|
Sterile water/saline, 500 ml
|
$1.40 |
$1.40 |
$1.40 |
$28.11
|
|
St evaluate speech sound production
|
$340.00 |
$340.00 |
$340.00 |
$292.95
|
|
St evaluation motion fluoroscopic swallow function cine/video
|
$406.40 |
$406.40 |
$406.40 |
$400.00
|
|
Stomach Emptying Scan (Nuclear Medicine)
|
$1,629.60 |
$1,629.60 |
$1,629.60 |
$1,345.40
|
|
Strep b dna amp probe
|
$163.20 |
$163.20 |
$163.20 |
$124.15
|
|
Succinylcholine chloride 20 mg/ml injection solution (wrapper)
|
$67.99 |
$67.99 |
$67.99 |
$54.80
|
|
Sumatriptan 6 mg/0.5 ml subcutaneous solution
|
$65.54 |
$65.54 |
$65.54 |
$129.89
|
|
Support clav 29.6-40.5in med
|
$30.40 |
$30.40 |
$30.40 |
$94.08
|
|
Surgical pathology level 1 gross examination only
|
$35.20 |
$35.20 |
$35.20 |
$81.00
|
|
Surgical pathology level 2 gross & microscopic examination
|
$85.60 |
$85.60 |
$85.60 |
$143.55
|
|
Surgical pathology level 3 gross & microscopic examination
|
$114.40 |
$114.40 |
$114.40 |
$184.21
|
|
Surgical pathology level 4 gross & microscopic examination
|
$119.20 |
$119.20 |
$119.20 |
$250.20
|
|
Surgical pathology level 5 gross & microscopic examination
|
$677.60 |
$677.60 |
$677.60 |
$480.60
|
|
Surgical pathology level 6 gross & microscopic examination
|
$963.20 |
$963.20 |
$963.20 |
$720.75
|
|
Susceptibility agar dilution per agent
|
$29.60 |
$29.60 |
$29.60 |
$45.60
|
|
Susceptibility enzyme detection per enzyme
|
$27.20 |
$27.20 |
$27.20 |
$35.89
|
|
Susceptibility mic per plate
|
$147.20 |
$147.20 |
$147.20 |
$106.00
|
|
Swallowing Evaluation (Bedside)
|
$316.80 |
$316.80 |
$316.80 |
$316.80
|
|
Swallowing Therapy Session
|
$254.40 |
$254.40 |
$254.40 |
$232.56
|
|
T3 (triiodothyronine) free
|
$99.20 |
$99.20 |
$99.20 |
$100.32
|
|
T3 (triiodothyronine) total
|
$69.60 |
$69.60 |
$69.60 |
$93.52
|
|
T4 (thyroxine) free
|
$63.20 |
$63.20 |
$63.20 |
$89.60
|
|
T4 (thyroxine) total
|
$28.80 |
$28.80 |
$28.80 |
$70.20
|
|
Tacrolimus 1 mg capsule, immediate-release
|
$1.20 |
$1.20 |
$1.20 |
$9.93
|
|
Tacrolimus therapeutic drug level
|
$101.60 |
$101.60 |
$101.60 |
$122.50
|
|
Tailbone (Sacrum and Coccyx) X-ray
|
$248.00 |
$248.00 |
$248.00 |
$289.20
|
|
Tb test cell mediated immunity antigen response enumeration gamma interferon t-cells
|
$301.60 |
$301.60 |
$301.60 |
$200.00
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$140.80 |
$140.80 |
$140.80 |
$179.95
|
|
Tc-99m labeled rbc
|
$428.00 |
$428.00 |
$428.00 |
$306.00
|
|
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 oxidronate
|
$168.00 |
$168.00 |
$168.00 |
$108.00
|
|
Tc-99m pentetate dtpa
|
$388.80 |
$388.80 |
$388.80 |
$222.60
|
|
Tc-99m pentetate dtpa aerosol
|
$388.80 |
$388.80 |
$388.80 |
$191.50
|
|
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
|
$131.20 |
$131.20 |
$131.20 |
$184.00
|
|
T cells absolute cd 4 count
|
$88.80 |
$88.80 |
$88.80 |
$111.20
|
|
T cells total count
|
$104.80 |
$104.80 |
$104.80 |
$130.20
|
|
Telehealth original site facility fee
|
$66.40 |
$66.40 |
$66.40 |
$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
|
$74.61 |
$74.61 |
$74.61 |
$39.33
|
|
Testicular imaging w/vasc flow
|
$1,150.40 |
$1,150.40 |
$1,150.40 |
$842.56
|
|
Test stress cardiovascular tracing only
|
$1,103.20 |
$1,103.20 |
$1,103.20 |
$953.40
|
|
Test urine for porphyrins
|
$104.00 |
$104.00 |
$104.00 |
$49.98
|
|
Tezepelumab-ekko 210 mg/1.91 ml (110 mg/ml) subcutaneous syringe
|
$11,759.93 |
$11,759.93 |
$11,759.93 |
$8,737.05
|
|
Theophylline therapeutic drug level
|
$73.60 |
$73.60 |
$73.60 |
$108.00
|
|
Therapeutic procd strg endur
|
$123.20 |
$123.20 |
$123.20 |
$85.68
|
|
Therapy Activity Training (each 15 minutes)
|
$127.20 |
$127.20 |
$127.20 |
$101.38
|
|
Therapy Exercise Session (each 15 minutes)
|
$129.60 |
$129.60 |
$129.60 |
$98.58
|
|
Therapy nutrition individual initial f2f w/patient each 15 minutes
|
$52.80 |
$52.80 |
$52.80 |
$57.50
|
|
Therapy nutrition individual reassessment/intervention f2f w/patient each 15 minutes
|
$60.00 |
$60.00 |
$60.00 |
$50.40
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$64.00 |
$64.00 |
$64.00 |
$25.54
|
|
Thigh Bone (Femur) X-ray (both sides)
|
$284.00 |
$284.00 |
$284.00 |
$313.60
|
|
Three-Phase Bone Scan (Nuclear Medicine)
|
$1,726.40 |
$1,726.40 |
$1,726.40 |
$1,703.45
|
|
Thrombin time
|
$39.20 |
$39.20 |
$39.20 |
$54.18
|
|
Thromboplastin time partial (ptt) substitution fractions each
|
$22.40 |
$22.40 |
$22.40 |
$62.01
|
|
Thyroglobulin antibody
|
$81.60 |
$81.60 |
$81.60 |
$82.50
|
|
Thyroid imaging
|
$1,004.00 |
$1,004.00 |
$1,004.00 |
$695.60
|
|
Thyroid (TSH) Test
|
$84.00 |
$84.00 |
$84.00 |
$112.70
|
|
Thyroid Ultrasound
|
$708.80 |
$708.80 |
$708.80 |
$588.50
|
|
Thyroid uptake measurement
|
$857.60 |
$857.60 |
$857.60 |
$591.25
|
|
Thyrotropin alfa 0.9 mg intramuscular solution
|
$2,764.81 |
$2,764.81 |
$2,764.81 |
$4,152.21
|
|
Thyroxine binding globulin (tbg)
|
$48.80 |
$48.80 |
$48.80 |
$64.51
|
|
Tirofiban 12.5 mg/50 ml
|
$313.30 |
$313.30 |
$313.30 |
$458.85
|
|
Tissue exam koh skin/hair/nails
|
$40.80 |
$40.80 |
$40.80 |
$47.40
|
|
Tissue transglutaminase iga
|
$47.20 |
$47.20 |
$47.20 |
$44.80
|
|
Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr
|
$60.62 |
$60.62 |
$60.62 |
$152.36
|
|
Tobramycin peak therapeutic drug level
|
$87.20 |
$87.20 |
$87.20 |
$120.60
|
|
Toe X-ray (both feet)
|
$264.00 |
$264.00 |
$264.00 |
$258.65
|
|
Tomosynthesis breast diagnostic left
|
$95.20 |
$95.20 |
$95.20 |
$74.10
|
|
Tomosynthesis breast screen bilateral
|
$125.60 |
$125.60 |
$125.60 |
$74.10
|
|
Toxoplasma antibody igg
|
$76.00 |
$76.00 |
$76.00 |
$91.65
|
|
Toxoplasma antibody igm
|
$75.20 |
$75.20 |
$75.20 |
$87.75
|
|
Training self management diabetes individual outpatient department per 30 minutes
|
$100.00 |
$100.00 |
$100.00 |
$102.27
|
|
Transferrin
|
$53.60 |
$53.60 |
$53.60 |
$82.00
|
|
Transvaginal Pelvic Ultrasound (not pregnancy)
|
$461.60 |
$461.60 |
$461.60 |
$561.60
|
|
Transvaginal Pregnancy Ultrasound
|
$450.40 |
$450.40 |
$450.40 |
$499.20
|
|
Trauma partial team response w/critical care services level 4
|
$3,074.40 |
$3,074.40 |
$3,074.40 |
$4,523.04
|
|
Treat ankle dislocation
|
$1,972.80 |
$1,972.80 |
$1,972.80 |
$2,360.00
|
|
Treat elbow dislocation
|
$2,223.20 |
$2,223.20 |
$2,223.20 |
$2,272.50
|
|
Treat fracture of radius
|
$1,155.20 |
$1,155.20 |
$1,155.20 |
$1,790.00
|
|
Treat kneecap dislocation
|
$569.60 |
$569.60 |
$569.60 |
$1,068.06
|
|
Treat ulnar fracture
|
$1,492.00 |
$1,492.00 |
$1,492.00 |
$1,677.20
|
|
Treponema pallidum antibody
|
$68.80 |
$68.80 |
$68.80 |
$72.05
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$66.96 |
$66.96 |
$66.96 |
$43.09
|
|
Triglycerides
|
$36.80 |
$36.80 |
$36.80 |
$58.50
|
|
Troponin quantitative
|
$97.60 |
$97.60 |
$97.60 |
$127.60
|
|
Ua w/micro/comp poc
|
$35.20 |
$35.20 |
$35.20 |
$23.00
|
|
Ultrasound breast complete
|
$466.40 |
$466.40 |
$466.40 |
$532.00
|
|
Ultrasound breast unilateral limited (both sides)
|
$468.80 |
$468.80 |
$468.80 |
$452.40
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$408.80 |
$408.80 |
$408.80 |
$338.00
|
|
Ultrasound encephalogram
|
$629.60 |
$629.60 |
$629.60 |
$494.92
|
|
Ultrasound exam k transpl w/doppler
|
$845.60 |
$845.60 |
$845.60 |
$578.40
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$674.40 |
$674.40 |
$674.40 |
$476.94
|
|
Ultrasound guidance for vascular access
|
$572.80 |
$572.80 |
$572.80 |
$388.08
|
|
Ultrasound guide intraoperative
|
$844.00 |
$844.00 |
$844.00 |
$632.85
|
