|
Sinus CT scan (without contrast)
|
$1,764.00 |
$1,764.00 |
$1,764.00 |
$1,292.04
|
|
Sinus/juglr venogram s&i
|
$2,644.00 |
$2,644.00 |
$2,644.00 |
$2,489.25
|
|
Skin Biopsy
|
$271.20 |
$271.20 |
$271.20 |
$360.34
|
|
Sleep Study (Polysomnography)
|
$5,449.60 |
$5,449.60 |
$5,449.60 |
$3,598.50
|
|
Sleep study unattended
|
$862.40 |
$862.40 |
$862.40 |
$579.26
|
|
Sling pelv split sam med
|
$410.40 |
$410.40 |
$410.40 |
$150.00
|
|
Slp stdy unatnd w/anal
|
$104.00 |
$104.00 |
$104.00 |
$296.34
|
|
Smear fluorescent and/or acid fast stain
|
$65.60 |
$65.60 |
$65.60 |
$64.20
|
|
Smear gram stain
|
$75.20 |
$75.20 |
$75.20 |
$55.25
|
|
Smear nasal eosinophil
|
$96.00 |
$96.00 |
$96.00 |
$46.15
|
|
Smear special stain inclusion bodies/parasites
|
$158.40 |
$158.40 |
$158.40 |
$73.15
|
|
Smear wet mount
|
$98.40 |
$98.40 |
$98.40 |
$66.72
|
|
Sodium 24 hour urine
|
$131.20 |
$131.20 |
$131.20 |
$48.60
|
|
Sodium serum/plasma/whole blood
|
$118.40 |
$118.40 |
$118.40 |
$45.50
|
|
So neo gsap dna mcrstl ins
|
$10,926.40 |
$10,926.40 |
$10,926.40 |
$2,296.00
|
|
Specific gravity body fluid
|
$100.00 |
$100.00 |
$100.00 |
$22.00
|
|
Specimen fat stain
|
$124.00 |
$124.00 |
$124.00 |
$34.00
|
|
Spinal puncture lumbar diagnostic w/fluoroscopic or CT guidance
|
$1,474.40 |
$1,474.40 |
$1,474.40 |
$1,439.40
|
|
Spirometry bronchodilation responsiveness pre/post bronchodilator administration
|
$467.20 |
$467.20 |
$467.20 |
$536.34
|
|
Splint extn xsm w sof-stretch rolyan
|
$113.60 |
$113.60 |
$113.60 |
$68.25
|
|
Splint func pos polyflex ii med
|
$1,524.00 |
$1,524.00 |
$1,524.00 |
$61.64
|
|
Splint rstrc wrst/cmc right med
|
$780.80 |
$780.80 |
$780.80 |
$99.04
|
|
Sputum specimen collection
|
$58.40 |
$58.40 |
$58.40 |
$180.00
|
|
St analysis behavior qualitative voice/resonance
|
$477.60 |
$477.60 |
$477.60 |
$296.00
|
|
St cognitve performance testing healthcare professional each hour
|
$373.60 |
$373.60 |
$373.60 |
$286.00
|
|
St evaluate speech sound production
|
$391.20 |
$391.20 |
$391.20 |
$292.95
|
|
St evaluate speech sound production comprehensive/expressive
|
$541.60 |
$541.60 |
$541.60 |
$376.84
|
|
St evaluation motion fluoroscopic swallow function cine/video
|
$547.20 |
$547.20 |
$547.20 |
$395.28
|
|
St evaluation swallow function
|
$412.80 |
$412.80 |
$412.80 |
$310.50
|
|
Strapping of ankle and/or ft 29540
|
$132.80 |
$132.80 |
$132.80 |
$223.45
|
|
Stress test pulmonary
|
$568.80 |
$568.80 |
$568.80 |
$322.85
|
|
Stress tte complete
|
$3,598.40 |
$3,598.40 |
$3,598.40 |
$1,862.10
|
|
St treatment speech individual
|
$342.40 |
$342.40 |
$342.40 |
$248.84
|
|
St treatment swallow dysfunction/oral
|
$288.00 |
$288.00 |
$288.00 |
$232.20
|
|
Sugars single quant
|
$408.00 |
$408.00 |
$408.00 |
$64.28
|
|
Support clav 29.6-40.5in med
|
$225.60 |
$225.60 |
$225.60 |
$94.19
|
|
Surgical pathology level 1 gross examination only
|
$280.80 |
$280.80 |
$280.80 |
$79.50
|
|
Surgical pathology level 2 gross & microscopic examination
|
$206.40 |
$206.40 |
$206.40 |
$141.33
|
|
Surgical pathology level 3 gross & microscopic examination
|
$252.80 |
$252.80 |
$252.80 |
$181.00
|
|
Surgical pathology level 4 gross & microscopic examination
|
$500.80 |
$500.80 |
$500.80 |
$239.85
|
|
Surgical pathology level 5 gross & microscopic examination
|
$588.80 |
$588.80 |
$588.80 |
$477.24
|
|
Surgical pathology level 6 gross & microscopic examination
|
$1,353.60 |
$1,353.60 |
$1,353.60 |
$716.00
|
|
Susceptibility agar dilution per agent
|
$112.80 |
$112.80 |
$112.80 |
$45.00
|
|
Susceptibility enzyme detection per enzyme
|
$55.20 |
$55.20 |
$55.20 |
$35.70
|
|
Susceptibility mic per plate
|
$80.80 |
$80.80 |
$80.80 |
$106.20
|
|
Syphilis test non-treponemal antibody quantitative rpr
|
$92.00 |
$92.00 |
$92.00 |
$41.60
|
|
T3 (triiodothyronine) free
|
$314.40 |
$314.40 |
$314.40 |
$98.80
|
|
T3 (triiodothyronine) total
|
$185.60 |
$185.60 |
$185.60 |
$93.52
|
|
T4 (thyroxine) free
|
$132.80 |
$132.80 |
$132.80 |
$85.20
|
|
T4 (thyroxine) total
|
$133.60 |
$133.60 |
$133.60 |
$68.40
|
|
Tacrolimus therapeutic drug level
|
$346.40 |
$346.40 |
$346.40 |
$121.50
|
|
Target gsa panel hmtlmph neop
|
$5,959.20 |
$5,959.20 |
$5,959.20 |
$2,246.30
|
|
Target gsa panel organ/hmtlmph neop
|
$4,790.40 |
$4,790.40 |
$4,790.40 |
$3,746.70
|
|
Target gsa panel organ neop
|
$3,642.40 |
$3,642.40 |
$3,642.40 |
$1,655.52
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$148.00 |
$148.00 |
$148.00 |
$176.92
|
|
T cells absolute cd4/cd8 including ratio
|
$271.20 |
$271.20 |
$271.20 |
$176.00
|
|
T cells total count
|
$171.20 |
$171.20 |
$171.20 |
$126.90
|
|
Telehealth original site facility fee
|
$58.40 |
$58.40 |
$58.40 |
$51.00
|
|
Tert gene targeted seq alys
|
$2,642.40 |
$2,642.40 |
$2,642.40 |
$335.00
|
|
Testicular imaging w/vasc flow
|
$1,602.40 |
$1,602.40 |
$1,602.40 |
$842.56
|
|
Test stress cardiovascular tracing only
|
$1,000.80 |
$1,000.80 |
$1,000.80 |
$949.70
|
|
Tgsap so/hl 51/< rna alys
|
$9,375.20 |
$9,375.20 |
$9,375.20 |
$4,347.00
|
|
Theophylline therapeutic drug level
|
$173.60 |
$173.60 |
$173.60 |
$107.94
|
|
Therapeutic procd strg endur
|
$100.00 |
$100.00 |
$100.00 |
$85.68
|
|
Therapy nutrition individual initial f2f w/patient each 15 minutes
|
$51.20 |
$51.20 |
$51.20 |
$57.08
|
|
Therapy nutrition individual reassessment/intervention f2f w/patient each 15 minutes
|
$51.20 |
$51.20 |
$51.20 |
$50.00
|
|
Ther/proph/diag inj ia
|
$200.00 |
$200.00 |
$200.00 |
$240.00
|
|
Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides)
|
$3,718.40 |
$3,718.40 |
$3,718.40 |
$1,687.50
|
|
Thrombin time
|
$161.60 |
$161.60 |
$161.60 |
$53.76
|
|
Thromboplastin time partial (ptt) substitution fractions each
|
$231.20 |
$231.20 |
$231.20 |
$61.50
|
|
Thyroglobulin antibody
|
$163.20 |
$163.20 |
$163.20 |
$81.90
|
|
Thyroid imaging
|
$1,165.60 |
$1,165.60 |
$1,165.60 |
$695.02
|
|
Thyroid (TSH) Test
|
$192.00 |
$192.00 |
$192.00 |
$111.00
|
|
Thyroid Ultrasound
|
$1,092.00 |
$1,092.00 |
$1,092.00 |
$586.95
|
|
Thyroid uptake measurement
|
$1,259.20 |
$1,259.20 |
$1,259.20 |
$589.22
|
|
Thyroxine binding globulin (tbg)
|
$168.80 |
$168.80 |
$168.80 |
$63.90
|
|
Tissue culture skin/biopsy
|
$1,740.00 |
$1,740.00 |
$1,740.00 |
$472.50
|
|
Tissue culture tumor
|
$4,223.20 |
$4,223.20 |
$4,223.20 |
$470.40
|
|
Tissue exam koh skin/hair/nails
|
$96.80 |
$96.80 |
$96.80 |
$47.20
|
|
Tixagev and cilgav inj
|
$128.00 |
$128.00 |
$128.00 |
$224.55
|
|
Tobramycin peak therapeutic drug level
|
$165.60 |
$165.60 |
$165.60 |
$118.30
|
|
Tomosynthesis breast diagnostic left
|
$131.20 |
$131.20 |
$131.20 |
$72.66
|
|
Tomosynthesis breast screen bilateral
|
$119.20 |
$119.20 |
$119.20 |
$72.68
|
|
Total tau
|
$444.00 |
$444.00 |
$444.00 |
$312.50
|
|
Toxoplasma antibody igg
|
$144.00 |
$144.00 |
$144.00 |
$89.40
|
|
Toxoplasma antibody igm
|
$184.80 |
$184.80 |
$184.80 |
$87.00
|
|
Tp53 gene full gene sequence
|
$829.60 |
$829.60 |
$829.60 |
$709.80
|
|
Tp53 gene trgt sequence alys
|
$1,241.60 |
$1,241.60 |
$1,241.60 |
$790.68
|
|
Tpmt gene com vrnts
|
$1,292.00 |
$1,292.00 |
$1,292.00 |
$370.92
|
|
Tracheostoma revision; simple, without flap rotation
|
$5,220.80 |
$5,220.80 |
$5,220.80 |
$3,837.72
|
|
Transcath biopsy
|
$4,653.60 |
$4,653.60 |
$4,653.60 |
$4,285.93
|
|
Transcath occlusion cns
|
$15,550.40 |
$15,550.40 |
$15,550.40 |
$7,157.76
|
|
Transcath occlusion non-cns
|
$9,609.60 |
$9,609.60 |
$9,609.60 |
$10,031.28
|
|
Transferrin
|
$162.40 |
$162.40 |
$162.40 |
$81.85
|
|
Transfusion blood/blood component(s)
|
$1,341.60 |
$1,341.60 |
$1,341.60 |
$983.00
|
|
Treat elbow fracture
|
$1,344.00 |
$1,344.00 |
$1,344.00 |
$1,919.13
|
|
Treat finger fracture each
|
$1,340.00 |
$1,340.00 |
$1,340.00 |
$1,536.00
|
|
Treat fracture of radius
|
$2,061.60 |
$2,061.60 |
$2,061.60 |
$1,790.00
|
|
Treat fracture of ulna
|
$907.20 |
$907.20 |
$907.20 |
$726.05
|
|
Treat hip dislocation
|
$2,144.80 |
$2,144.80 |
$2,144.80 |
$2,192.80
|
