|
Spirometry bronchodilation responsiveness pre/post bronchodilator administration
|
$490.20 |
$490.20 |
$490.20 |
$543.26
|
|
St evaluate speech sound production
|
$429.00 |
$429.00 |
$429.00 |
$292.95
|
|
St evaluate speech sound production comprehensive/expressive
|
$429.00 |
$429.00 |
$429.00 |
$377.00
|
|
St evaluation motion fluoroscopic swallow function cine/video
|
$738.60 |
$738.60 |
$738.60 |
$399.60
|
|
St evaluation swallow function
|
$558.60 |
$558.60 |
$558.60 |
$314.40
|
|
St treatment speech individual
|
$265.80 |
$265.80 |
$265.80 |
$248.84
|
|
St treatment swallow dysfunction/oral
|
$219.60 |
$219.60 |
$219.60 |
$240.31
|
|
Succinylcholine chloride 20 mg/ml injection solution (wrapper)
|
$64.80 |
$64.80 |
$64.80 |
$52.31
|
|
Sumatriptan 6 mg/0.5 ml subcutaneous solution
|
$247.20 |
$247.20 |
$247.20 |
$114.88
|
|
Surgical pathology level 1 gross examination only
|
$198.60 |
$198.60 |
$198.60 |
$79.50
|
|
Surgical pathology level 2 gross & microscopic examination
|
$348.00 |
$348.00 |
$348.00 |
$141.94
|
|
Surgical pathology level 3 gross & microscopic examination
|
$107.40 |
$107.40 |
$107.40 |
$181.00
|
|
Surgical pathology level 4 gross & microscopic examination
|
$110.40 |
$110.40 |
$110.40 |
$239.85
|
|
Surgical pathology level 5 gross & microscopic examination
|
$1,029.60 |
$1,029.60 |
$1,029.60 |
$480.00
|
|
Susceptibility agar dilution per agent
|
$57.00 |
$57.00 |
$57.00 |
$45.45
|
|
Susceptibility mic per plate
|
$1,488.60 |
$1,488.60 |
$1,488.60 |
$106.00
|
|
Synvisc or synvisc-one
|
$90.60 |
$90.60 |
$90.60 |
$1,274.94
|
|
Syphilis test non-treponemal antibody quantitative rpr
|
$35.40 |
$35.40 |
$35.40 |
$41.60
|
|
T3 (triiodothyronine) free
|
$331.80 |
$331.80 |
$331.80 |
$99.20
|
|
T3 (triiodothyronine) total
|
$189.60 |
$189.60 |
$189.60 |
$93.52
|
|
T4 (thyroxine) free
|
$175.20 |
$175.20 |
$175.20 |
$85.20
|
|
T4 (thyroxine) total
|
$189.00 |
$189.00 |
$189.00 |
$69.00
|
|
Tacrolimus therapeutic drug level
|
$115.20 |
$115.20 |
$115.20 |
$122.40
|
|
Talymed
|
$318.50 |
$318.50 |
$318.50 |
$3,411.49
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$132.60 |
$132.60 |
$132.60 |
$177.65
|
|
Tc-99m diag per dose
|
$458.40 |
$458.40 |
$458.40 |
$470.40
|
|
Tc-99m exametazime diag
|
$1,176.00 |
$1,176.00 |
$1,176.00 |
$2,033.20
|
|
Tc-99m maa
|
$73.80 |
$73.80 |
$73.80 |
$292.80
|
|
Tc-99m mebrofenin
|
$139.20 |
$139.20 |
$139.20 |
$157.65
|
|
Tc-99m medronate
|
$116.40 |
$116.40 |
$116.40 |
$111.01
|
|
Tc-99m mertiatide
|
$330.60 |
$330.60 |
$330.60 |
$756.00
|
|
Tc-99m pentetate dtpa
|
$73.80 |
$73.80 |
$73.80 |
$222.60
|
|
Tc-99m pertechnetate per mci
|
$3.60 |
$3.60 |
$3.60 |
$22.10
|
|
Tc-99m pyroph diag per dose up to 25 mci
|
$73.80 |
$73.80 |
$73.80 |
$136.40
|
|
Tc-99m sestamibi p study dose
|
$351.00 |
$351.00 |
$351.00 |
$274.45
|
|
Tc-99m sulfur colloid
|
$75.60 |
$75.60 |
$75.60 |
$240.50
|
|
Tc-99m tilmanocept diag
|
$860.40 |
$860.40 |
$860.40 |
$955.60
|
|
Telehealth original site facility fee
|
$30.60 |
$30.60 |
$30.60 |
$51.00
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$21,126.00 |
$21,126.00 |
$21,126.00 |
$15,245.38
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$14.40 |
$14.40 |
$14.40 |
$39.33
|
|
Test stress cardiovascular tracing only
|
$768.60 |
$768.60 |
$768.60 |
$949.70
|
|
Theophylline therapeutic drug level
|
$121.80 |
$121.80 |
$121.80 |
$108.00
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$17.40 |
$17.40 |
$17.40 |
$25.54
|
|
Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides)
|
$1,504.20 |
$1,504.20 |
$1,504.20 |
$1,687.50
|
|
Thrombin time
|
$76.80 |
$76.80 |
$76.80 |
$53.76
|
|
Thromboplastin inhibition
|
$46.80 |
$46.80 |
$46.80 |
$53.30
|
|
Thromboplastin time partial (ptt) substitution fractions each
|
$186.00 |
$186.00 |
$186.00 |
$61.52
|
|
Thyroglobulin antibody
|
$496.20 |
$496.20 |
$496.20 |
$82.00
|
|
Thyroid (TSH) Test
|
$159.00 |
$159.00 |
$159.00 |
$111.00
|
|
Thyroid Ultrasound
|
$764.40 |
$764.40 |
$764.40 |
$588.50
|
|
Thyroxine binding globulin (tbg)
|
$204.00 |
$204.00 |
$204.00 |
$64.35
|
|
Tilt table study
|
$678.00 |
$678.00 |
$678.00 |
$1,507.01
|
|
Tissue matrix 1.8x1.8cm collagen dermacell porous 4sq cm cost per sq cm
|
$152.63 |
$152.63 |
$152.63 |
$1,134.00
|
|
Tissue matrix xcm thk 20x30cm -cost per sq cm
|
$830.41 |
$830.41 |
$830.41 |
$18,999.96
|
|
Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr
|
$12.00 |
$12.00 |
$12.00 |
$152.36
|
|
Tobramycin peak therapeutic drug level
|
$183.60 |
$183.60 |
$183.60 |
$120.60
|
|
Tomosynthesis breast diagnostic left
|
$40.20 |
$40.20 |
$40.20 |
$73.00
|
|
Tomosynthesis breast screen bilateral
|
$40.20 |
$40.20 |
$40.20 |
$72.68
|
|
Total Hip Replacement
|
$4,007.40 |
$4,007.40 |
$4,007.40 |
$9,161.60
|
|
Total Knee Replacement
|
$3,774.60 |
$3,774.60 |
$3,774.60 |
$14,543.50
|
|
Toxoplasma antibody igg
|
$203.40 |
$203.40 |
$203.40 |
$89.40
|
|
Toxoplasma antibody igm
|
$445.80 |
$445.80 |
$445.80 |
$87.00
|
|
Training self management diabetes individual outpatient department per 30 minutes
|
$60.60 |
$60.60 |
$60.60 |
$101.25
|
|
Transferrin
|
$115.20 |
$115.20 |
$115.20 |
$82.00
|
|
Transfusion blood/blood component(s)
|
$511.20 |
$511.20 |
$511.20 |
$983.00
|
|
Treat ankle dislocation
|
$2,827.20 |
$2,827.20 |
$2,827.20 |
$2,358.40
|
|
Treat fracture of radius
|
$1,000.80 |
$1,000.80 |
$1,000.80 |
$1,790.00
|
|
Treat hip dislocation
|
$2,827.20 |
$2,827.20 |
$2,827.20 |
$2,641.60
|
|
Treat kneecap dislocation
|
$2,827.20 |
$2,827.20 |
$2,827.20 |
$1,068.90
|
|
Treat lower leg fracture
|
$1,941.00 |
$1,941.00 |
$1,941.00 |
$14,241.77
|
|
Treat lower leg joint
|
$1,208.40 |
$1,208.40 |
$1,208.40 |
$7,807.24
|
|
Treatment fx radial distal open w/internal fixation 2 frag left (restricted method ii cah)
|
$1,179.60 |
$1,179.60 |
$1,179.60 |
$8,370.75
|
|
Treatment fx radial distal open w/internal fixation left (restricted method ii cah)
|
$1,179.60 |
$1,179.60 |
$1,179.60 |
$8,370.75
|
|
Treatment inhalation pressurized/nonpressurized acute airway obstruction
|
$253.20 |
$253.20 |
$253.20 |
$203.35
|
|
Treatment of ankle fracture
|
$1,146.60 |
$1,146.60 |
$1,146.60 |
$8,412.89
|
|
Treatment of ankle fracture
|
$1,483.20 |
$1,483.20 |
$1,483.20 |
$8,453.60
|
|
Treatment of fibula fracture 27780
|
$290.40 |
$290.40 |
$290.40 |
$491.50
|
|
Treat metacarpal fracture
|
$1,141.20 |
$1,141.20 |
$1,141.20 |
$5,464.97
|
|
Treat thigh fracture
|
$2,464.20 |
$2,464.20 |
$2,464.20 |
$4,083.00
|
|
Treat thigh fracture
|
$2,601.00 |
$2,601.00 |
$2,601.00 |
$4,726.80
|
|
Treponema pallidum antibody
|
$166.20 |
$166.20 |
$166.20 |
$70.40
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$31.80 |
$31.80 |
$31.80 |
$43.21
|
|
Triglycerides
|
$88.80 |
$88.80 |
$88.80 |
$58.05
|
|
Trim nondyst nails
|
$145.20 |
$145.20 |
$145.20 |
$113.40
|
|
Troponin quantitative
|
$155.40 |
$155.40 |
$155.40 |
$127.20
|
|
Tx closed tib fx proximal w/w/o manip w/skel trac
|
$3,931.20 |
$3,931.20 |
$3,931.20 |
$3,977.49
|
|
Tx phalangeal shaft fx open prox/middle ea
|
$1,247.40 |
$1,247.40 |
$1,247.40 |
$4,499.12
|
|
Ua w/micro/comp poc
|
$52.80 |
$52.80 |
$52.80 |
$23.00
|
|
Ultrasound abdomen aorta screening study aaa
|
$438.60 |
$438.60 |
$438.60 |
$394.20
|
|
Ultrasound breast complete
|
$853.80 |
$853.80 |
$853.80 |
$528.41
|
|
Ultrasound breast unilateral limited (both sides)
|
$225.00 |
$225.00 |
$225.00 |
$449.35
|
|
Ultrasound chest
|
$1,012.20 |
$1,012.20 |
$1,012.20 |
$460.85
|
|
Ultrasound guided needle placement supervision & interpretation
|
$1,065.60 |
$1,065.60 |
$1,065.60 |
$720.15
|
|
Ultrasound joint complete left
|
$246.00 |
$246.00 |
$246.00 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$252.60 |
$252.60 |
$252.60 |
$425.45
|
|
Ultrasound ob >=14wks ea addl gest
|
$303.60 |
$303.60 |
$303.60 |
$407.20
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$702.00 |
$702.00 |
$702.00 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$879.00 |
$879.00 |
$879.00 |
$497.12
|
|
Ultrasound retroperitoneal limited
|
$151.20 |
$151.20 |
$151.20 |
$486.50
|
|
Ultrasound scrotum and contents
|
$962.40 |
$962.40 |
$962.40 |
$608.90
|
