4,843.29 |
$4,843.29 |
$15,454.40
|
|
Tb test cell mediated immunity antigen response enumeration gamma interferon t-cells
|
$89.11 |
$89.11 |
$89.11 |
$194.35
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$107.16 |
$107.16 |
$107.16 |
$177.65
|
|
Tc-99m bicisate
|
$345.80 |
$345.80 |
$345.80 |
$1,969.45
|
|
Tc-99m disofenin
|
$85.20 |
$85.20 |
$85.20 |
$124.32
|
|
Tc-99m exametazime diag
|
$582.16 |
$582.16 |
$582.16 |
$2,033.20
|
|
Tc-99m labeled rbc
|
$63.84 |
$63.84 |
$63.84 |
$302.40
|
|
Tc-99m maa
|
$46.17 |
$46.17 |
$46.17 |
$292.80
|
|
Tc-99m mebrofenin
|
$72.39 |
$72.39 |
$72.39 |
$157.65
|
|
Tc-99m medronate
|
$47.69 |
$47.69 |
$47.69 |
$111.01
|
|
Tc-99m mertiatide
|
$200.64 |
$200.64 |
$200.64 |
$756.00
|
|
Tc-99m non-heu per study dose
|
$1.90 |
$1.90 |
$1.90 |
$6.60
|
|
Tc-99m pentetate dtpa
|
$10.26 |
$10.26 |
$10.26 |
$222.60
|
|
Tc-99m pentetate dtpa aerosol
|
$18.24 |
$18.24 |
$18.24 |
$190.80
|
|
Tc-99m pertechnetate per mci
|
$0.21 |
$0.21 |
$0.21 |
$22.10
|
|
Tc-99m pyroph diag per dose up to 25 mci
|
$91.14 |
$91.14 |
$91.14 |
$136.40
|
|
Tc-99m sestamibi p study dose
|
$153.71 |
$153.71 |
$153.71 |
$274.45
|
|
Tc-99m succimer (dmsa)
|
$214.32 |
$214.32 |
$214.32 |
$1,128.40
|
|
Tc-99m sulfur colloid
|
$41.42 |
$41.42 |
$41.42 |
$240.50
|
|
Tc-99m tetrofosmin p study dose
|
$140.98 |
$140.98 |
$140.98 |
$190.80
|
|
Tc-99m tilmanocept diag
|
$297.54 |
$297.54 |
$297.54 |
$955.60
|
|
T cells absolute cd4/cd8 including ratio
|
$38.19 |
$38.19 |
$38.19 |
$176.40
|
|
T cells absolute cd 4 count
|
$55.86 |
$55.86 |
$55.86 |
$111.20
|
|
T cells total count
|
$98.23 |
$98.23 |
$98.23 |
$126.90
|
|
Telehealth original site facility fee
|
$13.11 |
$13.11 |
$13.11 |
$51.00
|
|
Telethx isodose plan cplx
|
$194.37 |
$194.37 |
$194.37 |
$1,526.85
|
|
Telethx isodose plan simple
|
$106.59 |
$106.59 |
$106.59 |
$873.62
|
|
Temozolomide
|
$266.37 |
$266.37 |
$266.37 |
$588.46
|
|
Temsirolimus 30 mg/3 ml (10 mg/ml) (first dilution) intravenous soln
|
$1,259.57 |
$1,259.57 |
$1,259.57 |
$3,723.60
|
|
Tenotomy open tndn flxr toe sgl tndn spx
|
$851.96 |
$851.96 |
$851.96 |
$2,139.67
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$19.00 |
$19.00 |
$19.00 |
$39.33
|
|
Test for chlorohydrocarbons
|
$136.42 |
$136.42 |
$136.42 |
$65.00
|
|
Test stress cardiovascular tracing only
|
$117.80 |
$117.80 |
$117.80 |
$949.70
|
|
Tgsap hl neo 5-50 rna alys
|
$468.35 |
$468.35 |
$468.35 |
$879.20
|
|
Tgsap so/hl 51/< rna alys
|
$1,799.87 |
$1,799.87 |
$1,799.87 |
$4,347.00
|
|
Tgsap so neo 5-50 rna alys
|
$368.79 |
$368.79 |
$368.79 |
$1,019.60
|
|
Theophylline therapeutic drug level
|
$50.35 |
$50.35 |
$50.35 |
$108.00
|
|
Therapeutic procd strg endur
|
$15.39 |
$15.39 |
$15.39 |
$85.68
|
|
Ther/proph/diag inj ia
|
$57.00 |
$57.00 |
$57.00 |
$240.35
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$26.23 |
$26.23 |
$26.23 |
$25.54
|
|
Thiotepa injection
|
$2,065.29 |
$2,065.29 |
$2,065.29 |
$1,485.00
|
|
Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides)
|
$417.24 |
$417.24 |
$417.24 |
$1,687.50
|
|
Thoracotomy w/expl
|
$552.14 |
$552.14 |
$552.14 |
$2,045.17
|
|
Thrombectmy crnry perq mechanical
|
$1,767.19 |
$1,767.19 |
$1,767.19 |
$3,580.00
|
|
Thrombectomy/inf pq dialysis circuit
|
$1,566.17 |
$1,566.17 |
$1,566.17 |
$8,084.00
|
