|
Smear gram stain
|
$111.10 |
$111.10 |
$111.10 |
$58.05
|
|
Smear nasal eosinophil
|
$42.35 |
$42.35 |
$42.35 |
$50.00
|
|
Smear special stain inclusion bodies/parasites
|
$49.50 |
$49.50 |
$49.50 |
$64.35
|
|
Smear wet mount
|
$78.65 |
$78.65 |
$78.65 |
$68.63
|
|
Sodium 24 hour urine
|
$55.55 |
$55.55 |
$55.55 |
$48.68
|
|
Sodium serum/plasma/whole blood
|
$53.35 |
$53.35 |
$53.35 |
$43.36
|
|
Special physics consult
|
$397.65 |
$397.65 |
$397.65 |
$700.74
|
|
Special radiation dosimetry
|
$209.00 |
$209.00 |
$209.00 |
$422.48
|
|
Special radiation treatment
|
$1,084.60 |
$1,084.60 |
$1,084.60 |
$1,905.15
|
|
Special teletx port plan
|
$471.35 |
$471.35 |
$471.35 |
$1,035.60
|
|
Specific gravity body fluid
|
$20.90 |
$20.90 |
$20.90 |
$22.40
|
|
Specimen fat stain
|
$25.85 |
$25.85 |
$25.85 |
$32.76
|
|
Sperm antibody test
|
$152.35 |
$152.35 |
$152.35 |
$56.44
|
|
Spinal puncture lumbar diagnostic w/fluoroscopic or CT guidance
|
$1,164.90 |
$1,164.90 |
$1,164.90 |
$1,439.40
|
|
Spirometry bronchodilation responsiveness pre/post bronchodilator administration
|
$499.95 |
$499.95 |
$499.95 |
$549.83
|
|
St analysis behavior qualitative voice/resonance
|
$140.58 |
$140.58 |
$140.58 |
$310.20
|
|
Stent/athrectomy/fem/pop/unilat 37227
|
$19,655.90 |
$19,655.90 |
$19,655.90 |
$23,387.00
|
|
Stent axios caut enh 15x10mm electrocaut
|
$2,039.40 |
$2,039.40 |
$2,039.40 |
$30,010.80
|
|
Stent bili rx wallflx 10x80 uncvr
|
$4,853.75 |
$4,853.75 |
$4,853.75 |
$11,162.49
|
|
Stent iliac/open or perc/uni/init 37221
|
$13,397.45 |
$13,397.45 |
$13,397.45 |
$17,281.80
|
|
Stent iliac/open/perc/ea ad/ipsila 37223
|
$4,547.95 |
$4,547.95 |
$4,547.95 |
$9,111.00
|
|
Stent/tib/peroneal/unilat/initial 37230
|
$15,624.95 |
$15,624.95 |
$15,624.95 |
$19,624.54
|
|
St evaluate speech sound production
|
$143.22 |
$143.22 |
$143.22 |
$314.60
|
|
St evaluate speech sound production comprehensive/expressive
|
$291.58 |
$291.58 |
$291.58 |
$416.85
|
|
St evaluation motion fluoroscopic swallow function cine/video
|
$200.75 |
$200.75 |
$200.75 |
$400.40
|
|
St evaluation swallow function
|
$180.40 |
$180.40 |
$180.40 |
$340.13
|
|
Strapping of ankle and/or ft 29540
|
$253.55 |
$253.55 |
$253.55 |
$247.03
|
|
Strapping of elbow or wrist 29260
|
$294.25 |
$294.25 |
$294.25 |
$176.31
|
|
Strapping of hand or finger
|
$261.25 |
$261.25 |
$261.25 |
$197.63
|
|
Strapping of knee
|
$319.55 |
$319.55 |
$319.55 |
$225.29
|
|
Stress test pulmonary
|
$252.45 |
$252.45 |
$252.45 |
$322.85
|
|
St treatment speech individual
|
$143.55 |
$143.55 |
$143.55 |
$256.75
|
|
St treatment swallow dysfunction/oral
|
$145.75 |
$145.75 |
$145.75 |
$256.19
|
|
Sugars single quant
|
$51.70 |
$51.70 |
$51.70 |
$52.47
|
|
Sulfonylurea screen qn-sendout
|
$155.10 |
$155.10 |
$155.10 |
$173.16
|
|
Surgical pathology level 1 gross examination only
|
$69.30 |
$69.30 |
$69.30 |
$92.95
|
|
Surgical pathology level 2 gross & microscopic examination
|
$143.55 |
$143.55 |
$143.55 |
$149.76
|
|
Surgical pathology level 3 gross & microscopic examination
|
$184.25 |
$184.25 |
$184.25 |
$191.00
|
|
Surgical pathology level 4 gross & microscopic examination
|
$224.40 |
$224.40 |
$224.40 |
$256.80
|
|
Surgical pathology level 5 gross & microscopic examination
|
$351.45 |
$351.45 |
$351.45 |
$493.60
|
|
Surgical pathology level 6 gross & microscopic examination
|
$402.05 |
$402.05 |
$402.05 |
$783.25
|
|
Susceptibility agar dilution per agent
|
$14.85 |
$14.85 |
$14.85 |
$40.68
|
|
Susceptibility enzyme detection per enzyme
|
$35.20 |
$35.20 |
$35.20 |
$35.22
|
|
Susceptibility mic per plate
|
$271.01 |
$271.01 |
$271.01 |
$94.38
|
|
Svc venogram s&i
|
$1,532.85 |
$1,532.85 |
$1,532.85 |
$1,890.50
|
|
Syphilis test non-treponemal antibody quantitative rpr
|
$31.35 |
$31.35 |
$31.35 |
$44.85
|
|
System cardiomems hosp electronics
|
$33,266.75 |
$33,266.75 |
$33,266.75 |
$37,141.60
|
|
System pacing micra av
|
$15,908.75 |
$15,908.75 |
$15,908.75 |
$20,408.85
|
|
System pcmkr dual chamber leadless micra av2 intrdcr cath
|
$11,541.20 |
$11,541.20 |
$11,541.20 |
$10,980.00
|
|
T3 (triiodothyronine) free
|
$87.45 |
$87.45 |
$87.45 |
$90.40
|
|
T3 (triiodothyronine) total
|
$84.70 |
$84.70 |
$84.70 |
$93.60
|
|
T4 (thyroxine) free
|
$41.25 |
$41.25 |
$41.25 |
$87.20
|
|
T4 (thyroxine) total
|
$50.05 |
$50.05 |
$50.05 |
$76.05
|
|
Tacrolimus therapeutic drug level
|
$197.45 |
$197.45 |
$197.45 |
$122.50
|
|
Tbs techl calculation only
|
$128.70 |
$128.70 |
$128.70 |
$121.05
|
|
Tb test cell mediated immunity antigen response enumeration gamma interferon t-cells
|
$65.45 |
$65.45 |
$65.45 |
$194.35
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$254.10 |
$254.10 |
$254.10 |
$165.10
|
|
Tc-99m diag per dose
|
$190.30 |
$190.30 |
$190.30 |
$279.95
|
|
Tc-99m exametazime diag
|
$971.85 |
$971.85 |
$971.85 |
$2,166.26
|
|
Tc-99m labeled rbc
|
$264.55 |
$264.55 |
$264.55 |
$319.56
|
|
Tc-99m maa
|
$78.10 |
$78.10 |
$78.10 |
$312.06
|
|
Tc-99m mebrofenin
|
$84.15 |
$84.15 |
$84.15 |
$169.53
|
|
Tc-99m medronate
|
$87.45 |
$87.45 |
$87.45 |
$122.46
|
|
Tc-99m mertiatide
|
$143.55 |
$143.55 |
$143.55 |
$757.25
|
|
Tc-99m pentetate dtpa
|
$90.20 |
$90.20 |
$90.20 |
$232.88
|
|
Tc-99m pentetate dtpa aerosol
|
$88.00 |
$88.00 |
$88.00 |
$244.02
|
|
Tc-99m pertechnetate per mci
|
$42.90 |
$42.90 |
$42.90 |
$27.20
|
|
Tc-99m sestamibi p study dose
|
$144.10 |
$144.10 |
$144.10 |
$221.60
|
|
Tc-99m sulfur colloid
|
$163.90 |
$163.90 |
$163.90 |
$245.20
|
|
Tc-99m tetrofosmin p study dose
|
$119.90 |
$119.90 |
$119.90 |
$198.05
|
|
Tc-99m tilmanocept diag
|
$751.85 |
$751.85 |
$751.85 |
$930.54
|
|
T cells absolute cd4/cd8 including ratio
|
$80.85 |
$80.85 |
$80.85 |
$179.40
|
|
T cells absolute cd 4 count
|
$386.10 |
$386.10 |
$386.10 |
$122.85
|
|
T cells total count
|
$77.00 |
$77.00 |
$77.00 |
$119.25
|
|
Telethx isodose plan cplx
|
$636.35 |
$636.35 |
$636.35 |
$1,627.54
|
|
Telethx isodose plan simple
|
$334.40 |
$334.40 |
$334.40 |
$813.43
|
|
Test stress cardiovascular tracing only
|
$413.60 |
$413.60 |
$413.60 |
$1,016.00
|
|
Theophylline therapeutic drug level
|
$155.65 |
$155.65 |
$155.65 |
$108.00
|
|
Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides)
|
$1,340.35 |
$1,340.35 |
$1,340.35 |
$1,769.04
|
|
Thrombectomy/inf pq dialysis circuit w/pta
|
$17,637.95 |
$17,637.95 |
$17,637.95 |
$14,875.00
|
|
Thrombin time
|
$24.20 |
$24.20 |
$24.20 |
$48.10
|
|
Thromboplastin time partial (ptt) substitution fractions each
|
$47.30 |
$47.30 |
$47.30 |
$57.50
|
|
Thyroglobulin antibody
|
$357.50 |
$357.50 |
$357.50 |
$85.15
|
|
Thyroid mets imag whole body
|
$902.00 |
$902.00 |
$902.00 |
$1,520.70
|
|
Thyroid (TSH) Test
|
$69.85 |
$69.85 |
$69.85 |
$120.00
|
|
Thyroid Ultrasound
|
$457.05 |
$457.05 |
$457.05 |
$589.96
|
|
Thyroxine binding globulin (tbg)
|
$108.35 |
$108.35 |
$108.35 |
$63.72
|
|
Tib/per revasc stent & ather 37231
|
$16,251.40 |
$16,251.40 |
$16,251.40 |
$21,900.00
|
|
Tib/per revasc stnt & ather
|
$7,553.15 |
$7,553.15 |
$7,553.15 |
$11,121.63
|
|
Tib/per revasc w/ather add-on 37233
|
$7,269.35 |
$7,269.35 |
$7,269.35 |
$9,769.65
|
|
Tissue culture skin/biopsy
|
$228.25 |
$228.25 |
$228.25 |
$558.87
|
|
Tissue exam koh skin/hair/nails
|
$134.75 |
$134.75 |
$134.75 |
$47.40
|
|
Tissue transglutaminase iga
|
$85.25 |
$85.25 |
$85.25 |
$48.57
|
|
Tl-201 thallium diag per mci
|
$52.25 |
$52.25 |
$52.25 |
$77.22
|
|
Tobramycin peak therapeutic drug level
|
$63.80 |
$63.80 |
$63.80 |
$118.30
|
|
Tomosynthesis breast screen bilateral
|
$94.60 |
$94.60 |
$94.60 |
$70.92
|
|
Total tau
|
$137.50 |
$137.50 |
$137.50 |
$293.00
|
|
Toxoplasma antibody igg
|
$44.55 |
$44.55 |
$44.55 |
$85.80
|
|
Toxoplasma antibody igm
|
$93.50 |
$93.50 |
$93.50 |
$87.75
|
|
Tp53 gene full gene sequence
|
$1,340.90 |
$1,340.90 |
$1,340.90 |
$706.04
|
