|
Sinus CT scan (with and without contrast)
|
$1,248.00 |
$1,248.00 |
$1,248.00 |
$1,610.70
|
|
Sinus CT scan (with contrast)
|
$1,329.90 |
$1,329.90 |
$1,329.90 |
$1,419.18
|
|
Sinus CT scan (without contrast)
|
$1,075.10 |
$1,075.10 |
$1,075.10 |
$1,151.00
|
|
Skin Biopsy
|
$793.00 |
$793.00 |
$793.00 |
$362.40
|
|
Smear fluorescent and/or acid fast stain
|
$48.75 |
$48.75 |
$48.75 |
$50.70
|
|
Smear gram stain
|
$66.30 |
$66.30 |
$66.30 |
$48.00
|
|
Smear special stain inclusion bodies/parasites
|
$106.60 |
$106.60 |
$106.60 |
$60.00
|
|
Smear wet mount
|
$66.30 |
$66.30 |
$66.30 |
$56.13
|
|
Sodium 24 hour urine
|
$51.35 |
$51.35 |
$51.35 |
$47.25
|
|
Sodium serum/plasma/whole blood
|
$57.20 |
$57.20 |
$57.20 |
$42.43
|
|
Sodium thiosulfate 12.5 gram/50 ml (250 mg/ml) intravenous solution
|
$7.15 |
$7.15 |
$7.15 |
$8.89
|
|
Spirometry bronchodilation responsiveness pre/post bronchodilator administration
|
$384.80 |
$384.80 |
$384.80 |
$526.80
|
|
St analysis behavior qualitative voice/resonance
|
$200.85 |
$200.85 |
$200.85 |
$295.10
|
|
Staph a dna amp probe
|
$116.35 |
$116.35 |
$116.35 |
$116.39
|
|
St cognitve performance testing healthcare professional each hour
|
$237.90 |
$237.90 |
$237.90 |
$313.96
|
|
St evaluate speech sound production
|
$193.05 |
$193.05 |
$193.05 |
$298.41
|
|
St evaluate speech sound production comprehensive/expressive
|
$399.75 |
$399.75 |
$399.75 |
$387.00
|
|
St evaluation swallow function
|
$152.10 |
$152.10 |
$152.10 |
$323.72
|
|
Stress test pulmonary
|
$81.25 |
$81.25 |
$81.25 |
$330.63
|
|
St treatment speech individual
|
$235.95 |
$235.95 |
$235.95 |
$246.87
|
|
St treatment swallow dysfunction/oral
|
$471.25 |
$471.25 |
$471.25 |
$221.00
|
|
Surgical pathology level 1 gross examination only
|
$31.20 |
$31.20 |
$31.20 |
$81.00
|
|
Surgical pathology level 2 gross & microscopic examination
|
$74.75 |
$74.75 |
$74.75 |
$138.00
|
|
Surgical pathology level 3 gross & microscopic examination
|
$97.50 |
$97.50 |
$97.50 |
$181.00
|
|
Surgical pathology level 4 gross & microscopic examination
|
$5,976.11 |
$5,976.11 |
$5,976.11 |
$239.85
|
|
Surgical pathology level 5 gross & microscopic examination
|
$291.85 |
$291.85 |
$291.85 |
$489.00
|
|
Surgical pathology level 6 gross & microscopic examination
|
$485.55 |
$485.55 |
$485.55 |
$720.75
|
|
Susceptibility enzyme detection per enzyme
|
$10.40 |
$10.40 |
$10.40 |
$31.85
|
|
Susceptibility mic per plate
|
$126.75 |
$126.75 |
$126.75 |
$89.70
|
|
Syphilis test non-treponemal antibody quantitative rpr
|
$38.35 |
$38.35 |
$38.35 |
$45.70
|
|
T3 (triiodothyronine) free
|
$395.85 |
$395.85 |
$395.85 |
$91.20
|
|
T3 (triiodothyronine) total
|
$107.90 |
$107.90 |
$107.90 |
$88.00
|
|
T4 (thyroxine) free
|
$174.20 |
$174.20 |
$174.20 |
$65.00
|
|
T4 (thyroxine) total
|
$72.15 |
$72.15 |
$72.15 |
$62.40
|
|
Tacrolimus therapeutic drug level
|
$193.05 |
$193.05 |
$193.05 |
$137.15
|
|
Tbo-filgrastim 300 mcg/0.5 ml subcutaneous syringe
|
$779.79 |
$779.79 |
$779.79 |
$760.95
|
|
Tb test cell mediated immunity antigen response enumeration gamma interferon t-cells
|
$89.05 |
$89.05 |
$89.05 |
$221.65
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$113.75 |
$113.75 |
$113.75 |
$178.40
|
|
T cells absolute cd4/cd8 including ratio
|
$213.20 |
$213.20 |
$213.20 |
$189.60
|
|
T cells total count
|
$213.20 |
$213.20 |
$213.20 |
$126.90
|
|
Telehealth original site facility fee
|
$30.55 |
$30.55 |
$30.55 |
$55.65
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$16,665.05 |
$16,665.05 |
$16,665.05 |
$16,233.59
|
|
Test stress cardiovascular tracing only
|
$490.75 |
$490.75 |
$490.75 |
$1,016.00
|
|
Tezepelumab-ekko 210 mg/1.91 ml (110 mg/ml) subcutaneous syringe
|
$11,189.61 |
$11,189.61 |
$11,189.61 |
$6,935.61
|
|
Theophylline therapeutic drug level
|
$143.65 |
$143.65 |
$143.65 |
$101.40
|
|
Therapeutic procd strg endur
|
$46.80 |
$46.80 |
$46.80 |
$72.39
|
|
Therapy nutrition individual initial f2f w/patient each 15 minutes
|
$40.30 |
$40.30 |
$40.30 |
$50.40
|
|
Therapy nutrition individual reassessment/intervention f2f w/patient each 15 minutes
|
$40.30 |
$40.30 |
$40.30 |
$47.50
|
|
Thrombin time
|
$59.80 |
$59.80 |
$59.80 |
$53.50
|
|
Thyroglobulin antibody
|
$87.10 |
$87.10 |
$87.10 |
$86.40
|
|
Thyroid (TSH) Test
|
$174.20 |
$174.20 |
$174.20 |
$101.40
|
|
Thyroid Ultrasound
|
$373.75 |
$373.75 |
$373.75 |
$553.80
|
|
Thyroxine binding globulin (tbg)
|
$126.10 |
$126.10 |
$126.10 |
$75.00
|
|
Tissue exam koh skin/hair/nails
|
$53.30 |
$53.30 |
$53.30 |
$45.23
|
|
Tissue transglutaminase iga
|
$37.70 |
$37.70 |
$37.70 |
$48.57
|
|
Tobramycin peak therapeutic drug level
|
$222.95 |
$222.95 |
$222.95 |
$117.00
|
|
Tocilizumab 162 mg/0.9 ml subcutaneous pen injector
|
$6,481.36 |
$6,481.36 |
$6,481.36 |
$2,743.02
|
|
Tomosynthesis breast diagnostic left
|
$141.70 |
$141.70 |
$141.70 |
$53.92
|
|
Tomosynthesis breast screen bilateral
|
$57.20 |
$57.20 |
$57.20 |
$77.46
|
|
Toxoplasma antibody igg
|
$61.10 |
$61.10 |
$61.10 |
$83.20
|
|
Toxoplasma antibody igm
|
$61.10 |
$61.10 |
$61.10 |
$85.80
|
|
Trabectedin 1 mg intravenous solution
|
$9,630.06 |
$9,630.06 |
$9,630.06 |
$2,653.88
|
|
Transferrin
|
$116.35 |
$116.35 |
$116.35 |
$83.07
|
|
Transfusion blood/blood component(s)
|
$3,254.32 |
$3,254.32 |
$3,254.32 |
$988.24
|
|
Trastuzumab 150 mg intravenous solution
|
$3,806.45 |
$3,806.45 |
$3,806.45 |
$934.80
|
|
Trastuzumab-anns 150 mg intravenous solution
|
$3,322.98 |
$3,322.98 |
$3,322.98 |
$43.28
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$72.80 |
$72.80 |
$72.80 |
$224.90
|
|
Treatment inhalation pressurized/nonpressurized acute airway obstruction
|
$72.15 |
$72.15 |
$72.15 |
$197.60
|
|
Treponema pallidum antibody
|
$73.45 |
$73.45 |
$73.45 |
$74.40
|
|
Triglycerides
|
$65.00 |
$65.00 |
$65.00 |
$48.75
|
|
Troponin quantitative
|
$135.85 |
$135.85 |
$135.85 |
$112.80
|
|
Ultrasound abdomen aorta screening study aaa
|
$232.70 |
$232.70 |
$232.70 |
$394.20
|
|
Ultrasound breast complete
|
$729.30 |
$729.30 |
$729.30 |
$519.20
|
|
Ultrasound breast unilateral limited (both sides)
|
$599.95 |
$599.95 |
$599.95 |
$427.00
|
|
Ultrasound chest
|
$477.75 |
$477.75 |
$477.75 |
$430.10
|
|
Ultrasound joint complete left
|
$626.60 |
$626.60 |
$626.60 |
$534.00
|
|
Ultrasound joint/nonvascular extremity limited left
|
$599.95 |
$599.95 |
$599.95 |
$426.60
|
|
Ultrasound ob >=14wks ea addl gest
|
$232.70 |
$232.70 |
$232.70 |
$431.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$232.70 |
$232.70 |
$232.70 |
$304.80
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$388.05 |
$388.05 |
$388.05 |
$680.71
|
|
Ultrasound pregnant uterus follow up per fetus
|
$311.35 |
$311.35 |
$311.35 |
$393.32
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$388.05 |
$388.05 |
$388.05 |
$434.20
|
|
Ultrasound pregnant uterus transvaginal
|
$477.75 |
$477.75 |
$477.75 |
$477.10
|
|
Ultrasound retroperitoneal limited
|
$230.10 |
$230.10 |
$230.10 |
$469.58
|
|
Ultrasound scrotum and contents
|
$474.50 |
$474.50 |
$474.50 |
$558.03
|
|
Ultrasound transabd ea addl gest
|
$232.70 |
$232.70 |
$232.70 |
$424.80
|
|
Ultrasound transvaginal non obstetric
|
$583.70 |
$583.70 |
$583.70 |
$523.20
|
|
Ultraviolet therapy
|
$43.55 |
$43.55 |
$43.55 |
$42.60
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$1,561.95 |
$1,561.95 |
$1,561.95 |
$2,590.50
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$1,450.15 |
$1,450.15 |
$1,450.15 |
$2,001.87
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$1,337.70 |
$1,337.70 |
$1,337.70 |
$1,794.00
|
|
Upper Endoscopy (EGD, diagnostic)
|
$7,432.50 |
$7,432.50 |
$7,432.50 |
$1,760.00
|
|
Upper Endoscopy (EGD, with biopsy)
|
$6,420.05 |
$6,420.05 |
$6,420.05 |
$1,760.00
|
|
Urea nitrogen
|
$57.20 |
$57.20 |
$57.20 |
$38.25
|
|
Urea nitrogen 24 hour urine
|
$3.25 |
$3.25 |
$3.25 |
$42.90
|
|
Uric acid blood
|
$48.75 |
$48.75 |
$48.75 |
$44.00
|
|
Uric acid urine
|
$118.95 |
$118.95 |
$118.95 |
$43.20
|
|
Urinalysis microscopic only
|
$18.85 |
$18.85 |
$18.85 |
$25.72
|
|
Urinalysis (with microscopy)
|
$62.40 |
$62.40 |
$62.40 |
$37.39
|
|
Urinalysis (without microscopy)
|
$20.15 |
$20.15 |
$20.15 |
$33.00
|
