|
Smear gram stain
|
$114.48 |
$114.48 |
$114.48 |
$55.25
|
|
Smear special stain inclusion bodies/parasites
|
$104.40 |
$104.40 |
$104.40 |
$73.15
|
|
Sodium 24 hour urine
|
$108.00 |
$108.00 |
$108.00 |
$48.60
|
|
Sodium chloride 0.9 % intravenous solution
|
$32.40 |
$32.40 |
$32.40 |
$48.00
|
|
Sodium chloride 0.9 % IV bolus
|
$32.40 |
$32.40 |
$32.40 |
$45.56
|
|
Sodium chloride 0.9 % IV bolus
|
$32.40 |
$32.40 |
$32.40 |
$37.50
|
|
Sodium chloride 3 % ivpb
|
$0.06 |
$0.06 |
$0.06 |
$40.61
|
|
Sodium serum/plasma/whole blood
|
$66.96 |
$66.96 |
$66.96 |
$45.50
|
|
Spirometry bronchodilation responsiveness pre/post bronchodilator administration
|
$652.32 |
$652.32 |
$652.32 |
$536.34
|
|
St analysis behavior qualitative voice/resonance
|
$275.04 |
$275.04 |
$275.04 |
$296.00
|
|
Staph a dna amp probe
|
$177.84 |
$177.84 |
$177.84 |
$125.00
|
|
St evaluate speech sound production
|
$314.64 |
$314.64 |
$314.64 |
$292.95
|
|
St evaluate speech sound production comprehensive/expressive
|
$421.20 |
$421.20 |
$421.20 |
$376.84
|
|
St evaluation motion fluoroscopic swallow function cine/video
|
$429.84 |
$429.84 |
$429.84 |
$395.28
|
|
St evaluation swallow function
|
$345.60 |
$345.60 |
$345.60 |
$310.50
|
|
Strep a dna quant
|
$75.60 |
$75.60 |
$75.60 |
$75.60
|
|
Stress test pulmonary
|
$257.04 |
$257.04 |
$257.04 |
$322.85
|
|
Stress tte complete
|
$1,026.00 |
$1,026.00 |
$1,026.00 |
$1,862.10
|
|
St treatment speech individual
|
$281.52 |
$281.52 |
$281.52 |
$248.84
|
|
St treatment swallow dysfunction/oral
|
$229.68 |
$229.68 |
$229.68 |
$232.20
|
|
Succinylcholine chloride 20 mg/ml injection solution (wrapper)
|
$3.60 |
$3.60 |
$3.60 |
$52.31
|
|
Sulfonylurea screen qn-sendout
|
$156.24 |
$156.24 |
$156.24 |
$156.16
|
|
Sumatriptan 6 mg/0.5 ml subcutaneous solution
|
$176.40 |
$176.40 |
$176.40 |
$112.74
|
|
Support clav 29.6-40.5in med
|
$21.60 |
$21.60 |
$21.60 |
$94.19
|
|
Surgical pathology level 1 gross examination only
|
$59.04 |
$59.04 |
$59.04 |
$79.50
|
|
Surgical pathology level 2 gross & microscopic examination
|
$75.60 |
$75.60 |
$75.60 |
$141.33
|
|
Surgical pathology level 3 gross & microscopic examination
|
$226.80 |
$226.80 |
$226.80 |
$181.00
|
|
Surgical pathology level 4 gross & microscopic examination
|
$281.52 |
$281.52 |
$281.52 |
$239.85
|
|
Surgical pathology level 5 gross & microscopic examination
|
$599.04 |
$599.04 |
$599.04 |
$477.24
|
|
Surgical pathology level 6 gross & microscopic examination
|
$1,029.60 |
$1,029.60 |
$1,029.60 |
$716.00
|
|
Susceptibility agar dilution per agent
|
$44.64 |
$44.64 |
$44.64 |
$45.00
|
|
Susceptibility enzyme detection per enzyme
|
$18.00 |
$18.00 |
$18.00 |
$35.70
|
|
Susceptibility mic per plate
|
$175.68 |
$175.68 |
$175.68 |
$106.20
|
|
Syphilis test non-treponemal antibody quantitative rpr
|
$48.96 |
$48.96 |
$48.96 |
$41.60
|
|
T3 (triiodothyronine) free
|
$279.36 |
$279.36 |
$279.36 |
$98.80
|
|
T3 (triiodothyronine) total
|
$156.24 |
$156.24 |
$156.24 |
$93.52
|
|
T4 (thyroxine) free
|
$167.04 |
$167.04 |
$167.04 |
$85.20
|
|
T4 (thyroxine) total
|
$108.72 |
$108.72 |
$108.72 |
$68.40
|
|
Tacrolimus therapeutic drug level
|
$344.16 |
$344.16 |
$344.16 |
$121.50
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$271.44 |
$271.44 |
$271.44 |
$176.92
|
|
Tc-99m non-heu per study dose
|
$18.72 |
$18.72 |
$18.72 |
$6.60
|
|
T cells absolute cd4/cd8 including ratio
|
$145.44 |
$145.44 |
$145.44 |
$176.00
|
|
T cells total count
|
$117.36 |
$117.36 |
$117.36 |
$126.90
|
|
Telehealth original site facility fee
|
$42.48 |
$42.48 |
$42.48 |
$51.00
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$573.51 |
$573.51 |
$573.51 |
$15,245.38
|
|
Test stress cardiovascular tracing only
|
$874.80 |
$874.80 |
$874.80 |
$949.70
|
|
Tgsap so neo 5-50 rna alys
|
$2,255.04 |
$2,255.04 |
$2,255.04 |
$1,019.60
|
|
Theophylline therapeutic drug level
|
$115.92 |
$115.92 |
$115.92 |
$107.94
|
|
Therapy nutrition individual initial f2f w/patient each 15 minutes
|
$39.60 |
$39.60 |
$39.60 |
$57.08
|
|
Therapy nutrition individual reassessment/intervention f2f w/patient each 15 minutes
|
$34.56 |
$34.56 |
$34.56 |
$50.00
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$17.28 |
$17.28 |
$17.28 |
$25.54
|
|
Thrombin time
|
$41.04 |
$41.04 |
$41.04 |
$53.76
|
|
Thyroglobulin antibody
|
$25.92 |
$25.92 |
$25.92 |
$81.90
|
|
Thyroid imaging
|
$792.00 |
$792.00 |
$792.00 |
$695.02
|
|
Thyroid (TSH) Test
|
$187.92 |
$187.92 |
$187.92 |
$111.00
|
|
Thyroid Ultrasound
|
$981.36 |
$981.36 |
$981.36 |
$586.95
|
|
Thyroxine binding globulin (tbg)
|
$115.20 |
$115.20 |
$115.20 |
$63.90
|
|
Tissue exam koh skin/hair/nails
|
$62.64 |
$62.64 |
$62.64 |
$47.20
|
|
Tissue transglutaminase iga
|
$109.44 |
$109.44 |
$109.44 |
$44.16
|
|
Tobramycin peak therapeutic drug level
|
$115.20 |
$115.20 |
$115.20 |
$118.30
|
|
Tomosynthesis breast diagnostic left
|
$108.00 |
$108.00 |
$108.00 |
$72.66
|
|
Tomosynthesis breast screen bilateral
|
$102.24 |
$102.24 |
$102.24 |
$72.68
|
|
Total tau
|
$511.20 |
$511.20 |
$511.20 |
$312.50
|
|
Toxoplasma antibody igg
|
$103.68 |
$103.68 |
$103.68 |
$89.40
|
|
Toxoplasma antibody igm
|
$103.68 |
$103.68 |
$103.68 |
$87.00
|
|
Training self management diabetes individual outpatient department per 30 minutes
|
$55.44 |
$55.44 |
$55.44 |
$101.25
|
|
Transferrin
|
$126.72 |
$126.72 |
$126.72 |
$81.85
|
|
Transfusion blood/blood component(s)
|
$488.16 |
$488.16 |
$488.16 |
$983.00
|
|
Treat fracture of radius
|
$1,728.72 |
$1,728.72 |
$1,728.72 |
$1,849.00
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$264.24 |
$264.24 |
$264.24 |
$224.90
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$236.88 |
$236.88 |
$236.88 |
$144.50
|
|
Treatment inhalation pressurized/nonpressurized acute airway obstruction
|
$192.96 |
$192.96 |
$192.96 |
$203.35
|
|
Treponema pallidum antibody
|
$151.20 |
$151.20 |
$151.20 |
$70.40
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$7.38 |
$7.38 |
$7.38 |
$43.20
|
|
Triglycerides
|
$101.52 |
$101.52 |
$101.52 |
$58.05
|
|
Trnscath tx thromblytc vein ini day
|
$3,399.12 |
$3,399.12 |
$3,399.12 |
$3,866.70
|
|
Troponin quantitative
|
$203.76 |
$203.76 |
$203.76 |
$125.00
|
|
Tte w or without contr, cont ecg
|
$1,519.92 |
$1,519.92 |
$1,519.92 |
$2,012.40
|
|
Tte w or without fol w/con,stres
|
$1,519.92 |
$1,519.92 |
$1,519.92 |
$1,632.80
|
|
Ultrasound abdomen aorta screening study aaa
|
$826.56 |
$826.56 |
$826.56 |
$394.20
|
|
Ultrasound breast complete
|
$807.84 |
$807.84 |
$807.84 |
$528.41
|
|
Ultrasound breast unilateral limited (both sides)
|
$245.52 |
$245.52 |
$245.52 |
$449.35
|
|
Ultrasound chest
|
$280.08 |
$280.08 |
$280.08 |
$460.85
|
|
Ultrasound exam k transpl w/doppler
|
$280.08 |
$280.08 |
$280.08 |
$573.54
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$826.56 |
$826.56 |
$826.56 |
$469.50
|
|
Ultrasound guidance for vascular access
|
$1,260.00 |
$1,260.00 |
$1,260.00 |
$400.20
|
|
Ultrasound guided needle placement supervision & interpretation
|
$905.76 |
$905.76 |
$905.76 |
$720.15
|
|
Ultrasound guide intraoperative
|
$972.72 |
$972.72 |
$972.72 |
$631.80
|
|
Ultrasound hips infant dynamic
|
$208.08 |
$208.08 |
$208.08 |
$403.88
|
|
Ultrasound infant hips ltd without stress
|
$208.08 |
$208.08 |
$208.08 |
$311.25
|
|
Ultrasound joint complete left
|
$601.20 |
$601.20 |
$601.20 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$826.56 |
$826.56 |
$826.56 |
$425.45
|
|
Ultrasound ob >=14wks ea addl gest
|
$363.60 |
$363.60 |
$363.60 |
$407.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$826.56 |
$826.56 |
$826.56 |
$331.50
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$591.84 |
$591.84 |
$591.84 |
$707.20
|
|
Ultrasound pregnant uterus follow up per fetus
|
$822.96 |
$822.96 |
$822.96 |
$425.60
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$697.68 |
$697.68 |
$697.68 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$794.88 |
$794.88 |
$794.88 |
$492.80
|
|
Ultrasound retroperitoneal limited
|
$318.96 |
$318.96 |
$318.96 |
$486.50
|
|
Ultrasound scrotum and contents
|
$907.20 |
$907.20 |
$907.20 |
$606.60
|
