|
Sodium 24 hour urine
|
$23.00 |
$23.00 |
$23.00 |
$48.98
|
|
Sodium chloride 0.9 % intravenous solution
|
$35.00 |
$35.00 |
$35.00 |
$49.07
|
|
Sodium chloride 0.9 % IV bolus
|
$18.24 |
$18.24 |
$18.24 |
$45.62
|
|
Sodium chloride 0.9 % IV bolus
|
$35.00 |
$35.00 |
$35.00 |
$37.64
|
|
Sodium chloride 3 % ivpb
|
$57.14 |
$57.14 |
$57.14 |
$40.61
|
|
Sodium ferric gluconate complex in sucrose 62.5 mg/5 ml intravenous
|
$133.56 |
$133.56 |
$133.56 |
$80.14
|
|
Sodium serum/plasma/whole blood
|
$24.00 |
$24.00 |
$24.00 |
$46.26
|
|
Sodium thiosulfate 12.5 gram/50 ml (250 mg/ml) intravenous solution
|
$330.63 |
$330.63 |
$330.63 |
$177.52
|
|
Somatropin injection
|
$1,688.16 |
$1,688.16 |
$1,688.16 |
$2,111.40
|
|
Sotalol hydrochloride IV
|
$15,216.60 |
$15,216.60 |
$15,216.60 |
$5,761.57
|
|
Special supplies phys/qhp
|
$231.22 |
$231.22 |
$231.22 |
$60.00
|
|
Specific gravity body fluid
|
$15.00 |
$15.00 |
$15.00 |
$22.00
|
|
Spinal puncture lumbar diagnostic w/fluoroscopic or CT guidance
|
$2,615.00 |
$2,615.00 |
$2,615.00 |
$1,439.40
|
|
Spine X-ray (single view, one level)
|
$440.00 |
$440.00 |
$440.00 |
$251.00
|
|
Splint finger 4 prong foam sm
|
$503.41 |
$503.41 |
$503.41 |
$34.00
|
|
St analysis behavior qualitative voice/resonance
|
$370.00 |
$370.00 |
$370.00 |
$297.60
|
|
Stent axios caut enh 15x10mm electrocaut
|
$6,466.34 |
$6,466.34 |
$6,466.34 |
$32,403.15
|
|
Stent bili dbl pgtl 10fx5cm
|
$3,337.20 |
$3,337.20 |
$3,337.20 |
$2,704.27
|
|
Stent bili rx wallflx 10x80 uncvr
|
$8,446.00 |
$8,446.00 |
$8,446.00 |
$20,962.50
|
|
Stomach Emptying Scan (Nuclear Medicine)
|
$1,577.00 |
$1,577.00 |
$1,577.00 |
$1,345.40
|
|
Strapping of ankle and/or ft 29540
|
$586.00 |
$586.00 |
$586.00 |
$223.45
|
|
Strapping of elbow or wrist 29260
|
$231.00 |
$231.00 |
$231.00 |
$157.46
|
|
Strapping of hand or finger
|
$231.00 |
$231.00 |
$231.00 |
$177.45
|
|
Strapping of knee
|
$466.00 |
$466.00 |
$466.00 |
$205.20
|
|
Strapping of toes 29550
|
$231.00 |
$231.00 |
$231.00 |
$164.70
|
|
Streptomycin injection
|
$328.13 |
$328.13 |
$328.13 |
$138.30
|
|
Stress test pulmonary
|
$495.00 |
$495.00 |
$495.00 |
$324.00
|
|
Succinylcholine chloride 20 mg/ml injection solution (wrapper)
|
$839.13 |
$839.13 |
$839.13 |
$54.80
|
|
Sulbactam 1 gram-durlobactam 1 gram (0.5 gram x2) intravenous solution
|
$33,552.00 |
$33,552.00 |
$33,552.00 |
$7,487.55
|
|
Sulfamethoxazole 400 mg-trimethoprim 80 mg/5 ml intravenous solution
|
$140.93 |
$140.93 |
$140.93 |
$82.46
|
|
Sumatriptan 6 mg/0.5 ml subcutaneous solution
|
$53.59 |
$53.59 |
$53.59 |
$129.89
|
|
Surgical pathology level 1 gross examination only
|
$106.00 |
$106.00 |
$106.00 |
$81.00
|
|
Surgical pathology level 2 gross & microscopic examination
|
$118.00 |
$118.00 |
$118.00 |
$143.55
|
|
Surgical pathology level 3 gross & microscopic examination
|
$214.00 |
$214.00 |
$214.00 |
$184.21
|
|
Surgical pathology level 4 gross & microscopic examination
|
$214.00 |
$214.00 |
$214.00 |
$250.20
|
|
Surgical pathology level 5 gross & microscopic examination
|
$1,358.00 |
$1,358.00 |
$1,358.00 |
$480.60
|
|
Surgical pathology level 6 gross & microscopic examination
|
$3,255.00 |
$3,255.00 |
$3,255.00 |
$720.75
|
|
Susceptibility enzyme detection per enzyme
|
$22.00 |
$22.00 |
$22.00 |
$35.89
|
|
Susceptibility mic per plate
|
$40.00 |
$40.00 |
$40.00 |
$106.00
|
|
Svc venogram s&i
|
$5,423.00 |
$5,423.00 |
$5,423.00 |
$1,990.95
|
|
Swallowing Therapy Session
|
$284.00 |
$284.00 |
$284.00 |
$232.56
|
|
Synvisc or synvisc-one
|
$3,287.08 |
$3,287.08 |
$3,287.08 |
$1,242.63
|
|
Syphilis test non-treponemal antibody quantitative rpr
|
$21.00 |
$21.00 |
$21.00 |
$42.24
|
|
System pacing micra av
|
$4,903.83 |
$4,903.83 |
$4,903.83 |
$24,316.50
|
|
System pcmkr dual chamber leadless micra av2 intrdcr cath
|
$6,806.50 |
$6,806.50 |
$6,806.50 |
$12,003.00
|
|
T3 (triiodothyronine) free
|
$78.00 |
$78.00 |
$78.00 |
$100.32
|
|
T3 (triiodothyronine) total
|
$66.00 |
$66.00 |
$66.00 |
$93.52
|
|
T4 (thyroxine) free
|
$41.00 |
$41.00 |
$41.00 |
$89.60
|
|
T4 (thyroxine) total
|
$32.00 |
$32.00 |
$32.00 |
$70.20
|
|
Tacrol envarsus ex rel oral
|
$29.20 |
$29.20 |
$29.20 |
$15.60
|
|
Tacrolimus 1 mg capsule, immediate-release
|
$78.58 |
$78.58 |
$78.58 |
$9.93
|
|
Tacrolimus 5 mg/ml intravenous solution
|
$1,039.92 |
$1,039.92 |
$1,039.92 |
$596.76
|
|
Tacrolimus therapeutic drug level
|
$63.00 |
$63.00 |
$63.00 |
$122.50
|
|
Tafasitamab-cxix 200 mg intravenous solution
|
$3,350.08 |
$3,350.08 |
$3,350.08 |
$2,762.00
|
|
Tailbone (Sacrum and Coccyx) X-ray
|
$440.00 |
$440.00 |
$440.00 |
$289.20
|
|
Talquetamab-tgvs 2 mg/ml subcutaneous solution
|
$27,727.28 |
$27,727.28 |
$27,727.28 |
$21,745.13
|
|
Target gsa panel hmtlmph neop
|
$3,494.00 |
$3,494.00 |
$3,494.00 |
$2,246.30
|
|
Target gsa panel organ/hmtlmph neop
|
$13,430.00 |
$13,430.00 |
$13,430.00 |
$3,746.70
|
|
Target gsa panel organ neop
|
$2,751.00 |
$2,751.00 |
$2,751.00 |
$1,701.91
|
|
Tarlatamab-dlle 10 mg intravenous solution
|
$36,000.00 |
$36,000.00 |
$36,000.00 |
$24,217.20
|
|
Tbo-filgrastim 300 mcg/0.5 ml subcutaneous syringe
|
$1,679.55 |
$1,679.55 |
$1,679.55 |
$937.50
|
|
Tb test cell mediated immunity antigen response enumeration gamma interferon t-cells
|
$460.00 |
$460.00 |
$460.00 |
$200.00
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$285.00 |
$285.00 |
$285.00 |
$179.95
|
|
Tc-99m exame autol wbc diag per dose
|
$312.00 |
$312.00 |
$312.00 |
$2,503.15
|
|
Tc-99m exametazime diag
|
$4,566.00 |
$4,566.00 |
$4,566.00 |
$2,135.70
|
|
Tc-99m labeled rbc
|
$606.00 |
$606.00 |
$606.00 |
$306.00
|
|
Tc-99m maa
|
$908.00 |
$908.00 |
$908.00 |
$312.06
|
|
Tc-99m mebrofenin
|
$210.00 |
$210.00 |
$210.00 |
$157.65
|
|
Tc-99m medronate
|
$228.00 |
$228.00 |
$228.00 |
$111.01
|
|
Tc-99m mertiatide
|
$1,864.00 |
$1,864.00 |
$1,864.00 |
$756.00
|
|
Tc-99m non-heu per study dose
|
$22.00 |
$22.00 |
$22.00 |
$8.00
|
|
Tc-99m pentetate dtpa
|
$840.00 |
$840.00 |
$840.00 |
$222.60
|
|
Tc-99m pentetate dtpa aerosol
|
$960.00 |
$960.00 |
$960.00 |
$191.50
|
|
Tc-99m sestamibi p study dose
|
$236.00 |
$236.00 |
$236.00 |
$287.20
|
|
Tc-99m sulfur colloid
|
$1,515.00 |
$1,515.00 |
$1,515.00 |
$245.70
|
|
Tc-99m tetrofosmin p study dose
|
$264.00 |
$264.00 |
$264.00 |
$193.28
|
|
T cells absolute cd4/cd8 including ratio
|
$216.00 |
$216.00 |
$216.00 |
$184.00
|
|
T cells absolute cd 4 count
|
$123.00 |
$123.00 |
$123.00 |
$111.20
|
|
T cells total count
|
$174.00 |
$174.00 |
$174.00 |
$130.20
|
|
Tebentafusp-tebn 100 mcg/0.5 ml intravenous solution
|
$50,376.00 |
$50,376.00 |
$50,376.00 |
$40,114.80
|
|
Telavancin injection
|
$2,367.83 |
$2,367.83 |
$2,367.83 |
$1,191.80
|
|
Temozolomide
|
$883.02 |
$883.02 |
$883.02 |
$540.06
|
|
Temozolomide 100 mg intravenous solution
|
$2,407.46 |
$2,407.46 |
$2,407.46 |
$1,867.28
|
|
Temsirolimus 30 mg/3 ml (10 mg/ml) (first dilution) intravenous soln
|
$14,402.28 |
$14,402.28 |
$14,402.28 |
$3,723.60
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$28,179.35 |
$28,179.35 |
$28,179.35 |
$14,951.87
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$82.74 |
$82.74 |
$82.74 |
$39.33
|
|
Test stress cardiovascular tracing only
|
$1,021.00 |
$1,021.00 |
$1,021.00 |
$953.40
|
|
Tetanus immune globulin inj
|
$2,407.11 |
$2,407.11 |
$2,407.11 |
$1,285.36
|
|
Tezepelumab-ekko 210 mg/1.91 ml (110 mg/ml) subcutaneous syringe
|
$16,029.13 |
$16,029.13 |
$16,029.13 |
$8,737.05
|
|
Theophylline therapeutic drug level
|
$66.00 |
$66.00 |
$66.00 |
$108.00
|
|
Therapeutic procd strg endur
|
$97.00 |
$97.00 |
$97.00 |
$85.68
|
|
Therapy Activity Training (each 15 minutes)
|
$198.00 |
$198.00 |
$198.00 |
$101.38
|
|
Therapy Exercise Session (each 15 minutes)
|
$156.00 |
$156.00 |
$156.00 |
$98.58
|
|
Ther/proph/diag inj ia
|
$678.00 |
$678.00 |
$678.00 |
$247.33
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$105.00 |
$105.00 |
$105.00 |
$25.54
|
|
Thigh Bone (Femur) X-ray (both sides)
|
$440.00 |
$440.00 |
$440.00 |
$313.60
|
|
Thiotepa 15 mg solution for injection
|
$7,200.00 |
$7,200.00 |
$7,200.00 |
$1,090.00
|
|
Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides)
|
$2,506.00 |
$2,506.00 |
$2,506.00 |
$1,724.25
|
|
Three-Phase Bone Scan (Nuclear Medicine)
|
$1,577.00 |
$1,577.00 |
$1,577.00 |
$1,703.45
|
|
Thrombectmy crnry perq mechanical
|
$3,720.00 |
$3,720.00 |
$3,720.00 |
$3,809.40
|
