|
Smear gram stain
|
$44.80 |
$44.80 |
$44.80 |
$55.55
|
|
Smear nasal eosinophil
|
$24.80 |
$24.80 |
$24.80 |
$46.20
|
|
Smear special stain inclusion bodies/parasites
|
$98.40 |
$98.40 |
$98.40 |
$73.50
|
|
Smear wet mount
|
$48.00 |
$48.00 |
$48.00 |
$67.55
|
|
Sodium 24 hour urine
|
$46.40 |
$46.40 |
$46.40 |
$48.98
|
|
Sodium chloride 0.9 % intravenous solution
|
$40.00 |
$40.00 |
$40.00 |
$49.07
|
|
Sodium chloride 0.9 % IV bolus
|
$40.00 |
$40.00 |
$40.00 |
$45.62
|
|
Sodium chloride 0.9 % IV bolus
|
$40.00 |
$40.00 |
$40.00 |
$37.64
|
|
Sodium chloride 3 % ivpb
|
$3.00 |
$3.00 |
$3.00 |
$40.61
|
|
Sodium ferric gluconate complex in sucrose 62.5 mg/5 ml intravenous
|
$29.96 |
$29.96 |
$29.96 |
$80.14
|
|
Sodium serum/plasma/whole blood
|
$45.60 |
$45.60 |
$45.60 |
$46.26
|
|
Specimen fat stain
|
$16.80 |
$16.80 |
$16.80 |
$37.40
|
|
Speech and Language Evaluation (comprehensive)
|
$337.60 |
$337.60 |
$337.60 |
$384.80
|
|
Speech Therapy Session (one-on-one)
|
$268.80 |
$268.80 |
$268.80 |
$246.87
|
|
Spine X-ray (single view, one level)
|
$272.80 |
$272.80 |
$272.80 |
$251.00
|
|
St analysis behavior qualitative voice/resonance
|
$248.00 |
$248.00 |
$248.00 |
$297.60
|
|
St cognitve performance testing healthcare professional each hour
|
$347.20 |
$347.20 |
$347.20 |
$286.00
|
|
Sterile water/saline, 10 ml
|
$2.40 |
$2.40 |
$2.40 |
$13.32
|
|
Sterile water/saline, 500 ml
|
$40.00 |
$40.00 |
$40.00 |
$28.11
|
|
St evaluate speech sound production
|
$237.60 |
$237.60 |
$237.60 |
$292.95
|
|
Strapping of ankle and/or ft 29540
|
$228.80 |
$228.80 |
$228.80 |
$223.45
|
|
Strapping of elbow or wrist 29260
|
$192.00 |
$192.00 |
$192.00 |
$157.46
|
|
Strep b dna amp probe
|
$71.20 |
$71.20 |
$71.20 |
$124.15
|
|
Succinylcholine chloride 20 mg/ml injection solution (wrapper)
|
$31.83 |
$31.83 |
$31.83 |
$54.80
|
|
Sulfamethoxazole 400 mg-trimethoprim 80 mg/5 ml intravenous solution
|
$29.92 |
$29.92 |
$29.92 |
$82.46
|
|
Sumatriptan 6 mg/0.5 ml subcutaneous solution
|
$33.12 |
$33.12 |
$33.12 |
$129.89
|
|
Surgical pathology level 1 gross examination only
|
$56.00 |
$56.00 |
$56.00 |
$81.00
|
|
Surgical pathology level 2 gross & microscopic examination
|
$85.60 |
$85.60 |
$85.60 |
$143.55
|
|
Surgical pathology level 3 gross & microscopic examination
|
$101.60 |
$101.60 |
$101.60 |
$184.21
|
|
Surgical pathology level 4 gross & microscopic examination
|
$154.40 |
$154.40 |
$154.40 |
$250.20
|
|
Surgical pathology level 5 gross & microscopic examination
|
$463.20 |
$463.20 |
$463.20 |
$480.60
|
|
Surgical pathology level 6 gross & microscopic examination
|
$716.00 |
$716.00 |
$716.00 |
$720.75
|
|
Susceptibility agar dilution per agent
|
$36.00 |
$36.00 |
$36.00 |
$45.60
|
|
Susceptibility mic per plate
|
$68.00 |
$68.00 |
$68.00 |
$106.00
|
|
Swallowing Evaluation (Bedside)
|
$338.40 |
$338.40 |
$338.40 |
$316.80
|
|
Swallowing Therapy Session
|
$273.60 |
$273.60 |
$273.60 |
$232.56
|
|
Synvisc or synvisc-one
|
$608.68 |
$608.68 |
$608.68 |
$1,242.63
|
|
Syphilis test non-treponemal antibody quantitative rpr
|
$11.20 |
$11.20 |
$11.20 |
$42.24
|
|
T3 (triiodothyronine) free
|
$122.40 |
$122.40 |
$122.40 |
$100.32
|
|
T3 (triiodothyronine) total
|
$107.20 |
$107.20 |
$107.20 |
$93.52
|
|
T4 (thyroxine) free
|
$81.60 |
$81.60 |
$81.60 |
$89.60
|
|
T4 (thyroxine) total
|
$44.80 |
$44.80 |
$44.80 |
$70.20
|
|
Tacrolimus 1 mg capsule, immediate-release
|
$2.40 |
$2.40 |
$2.40 |
$9.93
|
|
Tacrolimus therapeutic drug level
|
$180.00 |
$180.00 |
$180.00 |
$122.50
|
|
Tailbone (Sacrum and Coccyx) X-ray
|
$336.80 |
$336.80 |
$336.80 |
$289.20
|
|
Tb test cell mediated immunity antigen response enumeration gamma interferon t-cells
|
$289.60 |
$289.60 |
$289.60 |
$200.00
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$250.40 |
$250.40 |
$250.40 |
$179.95
|
|
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 sestamibi p study dose
|
$352.00 |
$352.00 |
$352.00 |
$287.20
|
|
T cells absolute cd4/cd8 including ratio
|
$156.00 |
$156.00 |
$156.00 |
$184.00
|
|
T cells absolute cd 4 count
|
$114.40 |
$114.40 |
$114.40 |
$111.20
|
|
T cells total count
|
$139.20 |
$139.20 |
$139.20 |
$130.20
|
|
Telehealth original site facility fee
|
$57.60 |
$57.60 |
$57.60 |
$51.00
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$8,632.32 |
$8,632.32 |
$8,632.32 |
$14,951.87
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$38.63 |
$38.63 |
$38.63 |
$39.33
|
|
Test stress cardiovascular tracing only
|
$824.80 |
$824.80 |
$824.80 |
$953.40
|
|
Theophylline therapeutic drug level
|
$108.80 |
$108.80 |
$108.80 |
$108.00
|
|
Therapy Activity Training (each 15 minutes)
|
$104.00 |
$104.00 |
$104.00 |
$101.38
|
|
Therapy Exercise Session (each 15 minutes)
|
$112.00 |
$112.00 |
$112.00 |
$98.58
|
|
Therapy nutrition individual initial f2f w/patient each 15 minutes
|
$62.40 |
$62.40 |
$62.40 |
$57.50
|
|
Therapy nutrition individual reassessment/intervention f2f w/patient each 15 minutes
|
$48.00 |
$48.00 |
$48.00 |
$50.40
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$30.12 |
$30.12 |
$30.12 |
$25.54
|
|
Thigh Bone (Femur) X-ray (both sides)
|
$313.60 |
$313.60 |
$313.60 |
$313.60
|
|
Three-Phase Bone Scan (Nuclear Medicine)
|
$2,024.00 |
$2,024.00 |
$2,024.00 |
$1,703.45
|
|
Thrombin time
|
$43.20 |
$43.20 |
$43.20 |
$54.18
|
|
Thromboplastin time partial (ptt) substitution fractions each
|
$20.00 |
$20.00 |
$20.00 |
$62.01
|
|
Thyroglobulin antibody
|
$79.20 |
$79.20 |
$79.20 |
$82.50
|
|
Thyroid imaging
|
$973.60 |
$973.60 |
$973.60 |
$695.60
|
|
Thyroid (TSH) Test
|
$104.00 |
$104.00 |
$104.00 |
$112.70
|
|
Thyroid Ultrasound
|
$674.40 |
$674.40 |
$674.40 |
$588.50
|
|
Thyroxine binding globulin (tbg)
|
$48.80 |
$48.80 |
$48.80 |
$64.51
|
|
Tissue exam koh skin/hair/nails
|
$44.00 |
$44.00 |
$44.00 |
$47.40
|
|
Tissue transglutaminase iga
|
$44.80 |
$44.80 |
$44.80 |
$44.80
|
|
Toe X-ray (both feet)
|
$220.80 |
$220.80 |
$220.80 |
$258.65
|
|
Tomosynthesis breast diagnostic left
|
$96.80 |
$96.80 |
$96.80 |
$74.10
|
|
Tomosynthesis breast screen bilateral
|
$91.20 |
$91.20 |
$91.20 |
$74.10
|
|
Toxoplasma antibody igg
|
$83.20 |
$83.20 |
$83.20 |
$91.65
|
|
Toxoplasma antibody igm
|
$61.60 |
$61.60 |
$61.60 |
$87.75
|
|
Tp53 gene trgt sequence alys
|
$869.60 |
$869.60 |
$869.60 |
$804.00
|
|
Transferrin
|
$55.20 |
$55.20 |
$55.20 |
$82.00
|
|
Transvaginal Pelvic Ultrasound (not pregnancy)
|
$680.80 |
$680.80 |
$680.80 |
$561.60
|
|
Transvaginal Pregnancy Ultrasound
|
$624.00 |
$624.00 |
$624.00 |
$499.20
|
|
Trauma partial team response w/critical care services level 4
|
$1,572.80 |
$1,572.80 |
$1,572.80 |
$4,523.04
|
|
Treat elbow dislocation
|
$2,626.40 |
$2,626.40 |
$2,626.40 |
$2,272.50
|
|
Treat fracture of radius
|
$1,348.80 |
$1,348.80 |
$1,348.80 |
$1,790.00
|
|
Treat fracture of ulna
|
$1,016.00 |
$1,016.00 |
$1,016.00 |
$731.04
|
|
Treat hip dislocation
|
$2,192.00 |
$2,192.00 |
$2,192.00 |
$2,211.05
|
|
Treat knee fracture 27530
|
$573.60 |
$573.60 |
$573.60 |
$550.73
|
|
Treatment of ankle fracture 27786
|
$556.80 |
$556.80 |
$556.80 |
$523.20
|
|
Treatment of fibula fracture 27780
|
$494.40 |
$494.40 |
$494.40 |
$501.20
|
|
Treatment of heel fracture 28400
|
$482.40 |
$482.40 |
$482.40 |
$473.00
|
|
Treatment of thigh fracture
|
$602.40 |
$602.40 |
$602.40 |
$549.00
|
|
Treatment of toe fracture 28510
|
$399.20 |
$399.20 |
$399.20 |
$371.40
|
|
Treat thigh fracture
|
$568.80 |
$568.80 |
$568.80 |
$661.00
|
|
Treat thigh fracture
|
$1,592.80 |
$1,592.80 |
$1,592.80 |
$1,893.86
|
|
Treat thigh fx growth plate
|
$332.80 |
$332.80 |
$332.80 |
$478.40
|
|
Treat ulnar fracture
|
$1,672.00 |
$1,672.00 |
$1,672.00 |
$1,677.20
|
|
Treponema pallidum antibody
|
$69.60 |
$69.60 |
$69.60 |
$72.05
|
