|
Smear nasal eosinophil
|
$66.40 |
$66.40 |
$66.40 |
$46.20
|
|
Smear special stain inclusion bodies/parasites
|
$162.40 |
$162.40 |
$162.40 |
$73.50
|
|
Smear wet mount
|
$101.60 |
$101.60 |
$101.60 |
$67.55
|
|
Sodium 24 hour urine
|
$81.60 |
$81.60 |
$81.60 |
$48.98
|
|
Sodium chloride 0.9 % intravenous solution
|
$80.00 |
$80.00 |
$80.00 |
$49.07
|
|
Sodium chloride 0.9 % IV bolus
|
$80.00 |
$80.00 |
$80.00 |
$45.62
|
|
Sodium chloride 0.9 % IV bolus
|
$72.00 |
$72.00 |
$72.00 |
$37.64
|
|
Sodium chloride 3 % ivpb
|
$5.19 |
$5.19 |
$5.19 |
$40.61
|
|
Sodium serum/plasma/whole blood
|
$100.00 |
$100.00 |
$100.00 |
$46.26
|
|
Sodium thiosulfate 12.5 gram/50 ml (250 mg/ml) intravenous solution
|
$95.89 |
$95.89 |
$95.89 |
$177.52
|
|
Specimen fat stain
|
$121.60 |
$121.60 |
$121.60 |
$37.40
|
|
Speech and Language Evaluation (comprehensive)
|
$490.40 |
$490.40 |
$490.40 |
$384.80
|
|
Speech Therapy Session (one-on-one)
|
$324.00 |
$324.00 |
$324.00 |
$246.87
|
|
Spine X-ray (single view, one level)
|
$393.60 |
$393.60 |
$393.60 |
$251.00
|
|
Spleen imaging
|
$759.20 |
$759.20 |
$759.20 |
$679.00
|
|
St analysis behavior qualitative voice/resonance
|
$390.40 |
$390.40 |
$390.40 |
$297.60
|
|
Stent bili dbl pgtl 10fx5cm
|
$202.40 |
$202.40 |
$202.40 |
$2,704.27
|
|
Sterile water/saline, 10 ml
|
$5.19 |
$5.19 |
$5.19 |
$13.32
|
|
Sterile water/saline, 500 ml
|
$60.56 |
$60.56 |
$60.56 |
$28.11
|
|
St evaluate speech sound production
|
$376.80 |
$376.80 |
$376.80 |
$292.95
|
|
Stomach Emptying Scan (Nuclear Medicine)
|
$1,900.00 |
$1,900.00 |
$1,900.00 |
$1,345.40
|
|
Succinylcholine chloride 20 mg/ml injection solution (wrapper)
|
$71.60 |
$71.60 |
$71.60 |
$54.80
|
|
Sumatriptan 6 mg/0.5 ml subcutaneous solution
|
$64.83 |
$64.83 |
$64.83 |
$129.89
|
|
Support clav 29.6-40.5in med
|
$31.20 |
$31.20 |
$31.20 |
$94.08
|
|
Surgical pathology level 1 gross examination only
|
$64.00 |
$64.00 |
$64.00 |
$81.00
|
|
Surgical pathology level 2 gross & microscopic examination
|
$136.00 |
$136.00 |
$136.00 |
$143.55
|
|
Surgical pathology level 3 gross & microscopic examination
|
$140.00 |
$140.00 |
$140.00 |
$184.21
|
|
Surgical pathology level 4 gross & microscopic examination
|
$145.60 |
$145.60 |
$145.60 |
$250.20
|
|
Surgical pathology level 5 gross & microscopic examination
|
$679.20 |
$679.20 |
$679.20 |
$480.60
|
|
Surgical pathology level 6 gross & microscopic examination
|
$1,002.40 |
$1,002.40 |
$1,002.40 |
$720.75
|
|
Susceptibility agar dilution per agent
|
$117.60 |
$117.60 |
$117.60 |
$45.60
|
|
Susceptibility enzyme detection per enzyme
|
$162.40 |
$162.40 |
$162.40 |
$35.89
|
|
Susceptibility mic per plate
|
$191.20 |
$191.20 |
$191.20 |
$106.00
|
|
Swallowing Evaluation (Bedside)
|
$410.40 |
$410.40 |
$410.40 |
$316.80
|
|
Swallowing Therapy Session
|
$312.80 |
$312.80 |
$312.80 |
$232.56
|
|
Synvisc or synvisc-one
|
$395.25 |
$395.25 |
$395.25 |
$1,242.63
|
|
Syphilis test non-treponemal antibody quantitative rpr
|
$48.80 |
$48.80 |
$48.80 |
$42.24
|
|
T3 (triiodothyronine) free
|
$147.20 |
$147.20 |
$147.20 |
$100.32
|
|
T3 (triiodothyronine) total
|
$92.00 |
$92.00 |
$92.00 |
$93.52
|
|
T4 (thyroxine) free
|
$160.80 |
$160.80 |
$160.80 |
$89.60
|
|
T4 (thyroxine) total
|
$103.20 |
$103.20 |
$103.20 |
$70.20
|
|
Tacrolimus therapeutic drug level
|
$196.00 |
$196.00 |
$196.00 |
$122.50
|
|
Tailbone (Sacrum and Coccyx) X-ray
|
$442.40 |
$442.40 |
$442.40 |
$289.20
|
|
Tb test cell mediated immunity antigen response enumeration gamma interferon t-cells
|
$279.20 |
$279.20 |
$279.20 |
$200.00
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$542.40 |
$542.40 |
$542.40 |
$179.95
|
|
Tc-99m labeled rbc
|
$428.00 |
$428.00 |
$428.00 |
$306.00
|
|
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 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 cd4/cd8 including ratio
|
$184.00 |
$184.00 |
$184.00 |
$184.00
|
|
T cells total count
|
$160.80 |
$160.80 |
$160.80 |
$130.20
|
|
Telavancin injection
|
$693.60 |
$693.60 |
$693.60 |
$1,191.80
|
|
Telehealth original site facility fee
|
$69.60 |
$69.60 |
$69.60 |
$51.00
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$8,113.89 |
$8,113.89 |
$8,113.89 |
$14,951.87
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$61.20 |
$61.20 |
$61.20 |
$39.33
|
|
Test stress cardiovascular tracing only
|
$1,112.80 |
$1,112.80 |
$1,112.80 |
$953.40
|
|
Tetanus immune globulin inj
|
$598.64 |
$598.64 |
$598.64 |
$1,285.36
|
|
Theophylline therapeutic drug level
|
$162.40 |
$162.40 |
$162.40 |
$108.00
|
|
Therapeutic procd strg endur
|
$136.00 |
$136.00 |
$136.00 |
$85.68
|
|
Therapy Activity Training (each 15 minutes)
|
$133.60 |
$133.60 |
$133.60 |
$101.38
|
|
Therapy Exercise Session (each 15 minutes)
|
$128.80 |
$128.80 |
$128.80 |
$98.58
|
|
Therapy nutrition individual initial f2f w/patient each 15 minutes
|
$70.40 |
$70.40 |
$70.40 |
$57.50
|
|
Therapy nutrition individual reassessment/intervention f2f w/patient each 15 minutes
|
$64.00 |
$64.00 |
$64.00 |
$50.40
|
|
Ther/proph/diag inj ia
|
$226.40 |
$226.40 |
$226.40 |
$247.33
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$63.40 |
$63.40 |
$63.40 |
$25.54
|
|
Thigh Bone (Femur) X-ray (both sides)
|
$468.80 |
$468.80 |
$468.80 |
$313.60
|
|
Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides)
|
$1,754.40 |
$1,754.40 |
$1,754.40 |
$1,724.25
|
|
Three-Phase Bone Scan (Nuclear Medicine)
|
$2,329.60 |
$2,329.60 |
$2,329.60 |
$1,703.45
|
|
Thrombin time
|
$57.60 |
$57.60 |
$57.60 |
$54.18
|
|
Thromboplastin time partial (ptt) substitution fractions each
|
$179.20 |
$179.20 |
$179.20 |
$62.01
|
|
Thyroglobulin antibody
|
$181.60 |
$181.60 |
$181.60 |
$82.50
|
|
Thyroid imaging
|
$1,136.00 |
$1,136.00 |
$1,136.00 |
$695.60
|
|
Thyroid (TSH) Test
|
$141.60 |
$141.60 |
$141.60 |
$112.70
|
|
Thyroid Ultrasound
|
$902.40 |
$902.40 |
$902.40 |
$588.50
|
|
Thyroid uptake measurement
|
$1,538.40 |
$1,538.40 |
$1,538.40 |
$591.25
|
|
Thyroxine binding globulin (tbg)
|
$48.80 |
$48.80 |
$48.80 |
$64.51
|
|
Tissue exam koh skin/hair/nails
|
$140.80 |
$140.80 |
$140.80 |
$47.40
|
|
Tissue transglutaminase iga
|
$11.20 |
$11.20 |
$11.20 |
$44.80
|
|
Toe X-ray (both feet)
|
$351.20 |
$351.20 |
$351.20 |
$258.65
|
|
Tomosynthesis breast screen bilateral
|
$90.40 |
$90.40 |
$90.40 |
$74.10
|
|
Toxoplasma antibody igg
|
$180.80 |
$180.80 |
$180.80 |
$91.65
|
|
Toxoplasma antibody igm
|
$184.00 |
$184.00 |
$184.00 |
$87.75
|
|
Tp53 gene trgt sequence alys
|
$550.40 |
$550.40 |
$550.40 |
$804.00
|
|
Training self management diabetes individual outpatient department per 30 minutes
|
$128.80 |
$128.80 |
$128.80 |
$102.27
|
|
Transferrin
|
$144.80 |
$144.80 |
$144.80 |
$82.00
|
|
Transvaginal Pelvic Ultrasound (not pregnancy)
|
$903.20 |
$903.20 |
$903.20 |
$561.60
|
|
Transvaginal Pregnancy Ultrasound
|
$896.80 |
$896.80 |
$896.80 |
$499.20
|
|
Trastuzumab 150 mg intravenous solution
|
$2,253.51 |
$2,253.51 |
$2,253.51 |
$3,141.85
|
|
Trastuzumab-anns 150 mg intravenous solution
|
$4,309.20 |
$4,309.20 |
$4,309.20 |
$7,540.20
|
|
Trauma partial team response w/critical care services level 4
|
$2,565.60 |
$2,565.60 |
$2,565.60 |
$4,523.04
|
|
Treat ankle dislocation
|
$2,006.40 |
$2,006.40 |
$2,006.40 |
$2,360.00
|
|
Treat elbow dislocation
|
$2,699.20 |
$2,699.20 |
$2,699.20 |
$2,272.50
|
|
Treat finger fracture each
|
$1,012.00 |
$1,012.00 |
$1,012.00 |
$1,592.00
|
|
Treat foot dislocation
|
$348.00 |
$348.00 |
$348.00 |
$405.60
|
|
Treat foot dislocation
|
$348.00 |
$348.00 |
$348.00 |
$534.05
|
|
Treat foot dislocation
|
$384.80 |
$384.80 |
$384.80 |
$445.80
|
|
Treat fracture of ulna
|
$1,955.20 |
$1,955.20 |
$1,955.20 |
$731.04
|
