|
Spirometry bronchodilation responsiveness pre/post bronchodilator administration
|
$302.40 |
$302.40 |
$302.40 |
$559.96
|
|
Splint dorsal bloc wh med perf 3.2mm lf polyflex ii
|
$344.00 |
$344.00 |
$344.00 |
$382.20
|
|
Split atogrft f/s/n/h/f/g/m/d gt 1st 100sqcm/</1 %
|
$1,244.00 |
$1,244.00 |
$1,244.00 |
$4,560.66
|
|
St analysis behavior qualitative voice/resonance
|
$202.40 |
$202.40 |
$202.40 |
$300.00
|
|
Staph a dna amp probe
|
$168.00 |
$168.00 |
$168.00 |
$116.39
|
|
St cognitve performance testing healthcare professional each hour
|
$191.20 |
$191.20 |
$191.20 |
$313.96
|
|
St evaluate speech sound production
|
$202.40 |
$202.40 |
$202.40 |
$300.00
|
|
St evaluate speech sound production comprehensive/expressive
|
$343.20 |
$343.20 |
$343.20 |
$393.00
|
|
St evaluation motion fluoroscopic swallow function cine/video
|
$295.20 |
$295.20 |
$295.20 |
$406.40
|
|
St evaluation swallow function
|
$128.00 |
$128.00 |
$128.00 |
$336.60
|
|
Strapping of ankle and/or ft 29540
|
$42.40 |
$42.40 |
$42.40 |
$248.05
|
|
Strapping of elbow or wrist 29260
|
$43.20 |
$43.20 |
$43.20 |
$171.00
|
|
Strapping of hand or finger
|
$44.80 |
$44.80 |
$44.80 |
$194.40
|
|
Strapping of knee
|
$44.00 |
$44.00 |
$44.00 |
$224.80
|
|
Strapping of toes 29550
|
$29.60 |
$29.60 |
$29.60 |
$185.36
|
|
Strep a ag ia
|
$51.20 |
$51.20 |
$51.20 |
$75.40
|
|
Strep b assay w/optic
|
$51.20 |
$51.20 |
$51.20 |
$32.00
|
|
Strep b dna amp probe
|
$237.60 |
$237.60 |
$237.60 |
$139.20
|
|
Stress test pulmonary
|
$182.40 |
$182.40 |
$182.40 |
$327.20
|
|
Stress tte complete
|
$341.60 |
$341.60 |
$341.60 |
$1,964.95
|
|
St treatment speech individual
|
$118.40 |
$118.40 |
$118.40 |
$254.15
|
|
St treatment swallow dysfunction/oral
|
$115.20 |
$115.20 |
$115.20 |
$261.60
|
|
Subq njx filling matrl 1cc/<
|
$117.60 |
$117.60 |
$117.60 |
$235.13
|
|
Subq njx fil matrl 5.1-10cc
|
$218.40 |
$218.40 |
$218.40 |
$748.14
|
|
Subsequent intensive care infant 1500-2500 grams 99479
|
$179.20 |
$179.20 |
$179.20 |
$224.80
|
|
Subsequent intensive care infant 2501-5000 grams 99480
|
$172.00 |
$172.00 |
$172.00 |
$216.00
|
|
Succinylcholine chloride 20 mg/ml injection solution (wrapper)
|
$132.98 |
$132.98 |
$132.98 |
$49.13
|
|
Sulfamethoxazole 400 mg-trimethoprim 80 mg/5 ml intravenous solution
|
$114.01 |
$114.01 |
$114.01 |
$66.80
|
|
Sumatriptan 6 mg/0.5 ml subcutaneous solution
|
$94.62 |
$94.62 |
$94.62 |
$84.15
|
|
Surg dx exam anorectal
|
$154.40 |
$154.40 |
$154.40 |
$3,035.44
|
|
Surg ect salp-oophorectomy 59120
|
$1,207.20 |
$1,207.20 |
$1,207.20 |
$1,955.20
|
|
Surgical pathology level 1 gross examination only
|
$73.60 |
$73.60 |
$73.60 |
$92.59
|
|
Surgical pathology level 2 gross & microscopic examination
|
$79.20 |
$79.20 |
$79.20 |
$149.76
|
|
Surgical pathology level 3 gross & microscopic examination
|
$81.60 |
$81.60 |
$81.60 |
$192.00
|
|
Surgical pathology level 4 gross & microscopic examination
|
$223.20 |
$223.20 |
$223.20 |
$253.75
|
|
Surgical pathology level 5 gross & microscopic examination
|
$144.80 |
$144.80 |
$144.80 |
$494.00
|
|
Surgical pathology level 6 gross & microscopic examination
|
$336.80 |
$336.80 |
$336.80 |
$790.00
|
|
Susceptibility agar dilution per agent
|
$89.60 |
$89.60 |
$89.60 |
$40.30
|
|
Susceptibility enzyme detection per enzyme
|
$32.80 |
$32.80 |
$32.80 |
$34.48
|
|
Susceptibility mic per plate
|
$208.00 |
$208.00 |
$208.00 |
$94.38
|
|
Suspension of testis
|
$446.40 |
$446.40 |
$446.40 |
$3,817.53
|
|
Synvisc or synvisc-one
|
$1,742.98 |
$1,742.98 |
$1,742.98 |
$1,696.83
|
|
T3 (triiodothyronine) free
|
$178.40 |
$178.40 |
$178.40 |
$89.82
|
|
T3 (triiodothyronine) total
|
$91.20 |
$91.20 |
$91.20 |
$94.90
|
|
T4 (thyroxine) free
|
$127.20 |
$127.20 |
$127.20 |
$81.60
|
|
T4 (thyroxine) total
|
$94.40 |
$94.40 |
$94.40 |
$73.64
|
|
Tacrolimus 1 mg capsule, immediate-release
|
$10.70 |
$10.70 |
$10.70 |
$9.99
|
|
Tacrolimus therapeutic drug level
|
$196.80 |
$196.80 |
$196.80 |
$122.40
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$289.60 |
$289.60 |
$289.60 |
$166.46
|
|
Tca peel dermal 15789
|
$776.80 |
$776.80 |
$776.80 |
$1,276.60
|
|
T cells absolute cd4/cd8 including ratio
|
$163.20 |
$163.20 |
$163.20 |
$186.00
|
|
T cells absolute cd 4 count
|
$117.60 |
$117.60 |
$117.60 |
$120.25
|
|
T cells total count
|
$156.80 |
$156.80 |
$156.80 |
$124.11
|
|
Tee w or without fol w/cont,cong
|
$1,011.20 |
$1,011.20 |
$1,011.20 |
$1,826.25
|
|
Telehealth original site facility fee
|
$31.20 |
$31.20 |
$31.20 |
$55.65
|
|
Temsirolimus 30 mg/3 ml (10 mg/ml) (first dilution) intravenous soln
|
$2,420.99 |
$2,420.99 |
$2,420.99 |
$3,891.20
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$20,393.69 |
$20,393.69 |
$20,393.69 |
$18,809.85
|
|
Tenodesis biceps tdn at elbw
|
$915.20 |
$915.20 |
$915.20 |
$5,886.74
|
|
Tenosynovectomy radic 26145
|
$794.40 |
$794.40 |
$794.40 |
$1,893.86
|
|
Tenotomy open tndn flxr toe sgl tndn spx
|
$556.80 |
$556.80 |
$556.80 |
$2,139.67
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$69.99 |
$69.99 |
$69.99 |
$44.17
|
|
Test for urine cystines
|
$34.40 |
$34.40 |
$34.40 |
$26.00
|
|
Test stress cardiovascular tracing only
|
$403.20 |
$403.20 |
$403.20 |
$1,001.55
|
|
Tetanus immune globulin inj
|
$1,461.98 |
$1,461.98 |
$1,461.98 |
$1,395.20
|
|
Theophylline therapeutic drug level
|
$149.60 |
$149.60 |
$149.60 |
$108.00
|
|
Therapeutic procd strg endur
|
$66.40 |
$66.40 |
$66.40 |
$81.36
|
|
Therapy nutrition individual initial f2f w/patient each 15 minutes
|
$66.40 |
$66.40 |
$66.40 |
$55.00
|
|
Therapy nutrition individual reassessment/intervention f2f w/patient each 15 minutes
|
$50.40 |
$50.40 |
$50.40 |
$50.40
|
|
Therapy photodnmc lght dstr lsn skn by staff rx per day
|
$196.00 |
$196.00 |
$196.00 |
$283.20
|
|
Ther fx nasal inf turbinate
|
$172.80 |
$172.80 |
$172.80 |
$3,589.62
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$79.74 |
$79.74 |
$79.74 |
$35.43
|
|
Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides)
|
$1,165.60 |
$1,165.60 |
$1,165.60 |
$1,804.00
|
|
Thoracoscopy surgical 32650
|
$991.20 |
$991.20 |
$991.20 |
$2,815.80
|
|
Thoracostomy w/flap drng 32036
|
$1,167.20 |
$1,167.20 |
$1,167.20 |
$3,198.00
|
|
Thoracotomy opn free adhesions 32124
|
$1,368.00 |
$1,368.00 |
$1,368.00 |
$2,256.80
|
|
Thoracotomy with cardiac massage
|
$3,482.40 |
$3,482.40 |
$3,482.40 |
$2,926.56
|
|
Thrombin time
|
$114.40 |
$114.40 |
$114.40 |
$48.75
|
|
Thromboplastin time partial (ptt) substitution fractions each
|
$172.00 |
$172.00 |
$172.00 |
$56.93
|
|
Thyroglobulin antibody
|
$158.40 |
$158.40 |
$158.40 |
$84.00
|
|
Thyroid (TSH) Test
|
$136.00 |
$136.00 |
$136.00 |
$120.00
|
|
Thyroid Ultrasound
|
$433.60 |
$433.60 |
$433.60 |
$589.96
|
|
Thyrotropin alfa 0.9 mg intramuscular solution
|
$5,468.87 |
$5,468.87 |
$5,468.87 |
$5,107.76
|
|
Thyroxine binding globulin (tbg)
|
$140.80 |
$140.80 |
$140.80 |
$63.60
|
|
Tigecycline injection
|
$200.18 |
$200.18 |
$200.18 |
$292.92
|
|
Tissue culture placenta
|
$664.00 |
$664.00 |
$664.00 |
$520.91
|
|
Tissue exam koh skin/hair/nails
|
$43.20 |
$43.20 |
$43.20 |
$47.40
|
|
Tissue transglutaminase iga
|
$80.00 |
$80.00 |
$80.00 |
$48.57
|
|
Tnot opn elbw to sho ea tdn
|
$705.60 |
$705.60 |
$705.60 |
$3,591.33
|
|
Tobramycin peak therapeutic drug level
|
$288.00 |
$288.00 |
$288.00 |
$121.55
|
|
Tocilizumab 162 mg/0.9 ml subcutaneous pen injector
|
$3,318.01 |
$3,318.01 |
$3,318.01 |
$5,842.37
|
|
Tomosynthesis breast diagnostic left
|
$62.40 |
$62.40 |
$62.40 |
$68.90
|
|
Tomosynthesis breast screen bilateral
|
$62.40 |
$62.40 |
$62.40 |
$73.45
|
|
Tongue biopsy; posterior one-third 41105
|
$278.40 |
$278.40 |
$278.40 |
$3,589.62
|
|
Tonsillectomy (age 12+)
|
$375.20 |
$375.20 |
$375.20 |
$3,837.72
|
|
Tonsillectomy (child under 12)
|
$394.40 |
$394.40 |
$394.40 |
$4,881.00
|
|
Topotecan 4 mg/4 ml (1 mg/ml) intravenous solution
|
$384.16 |
$384.16 |
$384.16 |
$298.27
|
|
Total Hip Replacement
|
$1,886.40 |
$1,886.40 |
$1,886.40 |
$6,675.20
|
|
Total hysterectomy
|
$1,491.20 |
$1,491.20 |
$1,491.20 |
$3,001.70
|
|
Total Knee Replacement
|
$1,884.00 |
$1,884.00 |
$1,884.00 |
$6,668.80
|
|
Toxoplasma antibody igg
|
$142.40 |
$142.40 |
$142.40 |
$84.35
|
