|
Stomach Emptying Scan (Nuclear Medicine)
|
$1,857.60 |
$1,857.60 |
$1,857.60 |
$1,345.40
|
|
Strep b dna amp probe
|
$180.80 |
$180.80 |
$180.80 |
$124.15
|
|
Stress test pulmonary
|
$332.00 |
$332.00 |
$332.00 |
$324.00
|
|
Succinylcholine chloride 20 mg/ml injection solution (wrapper)
|
$66.77 |
$66.77 |
$66.77 |
$54.80
|
|
Sumatriptan 6 mg/0.5 ml subcutaneous solution
|
$67.49 |
$67.49 |
$67.49 |
$129.89
|
|
Support clav 29.6-40.5in med
|
$24.80 |
$24.80 |
$24.80 |
$94.08
|
|
Surgical pathology level 1 gross examination only
|
$37.60 |
$37.60 |
$37.60 |
$81.00
|
|
Surgical pathology level 2 gross & microscopic examination
|
$86.40 |
$86.40 |
$86.40 |
$143.55
|
|
Surgical pathology level 3 gross & microscopic examination
|
$115.20 |
$115.20 |
$115.20 |
$184.21
|
|
Surgical pathology level 4 gross & microscopic examination
|
$128.80 |
$128.80 |
$128.80 |
$250.20
|
|
Surgical pathology level 5 gross & microscopic examination
|
$680.00 |
$680.00 |
$680.00 |
$480.60
|
|
Surgical pathology level 6 gross & microscopic examination
|
$1,016.80 |
$1,016.80 |
$1,016.80 |
$720.75
|
|
Susceptibility agar dilution per agent
|
$22.40 |
$22.40 |
$22.40 |
$45.60
|
|
Susceptibility enzyme detection per enzyme
|
$38.40 |
$38.40 |
$38.40 |
$35.89
|
|
Susceptibility mic per plate
|
$45.60 |
$45.60 |
$45.60 |
$106.00
|
|
Swallowing Evaluation (Bedside)
|
$370.40 |
$370.40 |
$370.40 |
$316.80
|
|
Swallowing Therapy Session
|
$284.00 |
$284.00 |
$284.00 |
$232.56
|
|
T3 (triiodothyronine) free
|
$111.20 |
$111.20 |
$111.20 |
$100.32
|
|
T3 (triiodothyronine) total
|
$76.00 |
$76.00 |
$76.00 |
$93.52
|
|
T4 (thyroxine) free
|
$72.00 |
$72.00 |
$72.00 |
$89.60
|
|
T4 (thyroxine) total
|
$32.80 |
$32.80 |
$32.80 |
$70.20
|
|
Tacrolimus 1 mg capsule, immediate-release
|
$5.19 |
$5.19 |
$5.19 |
$9.93
|
|
Tacrolimus therapeutic drug level
|
$122.40 |
$122.40 |
$122.40 |
$122.50
|
|
Tailbone (Sacrum and Coccyx) X-ray
|
$192.00 |
$192.00 |
$192.00 |
$289.20
|
|
Tb test cell mediated immunity antigen response enumeration gamma interferon t-cells
|
$306.40 |
$306.40 |
$306.40 |
$200.00
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$192.00 |
$192.00 |
$192.00 |
$179.95
|
|
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 aerosol
|
$388.80 |
$388.80 |
$388.80 |
$191.50
|
|
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
|
|
T cells absolute cd 4 count
|
$111.20 |
$111.20 |
$111.20 |
$111.20
|
|
Telehealth original site facility fee
|
$52.80 |
$52.80 |
$52.80 |
$51.00
|
|
Temsirolimus 30 mg/3 ml (10 mg/ml) (first dilution) intravenous soln
|
$1,490.76 |
$1,490.76 |
$1,490.76 |
$3,723.60
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$11,545.44 |
$11,545.44 |
$11,545.44 |
$14,951.87
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$61.20 |
$61.20 |
$61.20 |
$39.33
|
|
Test stress cardiovascular tracing only
|
$1,016.00 |
$1,016.00 |
$1,016.00 |
$953.40
|
|
Theophylline therapeutic drug level
|
$50.40 |
$50.40 |
$50.40 |
$108.00
|
|
Therapeutic procd strg endur
|
$72.80 |
$72.80 |
$72.80 |
$85.68
|
|
Therapy Activity Training (each 15 minutes)
|
$124.80 |
$124.80 |
$124.80 |
$101.38
|
|
Therapy Exercise Session (each 15 minutes)
|
$110.40 |
$110.40 |
$110.40 |
$98.58
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$61.56 |
$61.56 |
$61.56 |
$25.54
|
|
Thigh Bone (Femur) X-ray (both sides)
|
$304.80 |
$304.80 |
$304.80 |
$313.60
|
|
Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides)
|
$1,778.40 |
$1,778.40 |
$1,778.40 |
$1,724.25
|
|
Thoracotomy with cardiac massage
|
$7,071.20 |
$7,071.20 |
$7,071.20 |
$2,138.76
|
|
Three-Phase Bone Scan (Nuclear Medicine)
|
$2,199.20 |
$2,199.20 |
$2,199.20 |
$1,703.45
|
|
Thyroglobulin antibody
|
$86.40 |
$86.40 |
$86.40 |
$82.50
|
|
Thyroid imaging
|
$1,077.60 |
$1,077.60 |
$1,077.60 |
$695.60
|
|
Thyroid (TSH) Test
|
$90.40 |
$90.40 |
$90.40 |
$112.70
|
|
Thyroid Ultrasound
|
$736.80 |
$736.80 |
$736.80 |
$588.50
|
|
Thyroid uptake measurement
|
$754.40 |
$754.40 |
$754.40 |
$591.25
|
|
Tissue exam koh skin/hair/nails
|
$47.20 |
$47.20 |
$47.20 |
$47.40
|
|
Tissue transglutaminase iga
|
$37.60 |
$37.60 |
$37.60 |
$44.80
|
|
Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr
|
$61.04 |
$61.04 |
$61.04 |
$152.36
|
|
Tobramycin peak therapeutic drug level
|
$93.60 |
$93.60 |
$93.60 |
$120.60
|
|
Tocilizumab 162 mg/0.9 ml subcutaneous pen injector
|
$4,289.76 |
$4,289.76 |
$4,289.76 |
$5,258.52
|
|
Toe X-ray (both feet)
|
$200.80 |
$200.80 |
$200.80 |
$258.65
|
|
Tomosynthesis breast diagnostic left
|
$100.00 |
$100.00 |
$100.00 |
$74.10
|
|
Tomosynthesis breast screen bilateral
|
$124.00 |
$124.00 |
$124.00 |
$74.10
|
|
Topotecan 4 mg/4 ml (1 mg/ml) intravenous solution
|
$487.56 |
$487.56 |
$487.56 |
$316.84
|
|
Toxoplasma antibody igg
|
$84.00 |
$84.00 |
$84.00 |
$91.65
|
|
Toxoplasma antibody igm
|
$84.80 |
$84.80 |
$84.80 |
$87.75
|
|
Training self management diabetes individual outpatient department per 30 minutes
|
$124.80 |
$124.80 |
$124.80 |
$102.27
|
|
Transferrin
|
$69.60 |
$69.60 |
$69.60 |
$82.00
|
|
Transvaginal Pelvic Ultrasound (not pregnancy)
|
$761.60 |
$761.60 |
$761.60 |
$561.60
|
|
Transvaginal Pregnancy Ultrasound
|
$568.00 |
$568.00 |
$568.00 |
$499.20
|
|
Trauma partial team response w/critical care services level 4
|
$1,520.80 |
$1,520.80 |
$1,520.80 |
$4,523.04
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$257.60 |
$257.60 |
$257.60 |
$227.70
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$178.40 |
$178.40 |
$178.40 |
$147.48
|
|
Treponema pallidum antibody
|
$71.20 |
$71.20 |
$71.20 |
$72.05
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$68.99 |
$68.99 |
$68.99 |
$43.09
|
|
Triglycerides
|
$31.20 |
$31.20 |
$31.20 |
$58.50
|
|
Trimethobenzamide hcl inj
|
$75.57 |
$75.57 |
$75.57 |
$117.49
|
|
Troponin quantitative
|
$78.40 |
$78.40 |
$78.40 |
$127.60
|
|
Ua w/micro/comp poc
|
$38.40 |
$38.40 |
$38.40 |
$23.00
|
|
Ultrasound breast complete
|
$560.80 |
$560.80 |
$560.80 |
$532.00
|
|
Ultrasound breast unilateral limited (both sides)
|
$448.80 |
$448.80 |
$448.80 |
$452.40
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$656.00 |
$656.00 |
$656.00 |
$476.94
|
|
Ultrasound Guidance for a Needle Procedure
|
$824.00 |
$824.00 |
$824.00 |
$720.15
|
|
Ultrasound guidance for vascular access
|
$578.40 |
$578.40 |
$578.40 |
$388.08
|
|
Ultrasound ob >=14wks ea addl gest
|
$476.80 |
$476.80 |
$476.80 |
$407.20
|
|
Ultrasound pregnant uterus follow up per fetus
|
$511.20 |
$511.20 |
$511.20 |
$425.60
|
|
Ultrasound prostate/transrectal
|
$602.40 |
$602.40 |
$602.40 |
$557.40
|
|
Ultrasound spinal canal and contents
|
$619.20 |
$619.20 |
$619.20 |
$463.00
|
|
Unlisted chemotherapy px
|
$187.20 |
$187.20 |
$187.20 |
$149.15
|
|
Unlisted ultrasound procedure
|
$368.80 |
$368.80 |
$368.80 |
$332.16
|
|
Upper Arm (Humerus) X-ray (left side)
|
$198.40 |
$198.40 |
$198.40 |
$309.31
|
|
Upper Back (Thoracic Spine) CT Scan (without contrast)
|
$2,507.20 |
$2,507.20 |
$2,507.20 |
$1,425.85
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$4,279.20 |
$4,279.20 |
$4,279.20 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$3,209.60 |
$3,209.60 |
$3,209.60 |
$2,369.00
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$2,993.60 |
$2,993.60 |
$2,993.60 |
$2,034.41
|
|
Upper Back (Thoracic Spine) X-ray (2 views)
|
$218.40 |
$218.40 |
$218.40 |
$321.95
|
|
Upper Back (Thoracic Spine) X-ray (3 views)
|
$230.40 |
$230.40 |
$230.40 |
$381.60
|
|
Upper GI Barium X-ray (barium and gas)
|
$744.80 |
$744.80 |
$744.80 |
$660.40
|
|
Upper GI Barium X-ray (barium only)
|
$649.60 |
$649.60 |
$649.60 |
$607.20
|
|
Urea nitrogen
|
$25.60 |
$25.60 |
$25.60 |
$42.25
|
|
Urea nitrogen 24 hour urine
|
$25.60 |
$25.60 |
$25.60 |
$52.00
|