|
Speech evaluation complex
|
$85.80 |
$85.80 |
$85.80 |
$527.06
|
|
Speech Therapy Session (one-on-one)
|
$69.60 |
$69.60 |
$69.60 |
$246.87
|
|
Sperm antibody test
|
$291.60 |
$291.60 |
$291.60 |
$57.85
|
|
Spine X-ray (single view, one level)
|
$134.40 |
$134.40 |
$134.40 |
$251.00
|
|
Spleen imaging
|
$414.00 |
$414.00 |
$414.00 |
$679.00
|
|
Splint finger 4 prong foam sm
|
$155.40 |
$155.40 |
$155.40 |
$34.00
|
|
Splint func pos polyflex ii med
|
$84.60 |
$84.60 |
$84.60 |
$61.64
|
|
St analysis behavior qualitative voice/resonance
|
$216.00 |
$216.00 |
$216.00 |
$297.60
|
|
Sterile gauze <= 16 sq in
|
$8.40 |
$8.40 |
$8.40 |
$1.52
|
|
Sterile needle
|
$8.40 |
$8.40 |
$8.40 |
$190.13
|
|
Sterile water/saline, 500 ml
|
$13.20 |
$13.20 |
$13.20 |
$28.11
|
|
St evaluate speech sound production
|
$205.80 |
$205.80 |
$205.80 |
$292.95
|
|
Stomach Emptying Scan (Nuclear Medicine)
|
$663.00 |
$663.00 |
$663.00 |
$1,345.40
|
|
Strapping of knee
|
$249.00 |
$249.00 |
$249.00 |
$205.20
|
|
Stress test pulmonary
|
$156.00 |
$156.00 |
$156.00 |
$324.00
|
|
Stress tte complete
|
$2,037.00 |
$2,037.00 |
$2,037.00 |
$1,900.96
|
|
Succinylcholine chloride 20 mg/ml injection solution (wrapper)
|
$40.80 |
$40.80 |
$40.80 |
$54.80
|
|
Sumatriptan 6 mg/0.5 ml subcutaneous solution
|
$25.80 |
$25.80 |
$25.80 |
$129.89
|
|
Surgical pathology level 1 gross examination only
|
$138.60 |
$138.60 |
$138.60 |
$81.00
|
|
Surgical pathology level 2 gross & microscopic examination
|
$209.40 |
$209.40 |
$209.40 |
$143.55
|
|
Surgical pathology level 3 gross & microscopic examination
|
$169.20 |
$169.20 |
$169.20 |
$184.21
|
|
Surgical pathology level 4 gross & microscopic examination
|
$185.40 |
$185.40 |
$185.40 |
$250.20
|
|
Surgical pathology level 5 gross & microscopic examination
|
$297.00 |
$297.00 |
$297.00 |
$480.60
|
|
Surgical pathology level 6 gross & microscopic examination
|
$480.00 |
$480.00 |
$480.00 |
$720.75
|
|
Surgical trays
|
$70.80 |
$70.80 |
$70.80 |
$694.80
|
|
Susceptibility agar dilution per agent
|
$26.40 |
$26.40 |
$26.40 |
$45.60
|
|
Susceptibility mic per plate
|
$47.40 |
$47.40 |
$47.40 |
$106.00
|
|
Sutr lg intestine 1/mult perf without colostomy 44604
|
$3,733.80 |
$3,733.80 |
$3,733.80 |
$1,995.00
|
|
Swallowing Evaluation (Bedside)
|
$336.00 |
$336.00 |
$336.00 |
$316.80
|
|
Swallowing Therapy Session
|
$91.80 |
$91.80 |
$91.80 |
$232.56
|
|
Synvisc or synvisc-one
|
$2,958.00 |
$2,958.00 |
$2,958.00 |
$1,242.63
|
|
Syphilis test non-treponemal antibody quantitative rpr
|
$99.60 |
$99.60 |
$99.60 |
$42.24
|
|
T3 (triiodothyronine) free
|
$91.80 |
$91.80 |
$91.80 |
$100.32
|
|
T3 (triiodothyronine) total
|
$77.40 |
$77.40 |
$77.40 |
$93.52
|
|
T4 (thyroxine) free
|
$49.20 |
$49.20 |
$49.20 |
$89.60
|
|
T4 (thyroxine) total
|
$37.20 |
$37.20 |
$37.20 |
$70.20
|
|
Tacrolimus therapeutic drug level
|
$75.00 |
$75.00 |
$75.00 |
$122.50
|
|
Tailbone (Sacrum and Coccyx) X-ray
|
$112.80 |
$112.80 |
$112.80 |
$289.20
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$263.40 |
$263.40 |
$263.40 |
$179.95
|
|
Tc-99m apcitide diag
|
$1,711.20 |
$1,711.20 |
$1,711.20 |
$1,181.70
|
|
Tc-99m arcitumomab
|
$2,159.40 |
$2,159.40 |
$2,159.40 |
$2,085.68
|
|
Tc-99m depreotide
|
$1,055.40 |
$1,055.40 |
$1,055.40 |
$1,486.80
|
|
Tc-99m labeled rbc
|
$234.00 |
$234.00 |
$234.00 |
$306.00
|
|
Tc-99m maa
|
$46.20 |
$46.20 |
$46.20 |
$312.06
|
|
Tc-99m mebrofenin
|
$102.60 |
$102.60 |
$102.60 |
$157.65
|
|
Tc-99m medronate
|
$46.20 |
$46.20 |
$46.20 |
$111.01
|
|
Tc-99m mertiatide
|
$724.20 |
$724.20 |
$724.20 |
$756.00
|
|
Tc-99m pentetate dtpa
|
$102.60 |
$102.60 |
$102.60 |
$222.60
|
|
Tc-99m pentetate dtpa aerosol
|
$48.60 |
$48.60 |
$48.60 |
$191.50
|
|
Tc-99m pertechnetate per mci
|
$46.20 |
$46.20 |
$46.20 |
$18.67
|
|
Tc-99m sestamibi p study dose
|
$237.00 |
$237.00 |
$237.00 |
$287.20
|
|
Tc-99m succimer (dmsa)
|
$454.20 |
$454.20 |
$454.20 |
$1,128.40
|
|
Tc-99m sulfur colloid
|
$186.00 |
$186.00 |
$186.00 |
$245.70
|
|
T cells absolute cd4/cd8 including ratio
|
$446.40 |
$446.40 |
$446.40 |
$184.00
|
|
T cells absolute cd 4 count
|
$446.40 |
$446.40 |
$446.40 |
$111.20
|
|
T cells total count
|
$283.80 |
$283.80 |
$283.80 |
$130.20
|
|
Telehealth original site facility fee
|
$81.60 |
$81.60 |
$81.60 |
$51.00
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$8,955.00 |
$8,955.00 |
$8,955.00 |
$14,951.87
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$13.20 |
$13.20 |
$13.20 |
$39.33
|
|
Test for chlorohydrocarbons
|
$268.20 |
$268.20 |
$268.20 |
$65.00
|
|
Test for urine cystines
|
$298.20 |
$298.20 |
$298.20 |
$26.00
|
|
Testicular imaging w/vasc flow
|
$492.00 |
$492.00 |
$492.00 |
$842.56
|
|
Test stress cardiovascular tracing only
|
$747.00 |
$747.00 |
$747.00 |
$953.40
|
|
Tetanus immune globulin inj
|
$1,551.00 |
$1,551.00 |
$1,551.00 |
$1,285.36
|
|
Theophylline therapeutic drug level
|
$108.00 |
$108.00 |
$108.00 |
$108.00
|
|
Therapy Activity Training (each 15 minutes)
|
$90.60 |
$90.60 |
$90.60 |
$101.38
|
|
Therapy Exercise Session (each 15 minutes)
|
$90.60 |
$90.60 |
$90.60 |
$98.58
|
|
Therapy nutrition individual initial f2f w/patient each 15 minutes
|
$80.40 |
$80.40 |
$80.40 |
$57.50
|
|
Therapy nutrition individual reassessment/intervention f2f w/patient each 15 minutes
|
$52.20 |
$52.20 |
$52.20 |
$50.40
|
|
Ther nma rdctj intus/obstrcj
|
$664.80 |
$664.80 |
$664.80 |
$538.88
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$16.80 |
$16.80 |
$16.80 |
$25.54
|
|
Thigh Bone (Femur) X-ray (both sides)
|
$253.80 |
$253.80 |
$253.80 |
$313.60
|
|
Three-Phase Bone Scan (Nuclear Medicine)
|
$772.80 |
$772.80 |
$772.80 |
$1,703.45
|
|
Throat x-ray & fluoroscopy
|
$259.80 |
$259.80 |
$259.80 |
$259.60
|
|
Thromboplastin time partial (ptt) substitution fractions each
|
$30.00 |
$30.00 |
$30.00 |
$62.01
|
|
Thyroglobulin antibody
|
$168.00 |
$168.00 |
$168.00 |
$82.50
|
|
Thyroid imaging
|
$397.80 |
$397.80 |
$397.80 |
$695.60
|
|
Thyroid (TSH) Test
|
$108.00 |
$108.00 |
$108.00 |
$112.70
|
|
Thyroid Ultrasound
|
$308.40 |
$308.40 |
$308.40 |
$588.50
|
|
Thyroid uptake measurement
|
$367.80 |
$367.80 |
$367.80 |
$591.25
|
|
Thyroxine binding globulin (tbg)
|
$213.00 |
$213.00 |
$213.00 |
$64.51
|
|
Tissue exam koh skin/hair/nails
|
$84.00 |
$84.00 |
$84.00 |
$47.40
|
|
Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr
|
$24.00 |
$24.00 |
$24.00 |
$152.36
|
|
Tobramycin peak therapeutic drug level
|
$250.20 |
$250.20 |
$250.20 |
$120.60
|
|
Toe X-ray (both feet)
|
$382.20 |
$382.20 |
$382.20 |
$258.65
|
|
Tomosynthesis breast screen bilateral
|
$94.80 |
$94.80 |
$94.80 |
$74.10
|
|
Toxoplasma antibody igg
|
$184.20 |
$184.20 |
$184.20 |
$91.65
|
|
Toxoplasma antibody igm
|
$173.40 |
$173.40 |
$173.40 |
$87.75
|
|
Tracheostomy care kit
|
$10.80 |
$10.80 |
$10.80 |
$9.15
|
|
Training self management diabetes individual outpatient department per 30 minutes
|
$72.60 |
$72.60 |
$72.60 |
$102.27
|
|
Transferrin
|
$141.00 |
$141.00 |
$141.00 |
$82.00
|
|
Transparent film <= 16 sq in
|
$3.60 |
$3.60 |
$3.60 |
$4.50
|
|
Transvaginal Pelvic Ultrasound (not pregnancy)
|
$337.20 |
$337.20 |
$337.20 |
$561.60
|
|
Transvaginal Pregnancy Ultrasound
|
$328.80 |
$328.80 |
$328.80 |
$499.20
|
|
Treat finger fracture each
|
$1,131.60 |
$1,131.60 |
$1,131.60 |
$1,592.00
|
|
Treat humerus fracture
|
$1,131.60 |
$1,131.60 |
$1,131.60 |
$1,790.00
|
|
Treat knee fracture 27530
|
$397.80 |
$397.80 |
$397.80 |
$550.73
|
|
Treatment of ankle fracture 27786
|
$375.60 |
$375.60 |
$375.60 |
$523.20
|
|
Treatment of thigh fracture
|
$1,131.60 |
$1,131.60 |
$1,131.60 |
$1,790.00
|
|
Treatment of toe fracture 28510
|
$595.20 |
$595.20 |
$595.20 |
$371.40
|
