|
Skull X-ray (complete)
|
$416.80 |
$416.80 |
$416.80 |
$417.50
|
|
Sleep Study (Polysomnography)
|
$4,216.00 |
$4,216.00 |
$4,216.00 |
$3,734.50
|
|
Sling pelv split sam med
|
$278.40 |
$278.40 |
$278.40 |
$150.00
|
|
Sling suprapubic suburetheral
|
$3,114.40 |
$3,114.40 |
$3,114.40 |
$9,679.96
|
|
Slp eval non-spch gen comm dev
|
$399.20 |
$399.20 |
$399.20 |
$285.09
|
|
Slp pure tone screening
|
$61.60 |
$61.60 |
$61.60 |
$64.50
|
|
Slp ther svc non-spch gen
|
$303.20 |
$303.20 |
$303.20 |
$188.50
|
|
Small Bowel Barium X-ray (Follow-Through)
|
$924.00 |
$924.00 |
$924.00 |
$557.70
|
|
Smear fluorescent and/or acid fast stain
|
$72.80 |
$72.80 |
$72.80 |
$64.35
|
|
Smear gram stain
|
$38.40 |
$38.40 |
$38.40 |
$55.55
|
|
Smear nasal eosinophil
|
$45.60 |
$45.60 |
$45.60 |
$46.20
|
|
Smear special stain inclusion bodies/parasites
|
$71.20 |
$71.20 |
$71.20 |
$73.50
|
|
Smear wet mount
|
$53.60 |
$53.60 |
$53.60 |
$67.55
|
|
Sodium 24 hour urine
|
$43.20 |
$43.20 |
$43.20 |
$48.98
|
|
Sodium chloride 0.9 % intravenous solution
|
$40.00 |
$40.00 |
$40.00 |
$49.07
|
|
Sodium chloride 0.9 % IV bolus
|
$48.00 |
$48.00 |
$48.00 |
$45.62
|
|
Sodium chloride 0.9 % IV bolus
|
$48.00 |
$48.00 |
$48.00 |
$37.64
|
|
Sodium chloride 3 % ivpb
|
$5.25 |
$5.25 |
$5.25 |
$40.61
|
|
Sodium serum/plasma/whole blood
|
$36.00 |
$36.00 |
$36.00 |
$46.26
|
|
Sodium thiosulfate 12.5 gram/50 ml (250 mg/ml) intravenous solution
|
$91.86 |
$91.86 |
$91.86 |
$177.52
|
|
Specimen fat stain
|
$74.40 |
$74.40 |
$74.40 |
$37.40
|
|
Speech and Language Evaluation (comprehensive)
|
$484.80 |
$484.80 |
$484.80 |
$384.80
|
|
Speech Therapy Session (one-on-one)
|
$311.20 |
$311.20 |
$311.20 |
$246.87
|
|
Spine X-ray (single view, one level)
|
$323.20 |
$323.20 |
$323.20 |
$251.00
|
|
Splint extn xsm w sof-stretch rolyan
|
$88.00 |
$88.00 |
$88.00 |
$71.44
|
|
Splint finger frog med
|
$23.20 |
$23.20 |
$23.20 |
$38.08
|
|
Splint rstrc wrst/cmc right med
|
$168.80 |
$168.80 |
$168.80 |
$99.04
|
|
St analysis behavior qualitative voice/resonance
|
$388.00 |
$388.00 |
$388.00 |
$297.60
|
|
St cognitve performance testing healthcare professional each hour
|
$388.00 |
$388.00 |
$388.00 |
$286.00
|
|
Stent bili dbl pgtl 10fx5cm
|
$240.00 |
$240.00 |
$240.00 |
$2,704.27
|
|
Sterile water/saline, 500 ml
|
$61.65 |
$61.65 |
$61.65 |
$28.11
|
|
St evaluate speech sound production
|
$371.20 |
$371.20 |
$371.20 |
$292.95
|
|
St evaluation motion fluoroscopic swallow function cine/video
|
$510.40 |
$510.40 |
$510.40 |
$400.00
|
|
Stomach Emptying Scan (Nuclear Medicine)
|
$1,791.20 |
$1,791.20 |
$1,791.20 |
$1,345.40
|
|
Strep b dna amp probe
|
$232.80 |
$232.80 |
$232.80 |
$124.15
|
|
Stress test pulmonary
|
$418.40 |
$418.40 |
$418.40 |
$324.00
|
|
Succinylcholine chloride 20 mg/ml injection solution (wrapper)
|
$76.24 |
$76.24 |
$76.24 |
$54.80
|
|
Sumatriptan 6 mg/0.5 ml subcutaneous solution
|
$69.13 |
$69.13 |
$69.13 |
$129.89
|
|
Support clav 29.6-40.5in med
|
$40.00 |
$40.00 |
$40.00 |
$94.08
|
|
Surgical pathology level 1 gross examination only
|
$72.00 |
$72.00 |
$72.00 |
$81.00
|
|
Surgical pathology level 2 gross & microscopic examination
|
$153.60 |
$153.60 |
$153.60 |
$143.55
|
|
Surgical pathology level 3 gross & microscopic examination
|
$213.60 |
$213.60 |
$213.60 |
$184.21
|
|
Surgical pathology level 4 gross & microscopic examination
|
$359.20 |
$359.20 |
$359.20 |
$250.20
|
|
Surgical pathology level 5 gross & microscopic examination
|
$1,271.20 |
$1,271.20 |
$1,271.20 |
$480.60
|
|
Surgical pathology level 6 gross & microscopic examination
|
$1,754.40 |
$1,754.40 |
$1,754.40 |
$720.75
|
|
Susceptibility agar dilution per agent
|
$41.60 |
$41.60 |
$41.60 |
$45.60
|
|
Susceptibility enzyme detection per enzyme
|
$56.80 |
$56.80 |
$56.80 |
$35.89
|
|
Susceptibility mic per plate
|
$157.60 |
$157.60 |
$157.60 |
$106.00
|
|
Swallowing Evaluation (Bedside)
|
$372.00 |
$372.00 |
$372.00 |
$316.80
|
|
Swallowing Therapy Session
|
$288.00 |
$288.00 |
$288.00 |
$232.56
|
|
Synvisc or synvisc-one
|
$712.61 |
$712.61 |
$712.61 |
$1,242.63
|
|
T3 (triiodothyronine) free
|
$152.80 |
$152.80 |
$152.80 |
$100.32
|
|
T3 (triiodothyronine) total
|
$114.40 |
$114.40 |
$114.40 |
$93.52
|
|
T4 (thyroxine) free
|
$93.60 |
$93.60 |
$93.60 |
$89.60
|
|
T4 (thyroxine) total
|
$52.80 |
$52.80 |
$52.80 |
$70.20
|
|
Tacrol envarsus ex rel oral
|
$10.76 |
$10.76 |
$10.76 |
$15.60
|
|
Tacrolimus 1 mg capsule, immediate-release
|
$4.49 |
$4.49 |
$4.49 |
$9.93
|
|
Tacrolimus therapeutic drug level
|
$180.80 |
$180.80 |
$180.80 |
$122.50
|
|
Tailbone (Sacrum and Coccyx) X-ray
|
$346.40 |
$346.40 |
$346.40 |
$289.20
|
|
Tb test cell mediated immunity antigen response enumeration gamma interferon t-cells
|
$298.40 |
$298.40 |
$298.40 |
$200.00
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$273.60 |
$273.60 |
$273.60 |
$179.95
|
|
Tc-99m labeled rbc
|
$428.00 |
$428.00 |
$428.00 |
$306.00
|
|
Tc-99m maa
|
$936.80 |
$936.80 |
$936.80 |
$312.06
|
|
Tc-99m mebrofenin
|
$178.40 |
$178.40 |
$178.40 |
$157.65
|
|
Tc-99m medronate
|
$133.60 |
$133.60 |
$133.60 |
$111.01
|
|
Tc-99m mertiatide
|
$756.00 |
$756.00 |
$756.00 |
$756.00
|
|
Tc-99m oxidronate
|
$168.00 |
$168.00 |
$168.00 |
$108.00
|
|
Tc-99m pentetate dtpa
|
$388.80 |
$388.80 |
$388.80 |
$222.60
|
|
Tc-99m pentetate dtpa aerosol
|
$388.80 |
$388.80 |
$388.80 |
$191.50
|
|
Tc-99m pertechnetate per mci
|
$108.00 |
$108.00 |
$108.00 |
$18.67
|
|
Tc-99m sestamibi p study dose
|
$352.00 |
$352.00 |
$352.00 |
$287.20
|
|
Tc-99m sulfur colloid
|
$308.00 |
$308.00 |
$308.00 |
$245.70
|
|
Tc-99m tetrofosmin p study dose
|
$120.00 |
$120.00 |
$120.00 |
$193.28
|
|
T cells absolute cd4/cd8 including ratio
|
$324.00 |
$324.00 |
$324.00 |
$184.00
|
|
T cells absolute cd 4 count
|
$167.20 |
$167.20 |
$167.20 |
$111.20
|
|
T cells total count
|
$259.20 |
$259.20 |
$259.20 |
$130.20
|
|
Telavancin injection
|
$819.60 |
$819.60 |
$819.60 |
$1,191.80
|
|
Telehealth original site facility fee
|
$68.00 |
$68.00 |
$68.00 |
$51.00
|
|
Temsirolimus 30 mg/3 ml (10 mg/ml) (first dilution) intravenous soln
|
$1,831.93 |
$1,831.93 |
$1,831.93 |
$3,723.60
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$12,366.50 |
$12,366.50 |
$12,366.50 |
$14,951.87
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$74.61 |
$74.61 |
$74.61 |
$39.33
|
|
Test stress cardiovascular tracing only
|
$1,168.80 |
$1,168.80 |
$1,168.80 |
$953.40
|
|
Tetanus immune globulin inj
|
$660.69 |
$660.69 |
$660.69 |
$1,285.36
|
|
Theophylline therapeutic drug level
|
$115.20 |
$115.20 |
$115.20 |
$108.00
|
|
Therapeutic procd strg endur
|
$120.80 |
$120.80 |
$120.80 |
$85.68
|
|
Therapy Activity Training (each 15 minutes)
|
$128.00 |
$128.00 |
$128.00 |
$101.38
|
|
Therapy Exercise Session (each 15 minutes)
|
$132.80 |
$132.80 |
$132.80 |
$98.58
|
|
Therapy nutrition individual initial f2f w/patient each 15 minutes
|
$65.60 |
$65.60 |
$65.60 |
$57.50
|
|
Therapy nutrition individual reassessment/intervention f2f w/patient each 15 minutes
|
$60.00 |
$60.00 |
$60.00 |
$50.40
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$66.35 |
$66.35 |
$66.35 |
$25.54
|
|
Thigh Bone (Femur) X-ray (both sides)
|
$317.60 |
$317.60 |
$317.60 |
$313.60
|
|
Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides)
|
$1,886.40 |
$1,886.40 |
$1,886.40 |
$1,724.25
|
|
Three-Phase Bone Scan (Nuclear Medicine)
|
$2,139.20 |
$2,139.20 |
$2,139.20 |
$1,703.45
|
|
Thromboplastin time partial (ptt) substitution fractions each
|
$80.80 |
$80.80 |
$80.80 |
$62.01
|
|
Thyroglobulin antibody
|
$117.60 |
$117.60 |
$117.60 |
$82.50
|
|
Thyroid (TSH) Test
|
$124.00 |
$124.00 |
$124.00 |
$112.70
|
|
Thyroid Ultrasound
|
$728.80 |
$728.80 |
$728.80 |
$588.50
|
|
Thyroid uptake measurement
|
$900.80 |
$900.80 |
$900.80 |
$591.25
|
|
Tigecycline injection
|
$271.86 |
$271.86 |
$271.86 |
$235.29
|
|
Tirofiban 12.5 mg/50 ml
|
$458.51 |
$458.51 |
$458.51 |
$458.85
|
