|
Sulfamethoxazole 400 mg-trimethoprim 80 mg/5 ml intravenous solution
|
$43.35 |
$43.35 |
$43.35 |
$82.46
|
|
Sulfonylurea screen qn-sendout
|
$104.00 |
$104.00 |
$104.00 |
$158.75
|
|
Sumatriptan 6 mg/0.5 ml subcutaneous solution
|
$70.42 |
$70.42 |
$70.42 |
$129.89
|
|
Surgical pathology level 1 gross examination only
|
$59.20 |
$59.20 |
$59.20 |
$81.00
|
|
Surgical pathology level 2 gross & microscopic examination
|
$123.20 |
$123.20 |
$123.20 |
$143.55
|
|
Surgical pathology level 3 gross & microscopic examination
|
$164.80 |
$164.80 |
$164.80 |
$184.21
|
|
Surgical pathology level 4 gross & microscopic examination
|
$148.00 |
$148.00 |
$148.00 |
$250.20
|
|
Surgical pathology level 5 gross & microscopic examination
|
$522.40 |
$522.40 |
$522.40 |
$480.60
|
|
Surgical pathology level 6 gross & microscopic examination
|
$694.40 |
$694.40 |
$694.40 |
$720.75
|
|
Susceptibility agar dilution per agent
|
$61.60 |
$61.60 |
$61.60 |
$45.60
|
|
Susceptibility enzyme detection per enzyme
|
$32.80 |
$32.80 |
$32.80 |
$35.89
|
|
Susceptibility mic per plate
|
$176.00 |
$176.00 |
$176.00 |
$106.00
|
|
Swallowing Evaluation (Bedside)
|
$384.80 |
$384.80 |
$384.80 |
$316.80
|
|
Swallowing Therapy Session
|
$280.00 |
$280.00 |
$280.00 |
$232.56
|
|
Syphilis test non-treponemal antibody quantitative rpr
|
$11.20 |
$11.20 |
$11.20 |
$42.24
|
|
T3 (triiodothyronine) free
|
$102.40 |
$102.40 |
$102.40 |
$100.32
|
|
T3 (triiodothyronine) total
|
$102.40 |
$102.40 |
$102.40 |
$93.52
|
|
T4 (thyroxine) free
|
$89.60 |
$89.60 |
$89.60 |
$89.60
|
|
T4 (thyroxine) total
|
$52.80 |
$52.80 |
$52.80 |
$70.20
|
|
Tacrolimus 1 mg capsule, immediate-release
|
$5.58 |
$5.58 |
$5.58 |
$9.93
|
|
Tacrolimus therapeutic drug level
|
$180.80 |
$180.80 |
$180.80 |
$122.50
|
|
Tailbone (Sacrum and Coccyx) X-ray
|
$313.60 |
$313.60 |
$313.60 |
$289.20
|
|
Target gsa panel hmtlmph neop
|
$2,392.00 |
$2,392.00 |
$2,392.00 |
$2,246.30
|
|
Target gsa panel organ/hmtlmph neop
|
$7,123.20 |
$7,123.20 |
$7,123.20 |
$3,746.70
|
|
Tb test cell mediated immunity antigen response enumeration gamma interferon t-cells
|
$304.00 |
$304.00 |
$304.00 |
$200.00
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$229.60 |
$229.60 |
$229.60 |
$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 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 pyroph diag per dose up to 25 mci
|
$186.40 |
$186.40 |
$186.40 |
$141.00
|
|
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 tilmanocept diag
|
$1,171.20 |
$1,171.20 |
$1,171.20 |
$985.60
|
|
T cells absolute cd4/cd8 including ratio
|
$147.20 |
$147.20 |
$147.20 |
$184.00
|
|
T cells absolute cd 4 count
|
$124.00 |
$124.00 |
$124.00 |
$111.20
|
|
T cells total count
|
$117.60 |
$117.60 |
$117.60 |
$130.20
|
|
Telavancin injection
|
$1,068.99 |
$1,068.99 |
$1,068.99 |
$1,191.80
|
|
Telehealth original site facility fee
|
$60.80 |
$60.80 |
$60.80 |
$51.00
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$10,743.58 |
$10,743.58 |
$10,743.58 |
$14,951.87
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$35.74 |
$35.74 |
$35.74 |
$39.33
|
|
Tert gene targeted seq alys
|
$1,071.20 |
$1,071.20 |
$1,071.20 |
$335.00
|
|
Test stress cardiovascular tracing only
|
$440.00 |
$440.00 |
$440.00 |
$953.40
|
|
Tetanus immune globulin inj
|
$1,009.47 |
$1,009.47 |
$1,009.47 |
$1,285.36
|
|
Tgsap so/hl 51/< rna alys
|
$7,058.40 |
$7,058.40 |
$7,058.40 |
$4,347.00
|
|
Tgsap so neo 5-50 rna alys
|
$2,193.60 |
$2,193.60 |
$2,193.60 |
$1,009.32
|
|
Theophylline therapeutic drug level
|
$112.80 |
$112.80 |
$112.80 |
$108.00
|
|
Therapeutic procd strg endur
|
$120.80 |
$120.80 |
$120.80 |
$85.68
|
|
Therapy Activity Training (each 15 minutes)
|
$121.60 |
$121.60 |
$121.60 |
$101.38
|
|
Therapy Exercise Session (each 15 minutes)
|
$119.20 |
$119.20 |
$119.20 |
$98.58
|
|
Therapy nutrition individual initial f2f w/patient each 15 minutes
|
$63.20 |
$63.20 |
$63.20 |
$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
|
$41.18 |
$41.18 |
$41.18 |
$25.54
|
|
Thigh Bone (Femur) X-ray (both sides)
|
$305.60 |
$305.60 |
$305.60 |
$313.60
|
|
Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides)
|
$1,502.40 |
$1,502.40 |
$1,502.40 |
$1,724.25
|
|
Three-Phase Bone Scan (Nuclear Medicine)
|
$1,506.40 |
$1,506.40 |
$1,506.40 |
$1,703.45
|
|
Thrombin time
|
$53.60 |
$53.60 |
$53.60 |
$54.18
|
|
Thromboplastin time partial (ptt) substitution fractions each
|
$81.60 |
$81.60 |
$81.60 |
$62.01
|
|
Thyroglobulin antibody
|
$126.40 |
$126.40 |
$126.40 |
$82.50
|
|
Thyroid (TSH) Test
|
$103.20 |
$103.20 |
$103.20 |
$112.70
|
|
Thyroid Ultrasound
|
$507.20 |
$507.20 |
$507.20 |
$588.50
|
|
Thyroxine binding globulin (tbg)
|
$48.80 |
$48.80 |
$48.80 |
$64.51
|
|
Tigecycline injection
|
$226.89 |
$226.89 |
$226.89 |
$235.29
|
|
Tirofiban 12.5 mg/50 ml
|
$543.51 |
$543.51 |
$543.51 |
$458.85
|
|
Tissue culture skin/biopsy
|
$343.20 |
$343.20 |
$343.20 |
$488.74
|
|
Tissue exam koh skin/hair/nails
|
$43.20 |
$43.20 |
$43.20 |
$47.40
|
|
Tissue transglutaminase iga
|
$44.00 |
$44.00 |
$44.00 |
$44.80
|
|
Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr
|
$35.60 |
$35.60 |
$35.60 |
$152.36
|
|
Tobramycin peak therapeutic drug level
|
$167.20 |
$167.20 |
$167.20 |
$120.60
|
|
Tocilizumab 162 mg/0.9 ml subcutaneous pen injector
|
$4,621.01 |
$4,621.01 |
$4,621.01 |
$5,258.52
|
|
Toe X-ray (both feet)
|
$220.00 |
$220.00 |
$220.00 |
$258.65
|
|
Tomosynthesis breast diagnostic left
|
$80.00 |
$80.00 |
$80.00 |
$74.10
|
|
Tomosynthesis breast screen bilateral
|
$84.00 |
$84.00 |
$84.00 |
$74.10
|
|
Topotecan 4 mg/4 ml (1 mg/ml) intravenous solution
|
$475.71 |
$475.71 |
$475.71 |
$316.84
|
|
Toxoplasma antibody igg
|
$93.60 |
$93.60 |
$93.60 |
$91.65
|
|
Toxoplasma antibody igm
|
$120.80 |
$120.80 |
$120.80 |
$87.75
|
|
Tp53 gene full gene sequence
|
$1,503.20 |
$1,503.20 |
$1,503.20 |
$706.04
|
|
Tp53 gene trgt sequence alys
|
$804.00 |
$804.00 |
$804.00 |
$804.00
|
|
Training self management diabetes individual outpatient department per 30 minutes
|
$117.60 |
$117.60 |
$117.60 |
$102.27
|
|
Transferrin
|
$69.60 |
$69.60 |
$69.60 |
$82.00
|
|
Transvaginal Pelvic Ultrasound (not pregnancy)
|
$601.60 |
$601.60 |
$601.60 |
$561.60
|
|
Transvaginal Pregnancy Ultrasound
|
$387.20 |
$387.20 |
$387.20 |
$499.20
|
|
Trastuzumab 150 mg intravenous solution
|
$2,217.59 |
$2,217.59 |
$2,217.59 |
$3,141.85
|
|
Trastuzumab-anns 150 mg intravenous solution
|
$5,824.20 |
$5,824.20 |
$5,824.20 |
$7,540.20
|
|
Trastuzumab-qyyp 150 mg intravenous solution
|
$4,412.21 |
$4,412.21 |
$4,412.21 |
$5,846.40
|
|
Trauma partial team response w/critical care services level 4
|
$2,640.00 |
$2,640.00 |
$2,640.00 |
$4,523.04
|
|
Treat ankle dislocation
|
$2,207.20 |
$2,207.20 |
$2,207.20 |
$2,360.00
|
|
Treat clavicle dislocation 23545
|
$674.40 |
$674.40 |
$674.40 |
$692.80
|
|
Treat elbow dislocation
|
$2,404.00 |
$2,404.00 |
$2,404.00 |
$2,272.50
|
|
Treat finger fracture each
|
$1,419.20 |
$1,419.20 |
$1,419.20 |
$1,592.00
|
|
Treat hip dislocation
|
$2,448.80 |
$2,448.80 |
$2,448.80 |
$2,211.05
|
|
Treat humerus fracture
|
$1,609.60 |
$1,609.60 |
$1,609.60 |
$1,790.00
|
|
Treat humerus fracture
|
$1,733.60 |
$1,733.60 |
$1,733.60 |
$1,790.00
|
|
Treat kneecap dislocation
|
$1,268.80 |
$1,268.80 |
$1,268.80 |
$1,068.06
|
|
Treat knuckle dislocation
|
$820.80 |
$820.80 |
$820.80 |
$1,726.01
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$240.00 |
$240.00 |
$240.00 |
$227.70
|