|
Splint dorsal bloc wh med perf 3.2mm lf polyflex ii
|
$66.30 |
$66.30 |
$66.30 |
$388.80
|
|
Splint extn xsm w sof-stretch rolyan
|
$77.51 |
$77.51 |
$77.51 |
$71.44
|
|
Splint finger 4 prong foam sm
|
$0.85 |
$0.85 |
$0.85 |
$34.00
|
|
Splint finger fold over sm
|
$0.67 |
$0.67 |
$0.67 |
$146.88
|
|
Splint finger frog med
|
$0.83 |
$0.83 |
$0.83 |
$38.08
|
|
Splint fing stax assort 1-7in
|
$1.60 |
$1.60 |
$1.60 |
$5.60
|
|
Splint func pos polyflex ii med
|
$51.70 |
$51.70 |
$51.70 |
$61.64
|
|
Splint rstrc wrst/cmc right med
|
$155.66 |
$155.66 |
$155.66 |
$99.04
|
|
Sr-89 stront chlor ther / mci
|
$40,862.00 |
$40,862.00 |
$40,862.00 |
$2,515.15
|
|
St analysis behavior qualitative voice/resonance
|
$441.00 |
$441.00 |
$441.00 |
$297.60
|
|
St cognitve performance testing healthcare professional each hour
|
$629.00 |
$629.00 |
$629.00 |
$286.00
|
|
Stent axios caut enh 15x10mm electrocaut
|
$49,851.00 |
$49,851.00 |
$49,851.00 |
$32,403.15
|
|
Stent bili dbl pgtl 10fx5cm
|
$9,328.16 |
$9,328.16 |
$9,328.16 |
$2,704.27
|
|
Stent bili rx wallflx 10x80 uncvr
|
$28,791.53 |
$28,791.53 |
$28,791.53 |
$20,962.50
|
|
Stent bronch dumon sil 10x40mm
|
$7,567.48 |
$7,567.48 |
$7,567.48 |
$4,631.82
|
|
St evaluate speech sound production
|
$518.00 |
$518.00 |
$518.00 |
$292.95
|
|
St evaluation motion fluoroscopic swallow function cine/video
|
$481.00 |
$481.00 |
$481.00 |
$400.00
|
|
Stomach Emptying Scan (Nuclear Medicine)
|
$1,905.00 |
$1,905.00 |
$1,905.00 |
$1,345.40
|
|
Strap chin dlx f/cpap
|
$53.70 |
$53.70 |
$53.70 |
$34.90
|
|
Strap montgmry ns 8 hl sht 7.25 x 11.25in
|
$0.39 |
$0.39 |
$0.39 |
$5.04
|
|
Stress test pulmonary
|
$421.00 |
$421.00 |
$421.00 |
$324.00
|
|
Succinylcholine chloride 20 mg/ml injection solution (wrapper)
|
$13.80 |
$13.80 |
$13.80 |
$54.80
|
|
Sulfamethoxazole 400 mg-trimethoprim 80 mg/5 ml intravenous solution
|
$23.00 |
$23.00 |
$23.00 |
$82.46
|
|
Sulfonylurea screen qn-sendout
|
$213.00 |
$213.00 |
$213.00 |
$158.75
|
|
Sumatriptan 6 mg/0.5 ml subcutaneous solution
|
$41.40 |
$41.40 |
$41.40 |
$129.89
|
|
Support clav 29.6-40.5in med
|
$144.91 |
$144.91 |
$144.91 |
$94.08
|
|
Surgical pathology level 1 gross examination only
|
$111.00 |
$111.00 |
$111.00 |
$81.00
|
|
Surgical pathology level 2 gross & microscopic examination
|
$179.00 |
$179.00 |
$179.00 |
$143.55
|
|
Surgical pathology level 3 gross & microscopic examination
|
$188.00 |
$188.00 |
$188.00 |
$184.21
|
|
Surgical pathology level 4 gross & microscopic examination
|
$274.00 |
$274.00 |
$274.00 |
$250.20
|
|
Surgical pathology level 5 gross & microscopic examination
|
$494.00 |
$494.00 |
$494.00 |
$480.60
|
|
Surgical pathology level 6 gross & microscopic examination
|
$817.00 |
$817.00 |
$817.00 |
$720.75
|
|
Susceptibility agar dilution per agent
|
$84.00 |
$84.00 |
$84.00 |
$45.60
|
|
Susceptibility enzyme detection per enzyme
|
$22.00 |
$22.00 |
$22.00 |
$35.89
|
|
Susceptibility mic per plate
|
$138.00 |
$138.00 |
$138.00 |
$106.00
|
|
Swallowing Evaluation (Bedside)
|
$451.00 |
$451.00 |
$451.00 |
$316.80
|
|
Swallowing Therapy Session
|
$340.00 |
$340.00 |
$340.00 |
$232.56
|
|
Synvisc or synvisc-one
|
$6,298.90 |
$6,298.90 |
$6,298.90 |
$1,242.63
|
|
Syphilis test non-treponemal antibody quantitative rpr
|
$33.00 |
$33.00 |
$33.00 |
$42.24
|
|
System cardiomems hosp electronics
|
$36,958.50 |
$36,958.50 |
$36,958.50 |
$38,234.70
|
|
System pacing micra av
|
$25,785.00 |
$25,785.00 |
$25,785.00 |
$24,316.50
|
|
System pcmkr dual chamber leadless micra av2 intrdcr cath
|
$41,690.91 |
$41,690.91 |
$41,690.91 |
$12,003.00
|
|
System recell skin grafting/harvesting
|
$13,777.23 |
$13,777.23 |
$13,777.23 |
$11,183.00
|
|
System sealant biosentry tract
|
$1,003.62 |
$1,003.62 |
$1,003.62 |
$889.35
|
|
T3 (triiodothyronine) free
|
$188.00 |
$188.00 |
$188.00 |
$100.32
|
|
T3 (triiodothyronine) total
|
$149.00 |
$149.00 |
$149.00 |
$93.52
|
|
T4 (thyroxine) free
|
$121.00 |
$121.00 |
$121.00 |
$89.60
|
|
T4 (thyroxine) total
|
$81.00 |
$81.00 |
$81.00 |
$70.20
|
|
Tacrolimus 1 mg capsule, immediate-release
|
$170.70 |
$170.70 |
$170.70 |
$9.93
|
|
Tacrolimus 5 mg/ml intravenous solution
|
$1,208.10 |
$1,208.10 |
$1,208.10 |
$596.76
|
|
Tacrolimus therapeutic drug level
|
$244.00 |
$244.00 |
$244.00 |
$122.50
|
|
Tafasitamab-cxix 200 mg intravenous solution
|
$4,272.00 |
$4,272.00 |
$4,272.00 |
$2,762.00
|
|
Tailbone (Sacrum and Coccyx) X-ray
|
$341.00 |
$341.00 |
$341.00 |
$289.20
|
|
Talimogene laherparepvec 10exp6 (1 million) pfu/ml susp for injection
|
$88,021.00 |
$88,021.00 |
$88,021.00 |
$1,223.36
|
|
Talquetamab-tgvs 2 mg/ml subcutaneous solution
|
$35,941.50 |
$35,941.50 |
$35,941.50 |
$21,745.13
|
|
Tape plstc 1inx5yd hosp tb pk
|
$4.67 |
$4.67 |
$4.67 |
$2.06
|
|
Target gsa panel hmtlmph neop
|
$3,319.00 |
$3,319.00 |
$3,319.00 |
$2,246.30
|
|
Tarlatamab-dlle 10 mg intravenous solution
|
$46,350.00 |
$46,350.00 |
$46,350.00 |
$24,217.20
|
|
Tbo-filgrastim 300 mcg/0.5 ml subcutaneous syringe
|
$463.10 |
$463.10 |
$463.10 |
$937.50
|
|
Tb test cell mediated immunity antigen response enumeration gamma interferon t-cells
|
$341.00 |
$341.00 |
$341.00 |
$200.00
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$253.00 |
$253.00 |
$253.00 |
$179.95
|
|
Tc-99m apcitide diag
|
$1,765.30 |
$1,765.30 |
$1,765.30 |
$1,181.70
|
|
Tc-99m arcitumomab
|
$4,224.15 |
$4,224.15 |
$4,224.15 |
$2,085.68
|
|
Tc-99m bicisate
|
$7,128.20 |
$7,128.20 |
$7,128.20 |
$2,070.00
|
|
Tc-99m depreotide
|
$1,937.35 |
$1,937.35 |
$1,937.35 |
$1,486.80
|
|
Tc-99m diag per dose
|
$575.50 |
$575.50 |
$575.50 |
$470.40
|
|
Tc-99m disofenin
|
$339.80 |
$339.80 |
$339.80 |
$124.32
|
|
Tc-99m exame autol wbc diag per dose
|
$8,194.15 |
$8,194.15 |
$8,194.15 |
$2,503.15
|
|
Tc-99m exametazime diag
|
$7,382.05 |
$7,382.05 |
$7,382.05 |
$2,135.70
|
|
Tc-99m fanolesomab diag
|
$17,688.75 |
$17,688.75 |
$17,688.75 |
$2,115.12
|
|
Tc-99m gluceptate
|
$1,105.40 |
$1,105.40 |
$1,105.40 |
$31.35
|
|
Tc-99m labeled rbc
|
$857.40 |
$857.40 |
$857.40 |
$306.00
|
|
Tc-99m maa
|
$760.95 |
$760.95 |
$760.95 |
$312.06
|
|
Tc-99m mebrofenin
|
$308.25 |
$308.25 |
$308.25 |
$157.65
|
|
Tc-99m medronate
|
$210.35 |
$210.35 |
$210.35 |
$111.01
|
|
Tc-99m mertiatide
|
$1,340.90 |
$1,340.90 |
$1,340.90 |
$756.00
|
|
Tc-99m non-heu per study dose
|
$1.00 |
$1.00 |
$1.00 |
$8.00
|
|
Tc-99m oxidronate
|
$199.60 |
$199.60 |
$199.60 |
$108.00
|
|
Tc-99m pentetate dtpa
|
$627.25 |
$627.25 |
$627.25 |
$222.60
|
|
Tc-99m pentetate dtpa aerosol
|
$627.25 |
$627.25 |
$627.25 |
$191.50
|
|
Tc-99m pertechnetate per mci
|
$99.30 |
$99.30 |
$99.30 |
$18.67
|
|
Tc-99m pyroph diag per dose up to 25 mci
|
$335.80 |
$335.80 |
$335.80 |
$141.00
|
|
Tc-99m sestamibi p study dose
|
$221.60 |
$221.60 |
$221.60 |
$287.20
|
|
Tc-99m succimer (dmsa)
|
$2,988.10 |
$2,988.10 |
$2,988.10 |
$1,128.40
|
|
Tc-99m sulfur colloid
|
$855.40 |
$855.40 |
$855.40 |
$245.70
|
|
Tc-99m tetrofosmin p study dose
|
$198.05 |
$198.05 |
$198.05 |
$193.28
|
|
Tc-99m tilmanocept diag
|
$2,740.00 |
$2,740.00 |
$2,740.00 |
$985.60
|
|
T cells absolute cd4/cd8 including ratio
|
$153.00 |
$153.00 |
$153.00 |
$184.00
|
|
T cells total count
|
$141.00 |
$141.00 |
$141.00 |
$130.20
|
|
Tebentafusp-tebn 100 mcg/0.5 ml intravenous solution
|
$107,550.00 |
$107,550.00 |
$107,550.00 |
$40,114.80
|
|
Telehealth original site facility fee
|
$80.00 |
$80.00 |
$80.00 |
$51.00
|
|
Temozolomide 100 mg intravenous solution
|
$5,015.55 |
$5,015.55 |
$5,015.55 |
$1,867.28
|
|
Temsirolimus 30 mg/3 ml (10 mg/ml) (first dilution) intravenous soln
|
$10,501.70 |
$10,501.70 |
$10,501.70 |
$3,723.60
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$23,582.35 |
$23,582.35 |
$23,582.35 |
$14,951.87
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$6.90 |
$6.90 |
$6.90 |
$39.33
|
|
Test pathogen(s) for platelets reference
|
$113.00 |
$113.00 |
$113.00 |
$70.00
|
|
Test stress cardiovascular tracing only
|
$1,177.00 |
$1,177.00 |
$1,177.00 |
$953.40
|
|
Tetanus immune globulin inj
|
$2,622.15 |
$2,622.15 |
$2,622.15 |
$1,285.36
|
|
Tezepelumab-ekko 210 mg/1.91 ml (110 mg/ml) subcutaneous syringe
|
$22,937.05 |
$22,937.05 |
$22,937.05 |
$8,737.05
|
|
Theophylline therapeutic drug level
|
$180.00 |
$180.00 |
$180.00 |
$108.00
|
