|
Sincalide 5 mcg solution for injection
|
$545.40 |
$545.40 |
$545.40 |
$309.14
|
|
Sinus CT scan (with and without contrast)
|
$1,966.80 |
$1,966.80 |
$1,966.80 |
$1,796.50
|
|
Sinus CT scan (with contrast)
|
$1,735.20 |
$1,735.20 |
$1,735.20 |
$1,527.60
|
|
Sinus CT scan (without contrast)
|
$2,133.60 |
$2,133.60 |
$2,133.60 |
$1,292.04
|
|
Skin full graft 20sq cm less 15200
|
$1,048.20 |
$1,048.20 |
$1,048.20 |
$2,371.50
|
|
Skin split graft addl 100sq cm 15101
|
$499.20 |
$499.20 |
$499.20 |
$1,793.40
|
|
Sleep study attended
|
$2,011.80 |
$2,011.80 |
$2,011.80 |
$1,237.08
|
|
Sleep Study (Polysomnography)
|
$2,021.40 |
$2,021.40 |
$2,021.40 |
$3,598.50
|
|
Small bowel endoscopy
|
$627.00 |
$627.00 |
$627.00 |
$2,244.82
|
|
Smear fluorescent and/or acid fast stain
|
$85.20 |
$85.20 |
$85.20 |
$64.00
|
|
Smear gram stain
|
$37.20 |
$37.20 |
$37.20 |
$54.03
|
|
Sodium 24 hour urine
|
$77.40 |
$77.40 |
$77.40 |
$48.60
|
|
Sodium chloride 0.9 % IV bolus
|
$18.60 |
$18.60 |
$18.60 |
$43.45
|
|
Sodium chloride 3 % ivpb
|
$52.80 |
$52.80 |
$52.80 |
$37.80
|
|
Sodium hyaluronate 20 mg/2 ml syringe
|
$767.10 |
$767.10 |
$767.10 |
$410.40
|
|
Sodium serum/plasma/whole blood
|
$66.00 |
$66.00 |
$66.00 |
$45.50
|
|
Spirometry bronchodilation responsiveness pre/post bronchodilator administration
|
$567.00 |
$567.00 |
$567.00 |
$543.26
|
|
St analysis behavior qualitative voice/resonance
|
$438.00 |
$438.00 |
$438.00 |
$295.10
|
|
St evaluate speech sound production
|
$480.00 |
$480.00 |
$480.00 |
$289.20
|
|
St evaluate speech sound production comprehensive/expressive
|
$480.00 |
$480.00 |
$480.00 |
$376.23
|
|
St evaluation motion fluoroscopic swallow function cine/video
|
$610.20 |
$610.20 |
$610.20 |
$370.50
|
|
St evaluation swallow function
|
$462.60 |
$462.60 |
$462.60 |
$309.60
|
|
Strep b dna amp probe
|
$60.00 |
$60.00 |
$60.00 |
$126.10
|
|
Stress test pulmonary
|
$306.60 |
$306.60 |
$306.60 |
$322.85
|
|
Stress tte complete
|
$169.20 |
$169.20 |
$169.20 |
$1,797.59
|
|
St treatment speech individual
|
$294.60 |
$294.60 |
$294.60 |
$249.00
|
|
St treatment swallow dysfunction/oral
|
$180.60 |
$180.60 |
$180.60 |
$243.99
|
|
Succinylcholine chloride 20 mg/ml injection solution (wrapper)
|
$64.80 |
$64.80 |
$64.80 |
$54.55
|
|
Sugars single quant
|
$168.00 |
$168.00 |
$168.00 |
$58.80
|
|
Sulbactam 1 gram-durlobactam 1 gram (0.5 gram x2) intravenous solution
|
$637.20 |
$637.20 |
$637.20 |
$7,487.55
|
|
Sumatriptan 6 mg/0.5 ml subcutaneous solution
|
$247.20 |
$247.20 |
$247.20 |
$122.16
|
|
Surg dx exam anorectal
|
$100.20 |
$100.20 |
$100.20 |
$3,245.23
|
|
Surgical pathology level 1 gross examination only
|
$54.00 |
$54.00 |
$54.00 |
$79.20
|
|
Surgical pathology level 2 gross & microscopic examination
|
$55.80 |
$55.80 |
$55.80 |
$143.65
|
|
Surgical pathology level 3 gross & microscopic examination
|
$107.40 |
$107.40 |
$107.40 |
$182.25
|
|
Surgical pathology level 4 gross & microscopic examination
|
$95.40 |
$95.40 |
$95.40 |
$252.60
|
|
Surgical pathology level 5 gross & microscopic examination
|
$162.60 |
$162.60 |
$162.60 |
$480.00
|
|
Surgical pathology level 6 gross & microscopic examination
|
$318.60 |
$318.60 |
$318.60 |
$720.75
|
|
Susceptibility agar dilution per agent
|
$60.00 |
$60.00 |
$60.00 |
$43.20
|
|
Susceptibility mic per plate
|
$120.60 |
$120.60 |
$120.60 |
$104.58
|
|
Sutr lg intestine 1/mult perf without colostomy 44604
|
$1,673.40 |
$1,673.40 |
$1,673.40 |
$1,995.00
|
|
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 |
$40.00
|
|
System pcmkr dual chamber leadless micra av2 intrdcr cath
|
$7,465.25 |
$7,465.25 |
$7,465.25 |
$12,003.00
|
|
T3 (triiodothyronine) free
|
$346.80 |
$346.80 |
$346.80 |
$99.00
|
|
T3 (triiodothyronine) total
|
$171.60 |
$171.60 |
$171.60 |
$93.52
|
|
T4 (thyroxine) free
|
$190.20 |
$190.20 |
$190.20 |
$84.15
|
|
T4 (thyroxine) total
|
$189.00 |
$189.00 |
$189.00 |
$67.10
|
|
Tacrolimus 1 mg capsule, immediate-release
|
$9.60 |
$9.60 |
$9.60 |
$9.93
|
|
Tacrolimus therapeutic drug level
|
$120.60 |
$120.60 |
$120.60 |
$120.60
|
|
Talymed
|
$318.50 |
$318.50 |
$318.50 |
$3,411.49
|
|
Target gsa panel hmtlmph neop
|
$5,292.60 |
$5,292.60 |
$5,292.60 |
$2,160.00
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$132.60 |
$132.60 |
$132.60 |
$175.92
|
|
Tc-99m labeled rbc
|
$3.60 |
$3.60 |
$3.60 |
$302.40
|
|
Tc-99m maa
|
$166.80 |
$166.80 |
$166.80 |
$288.75
|
|
Tc-99m mebrofenin
|
$114.00 |
$114.00 |
$114.00 |
$157.65
|
|
Tc-99m oxidronate
|
$82.80 |
$82.80 |
$82.80 |
$105.30
|
|
Tc-99m pentetate dtpa
|
$166.80 |
$166.80 |
$166.80 |
$224.40
|
|
Tc-99m pertechnetate per mci
|
$3.60 |
$3.60 |
$3.60 |
$22.10
|
|
Tc-99m pyroph diag per dose up to 25 mci
|
$183.00 |
$183.00 |
$183.00 |
$136.40
|
|
Tc-99m sestamibi p study dose
|
$401.40 |
$401.40 |
$401.40 |
$289.80
|
|
Tc-99m sulfur colloid
|
$162.60 |
$162.60 |
$162.60 |
$240.50
|
|
Tc-99m tetrofosmin p study dose
|
$315.60 |
$315.60 |
$315.60 |
$188.50
|
|
T cells absolute cd4/cd8 including ratio
|
$158.40 |
$158.40 |
$158.40 |
$175.00
|
|
T cells total count
|
$126.00 |
$126.00 |
$126.00 |
$123.00
|
|
Telehealth original site facility fee
|
$32.40 |
$32.40 |
$32.40 |
$51.85
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$21,126.00 |
$21,126.00 |
$21,126.00 |
$15,245.38
|
|
Tenosynovectomy radic 26145
|
$1,077.00 |
$1,077.00 |
$1,077.00 |
$1,893.86
|
|
Test stress cardiovascular tracing only
|
$763.20 |
$763.20 |
$763.20 |
$949.92
|
|
Theophylline therapeutic drug level
|
$127.80 |
$127.80 |
$127.80 |
$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)
|
$1,608.00 |
$1,608.00 |
$1,608.00 |
$1,687.50
|
|
Thrombin time
|
$76.80 |
$76.80 |
$76.80 |
$53.76
|
|
Thromboplastin inhibition
|
$46.80 |
$46.80 |
$46.80 |
$55.20
|
|
Thromboplastin time partial (ptt) substitution fractions each
|
$77.40 |
$77.40 |
$77.40 |
$61.50
|
|
Thyroglobulin antibody
|
$199.20 |
$199.20 |
$199.20 |
$81.90
|
|
Thyroid imaging
|
$871.80 |
$871.80 |
$871.80 |
$695.02
|
|
Thyroid (TSH) Test
|
$168.00 |
$168.00 |
$168.00 |
$112.00
|
|
Thyroid Ultrasound
|
$924.60 |
$924.60 |
$924.60 |
$588.50
|
|
Thyrotropin alfa 0.9 mg intramuscular solution
|
$6,846.00 |
$6,846.00 |
$6,846.00 |
$4,062.19
|
|
Tilt table study
|
$727.80 |
$727.80 |
$727.80 |
$1,548.30
|
|
Tissue matrix 1.8x1.8cm collagen dermacell porous 4sq cm cost per sq cm
|
$152.63 |
$152.63 |
$152.63 |
$2,516.07
|
|
Tissue matrix xcm thk 20x30cm -cost per sq cm
|
$830.41 |
$830.41 |
$830.41 |
$18,999.96
|
|
Tissue transglutaminase iga
|
$21.60 |
$21.60 |
$21.60 |
$44.25
|
|
Tnot opn elbw to sho ea tdn
|
$876.00 |
$876.00 |
$876.00 |
$2,564.80
|
|
Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr
|
$12.00 |
$12.00 |
$12.00 |
$152.36
|
|
Tobramycin peak therapeutic drug level
|
$140.40 |
$140.40 |
$140.40 |
$121.55
|
|
Tomosynthesis breast diagnostic left
|
$40.20 |
$40.20 |
$40.20 |
$71.40
|
|
Tomosynthesis breast screen bilateral
|
$40.20 |
$40.20 |
$40.20 |
$68.43
|
|
Tonsillectomy (age 12+)
|
$570.60 |
$570.60 |
$570.60 |
$3,837.72
|
|
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 |
$14,254.12
|
|
Toxoplasma antibody igg
|
$210.60 |
$210.60 |
$210.60 |
$89.24
|
|
Toxoplasma antibody igm
|
$210.60 |
$210.60 |
$210.60 |
$87.00
|
|
Tp53 gene trgt sequence alys
|
$1,245.60 |
$1,245.60 |
$1,245.60 |
$823.00
|
|
Tracheostoma revision; simple, without flap rotation
|
$543.60 |
$543.60 |
$543.60 |
$3,837.72
|
|
Transferrin
|
$118.80 |
$118.80 |
$118.80 |
$81.60
|
|
Transfer skin pedicle flap
|
$932.40 |
$932.40 |
$932.40 |
$3,209.30
|
|
Transfusion blood/blood component(s)
|
$625.80 |
$625.80 |
$625.80 |
$936.80
|
|
Trastuzumab 150 mg intravenous solution
|
$5,196.60 |
$5,196.60 |
$5,196.60 |
$3,141.85
|
