|
Shot (Injection into Muscle or Under the Skin)
|
$172.00 |
$172.00 |
$172.00 |
$136.20
|
|
Shoulder AC Joint X-ray (both sides)
|
$356.00 |
$356.00 |
$356.00 |
$270.20
|
|
Shoulder Blade (Scapula) X-ray (both sides)
|
$408.80 |
$408.80 |
$408.80 |
$286.89
|
|
Shoulder MRI (with and without contrast)
|
$4,104.00 |
$4,104.00 |
$4,104.00 |
$2,743.02
|
|
Shoulder MRI (with contrast)
|
$3,597.60 |
$3,597.60 |
$3,597.60 |
$2,476.20
|
|
Shoulder MRI (without contrast)
|
$2,979.20 |
$2,979.20 |
$2,979.20 |
$2,096.84
|
|
Shoulder X-ray
|
$365.60 |
$365.60 |
$365.60 |
$340.10
|
|
Shoulder X-ray (single view, both shoulders)
|
$296.80 |
$296.80 |
$296.80 |
$263.25
|
|
Sickling rbc
|
$32.80 |
$32.80 |
$32.80 |
$59.40
|
|
Sincalide 5 mcg solution for injection
|
$424.00 |
$424.00 |
$424.00 |
$309.14
|
|
Sinus CT scan (with and without contrast)
|
$2,929.60 |
$2,929.60 |
$2,929.60 |
$1,796.30
|
|
Sinus CT scan (with contrast)
|
$2,228.00 |
$2,228.00 |
$2,228.00 |
$1,527.60
|
|
Sinus CT scan (without contrast)
|
$2,128.00 |
$2,128.00 |
$2,128.00 |
$1,289.00
|
|
Sinus X-ray (complete)
|
$536.00 |
$536.00 |
$536.00 |
$346.45
|
|
Sinus X-ray (limited)
|
$324.00 |
$324.00 |
$324.00 |
$215.40
|
|
Skull X-ray (1 to 3 views)
|
$427.20 |
$427.20 |
$427.20 |
$294.45
|
|
Skull X-ray (complete)
|
$621.60 |
$621.60 |
$621.60 |
$417.50
|
|
Sleep Study (Polysomnography)
|
$4,360.80 |
$4,360.80 |
$4,360.80 |
$3,734.50
|
|
Slp eval non-spch gen comm dev
|
$376.80 |
$376.80 |
$376.80 |
$285.09
|
|
Slp ther svc non-spch gen
|
$296.00 |
$296.00 |
$296.00 |
$188.50
|
|
Smear fluorescent and/or acid fast stain
|
$73.60 |
$73.60 |
$73.60 |
$64.35
|
|
Smear gram stain
|
$56.00 |
$56.00 |
$56.00 |
$55.55
|
|
Smear nasal eosinophil
|
$44.00 |
$44.00 |
$44.00 |
$46.20
|
|
Smear wet mount
|
$38.40 |
$38.40 |
$38.40 |
$67.55
|
|
Sodium 24 hour urine
|
$32.80 |
$32.80 |
$32.80 |
$48.98
|
|
Sodium chloride 0.9 % intravenous solution
|
$86.40 |
$86.40 |
$86.40 |
$49.07
|
|
Sodium chloride 0.9 % IV bolus
|
$86.40 |
$86.40 |
$86.40 |
$45.62
|
|
Sodium chloride 0.9 % IV bolus
|
$64.80 |
$64.80 |
$64.80 |
$37.64
|
|
Sodium ferric gluconate complex in sucrose 62.5 mg/5 ml intravenous
|
$67.06 |
$67.06 |
$67.06 |
$80.14
|
|
Sodium serum/plasma/whole blood
|
$40.00 |
$40.00 |
$40.00 |
$46.26
|
|
Sodium thiosulfate 12.5 gram/50 ml (250 mg/ml) intravenous solution
|
$99.92 |
$99.92 |
$99.92 |
$177.52
|
|
Specimen fat stain
|
$52.00 |
$52.00 |
$52.00 |
$37.40
|
|
Speech and Language Evaluation (comprehensive)
|
$446.40 |
$446.40 |
$446.40 |
$384.80
|
|
Speech Therapy Session (one-on-one)
|
$315.20 |
$315.20 |
$315.20 |
$246.87
|
|
Spine X-ray (single view, one level)
|
$248.80 |
$248.80 |
$248.80 |
$251.00
|
|
St analysis behavior qualitative voice/resonance
|
$248.00 |
$248.00 |
$248.00 |
$297.60
|
|
St cognitve performance testing healthcare professional each hour
|
$313.60 |
$313.60 |
$313.60 |
$286.00
|
|
Sterile water/saline, 10 ml
|
$4.16 |
$4.16 |
$4.16 |
$13.32
|
|
St evaluate speech sound production
|
$346.40 |
$346.40 |
$346.40 |
$292.95
|
|
St evaluation motion fluoroscopic swallow function cine/video
|
$501.60 |
$501.60 |
$501.60 |
$400.00
|
|
Stomach Emptying Scan (Nuclear Medicine)
|
$1,841.60 |
$1,841.60 |
$1,841.60 |
$1,345.40
|
|
Stress test pulmonary
|
$413.60 |
$413.60 |
$413.60 |
$324.00
|
|
Succinylcholine chloride 20 mg/ml injection solution (wrapper)
|
$71.61 |
$71.61 |
$71.61 |
$54.80
|
|
Support clav 29.6-40.5in med
|
$24.80 |
$24.80 |
$24.80 |
$94.08
|
|
Surgical pathology level 1 gross examination only
|
$36.00 |
$36.00 |
$36.00 |
$81.00
|
|
Surgical pathology level 2 gross & microscopic examination
|
$77.60 |
$77.60 |
$77.60 |
$143.55
|
|
Surgical pathology level 3 gross & microscopic examination
|
$108.80 |
$108.80 |
$108.80 |
$184.21
|
|
Surgical pathology level 4 gross & microscopic examination
|
$118.40 |
$118.40 |
$118.40 |
$250.20
|
|
Surgical pathology level 5 gross & microscopic examination
|
$576.80 |
$576.80 |
$576.80 |
$480.60
|
|
Surgical pathology level 6 gross & microscopic examination
|
$894.40 |
$894.40 |
$894.40 |
$720.75
|
|
Susceptibility agar dilution per agent
|
$76.00 |
$76.00 |
$76.00 |
$45.60
|
|
Susceptibility enzyme detection per enzyme
|
$48.80 |
$48.80 |
$48.80 |
$35.89
|
|
Susceptibility mic per plate
|
$76.00 |
$76.00 |
$76.00 |
$106.00
|
|
Swallowing Evaluation (Bedside)
|
$378.40 |
$378.40 |
$378.40 |
$316.80
|
|
Swallowing Therapy Session
|
$300.00 |
$300.00 |
$300.00 |
$232.56
|
|
T3 (triiodothyronine) free
|
$132.00 |
$132.00 |
$132.00 |
$100.32
|
|
T3 (triiodothyronine) total
|
$124.00 |
$124.00 |
$124.00 |
$93.52
|
|
T4 (thyroxine) free
|
$66.40 |
$66.40 |
$66.40 |
$89.60
|
|
T4 (thyroxine) total
|
$70.40 |
$70.40 |
$70.40 |
$70.20
|
|
Tacrolimus therapeutic drug level
|
$219.20 |
$219.20 |
$219.20 |
$122.50
|
|
Tailbone (Sacrum and Coccyx) X-ray
|
$351.20 |
$351.20 |
$351.20 |
$289.20
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$214.40 |
$214.40 |
$214.40 |
$179.95
|
|
Tc-99m maa
|
$936.80 |
$936.80 |
$936.80 |
$312.06
|
|
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
|
|
Tc-99m sulfur colloid
|
$308.00 |
$308.00 |
$308.00 |
$245.70
|
|
Tc-99m tetrofosmin p study dose
|
$120.00 |
$120.00 |
$120.00 |
$193.28
|
|
T cells absolute cd4/cd8 including ratio
|
$188.00 |
$188.00 |
$188.00 |
$184.00
|
|
T cells absolute cd 4 count
|
$168.80 |
$168.80 |
$168.80 |
$111.20
|
|
T cells total count
|
$188.80 |
$188.80 |
$188.80 |
$130.20
|
|
Telehealth original site facility fee
|
$56.00 |
$56.00 |
$56.00 |
$51.00
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$12,366.50 |
$12,366.50 |
$12,366.50 |
$14,951.87
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$63.00 |
$63.00 |
$63.00 |
$39.33
|
|
Test stress cardiovascular tracing only
|
$1,179.20 |
$1,179.20 |
$1,179.20 |
$953.40
|
|
Tetanus immune globulin inj
|
$598.64 |
$598.64 |
$598.64 |
$1,285.36
|
|
Theophylline therapeutic drug level
|
$112.80 |
$112.80 |
$112.80 |
$108.00
|
|
Therapy Activity Training (each 15 minutes)
|
$125.60 |
$125.60 |
$125.60 |
$101.38
|
|
Therapy Exercise Session (each 15 minutes)
|
$126.40 |
$126.40 |
$126.40 |
$98.58
|
|
Therapy nutrition individual initial f2f w/patient each 15 minutes
|
$64.00 |
$64.00 |
$64.00 |
$57.50
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$63.50 |
$63.50 |
$63.50 |
$25.54
|
|
Thigh Bone (Femur) X-ray (both sides)
|
$321.60 |
$321.60 |
$321.60 |
$313.60
|
|
Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides)
|
$1,804.00 |
$1,804.00 |
$1,804.00 |
$1,724.25
|
|
Three-Phase Bone Scan (Nuclear Medicine)
|
$2,268.00 |
$2,268.00 |
$2,268.00 |
$1,703.45
|
|
Thromboplastin time partial (ptt) substitution fractions each
|
$69.60 |
$69.60 |
$69.60 |
$62.01
|
|
Thyroglobulin antibody
|
$125.60 |
$125.60 |
$125.60 |
$82.50
|
|
Thyroid (TSH) Test
|
$81.60 |
$81.60 |
$81.60 |
$112.70
|
|
Thyroid Ultrasound
|
$807.20 |
$807.20 |
$807.20 |
$588.50
|
|
Thyroxine binding globulin (tbg)
|
$48.80 |
$48.80 |
$48.80 |
$64.51
|
|
Tigecycline injection
|
$271.86 |
$271.86 |
$271.86 |
$235.29
|
|
Tirofiban 12.5 mg/50 ml
|
$473.23 |
$473.23 |
$473.23 |
$458.85
|
|
Tissue exam koh skin/hair/nails
|
$47.20 |
$47.20 |
$47.20 |
$47.40
|
|
Tissue transglutaminase iga
|
$79.20 |
$79.20 |
$79.20 |
$44.80
|
|
Tl-201 thallium diag per mci
|
$78.40 |
$78.40 |
$78.40 |
$80.10
|
|
Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr
|
$61.82 |
$61.82 |
$61.82 |
$152.36
|
|
Tobramycin peak therapeutic drug level
|
$177.60 |
$177.60 |
$177.60 |
$120.60
|
|
Toe X-ray (both feet)
|
$240.80 |
$240.80 |
$240.80 |
$258.65
|
|
Tomosynthesis breast screen bilateral
|
$90.40 |
$90.40 |
$90.40 |
$74.10
|
|
Toxoplasma antibody igg
|
$112.80 |
$112.80 |
$112.80 |
$91.65
|
