|
Smear nasal eosinophil
|
$13.12 |
$13.12 |
$13.12 |
$46.20
|
|
Smear special stain inclusion bodies/parasites
|
$19.20 |
$19.20 |
$19.20 |
$73.15
|
|
Smear wet mount
|
$13.12 |
$13.12 |
$13.12 |
$67.49
|
|
Sodium 24 hour urine
|
$15.68 |
$15.68 |
$15.68 |
$48.60
|
|
Sodium ferric gluconate complex in sucrose 62.5 mg/5 ml intravenous
|
$19.87 |
$19.87 |
$19.87 |
$77.77
|
|
Sodium hyaluronate 20 mg/2 ml syringe
|
$258.69 |
$258.69 |
$258.69 |
$410.40
|
|
Sodium serum/plasma/whole blood
|
$15.36 |
$15.36 |
$15.36 |
$45.60
|
|
Sodium thiosulfate 12.5 gram/50 ml (250 mg/ml) intravenous solution
|
$199.96 |
$199.96 |
$199.96 |
$177.52
|
|
Somatropin injection
|
$885.90 |
$885.90 |
$885.90 |
$2,381.48
|
|
So neo gsap dna/dna&rna
|
$2,304.00 |
$2,304.00 |
$2,304.00 |
$2,989.55
|
|
So neo gsap dna mcrstl ins
|
$973.44 |
$973.44 |
$973.44 |
$2,296.00
|
|
Special physics consult
|
$176.96 |
$176.96 |
$176.96 |
$725.00
|
|
Special radiation dosimetry
|
$71.68 |
$71.68 |
$71.68 |
$392.50
|
|
Special radiation treatment
|
$415.04 |
$415.04 |
$415.04 |
$1,986.00
|
|
Special teletx port plan
|
$212.16 |
$212.16 |
$212.16 |
$1,086.99
|
|
Specific gravity body fluid
|
$7.68 |
$7.68 |
$7.68 |
$22.00
|
|
Spinal puncture lumbar diagnostic w/fluoroscopic or CT guidance
|
$346.24 |
$346.24 |
$346.24 |
$1,439.40
|
|
Spirometry bronchodilation responsiveness pre/post bronchodilator administration
|
$183.04 |
$183.04 |
$183.04 |
$543.26
|
|
Splint dorsal bloc wh med perf 3.2mm lf polyflex ii
|
$156.16 |
$156.16 |
$156.16 |
$392.09
|
|
Splint finger frog med
|
$12.80 |
$12.80 |
$12.80 |
$38.08
|
|
Split blood or products
|
$13.44 |
$13.44 |
$13.44 |
$127.48
|
|
St analysis behavior qualitative voice/resonance
|
$58.24 |
$58.24 |
$58.24 |
$297.60
|
|
St cognitve performance testing healthcare professional each hour
|
$43.20 |
$43.20 |
$43.20 |
$286.00
|
|
Stent axios caut enh 15x10mm electrocaut
|
$5,808.00 |
$5,808.00 |
$5,808.00 |
$32,403.15
|
|
Stent bili dbl pgtl 10fx5cm
|
$298.22 |
$298.22 |
$298.22 |
$2,520.08
|
|
St evaluate speech sound production
|
$58.24 |
$58.24 |
$58.24 |
$292.95
|
|
St evaluate speech sound production comprehensive/expressive
|
$58.24 |
$58.24 |
$58.24 |
$377.00
|
|
St evaluation motion fluoroscopic swallow function cine/video
|
$96.32 |
$96.32 |
$96.32 |
$399.60
|
|
St evaluation swallow function
|
$58.24 |
$58.24 |
$58.24 |
$314.40
|
|
Stress test pulmonary
|
$70.08 |
$70.08 |
$70.08 |
$322.85
|
|
Str markers specimen anal
|
$288.64 |
$288.64 |
$288.64 |
$751.50
|
|
St treatment speech individual
|
$53.44 |
$53.44 |
$53.44 |
$248.84
|
|
St treatment swallow dysfunction/oral
|
$61.76 |
$61.76 |
$61.76 |
$240.31
|
|
Sumatriptan 6 mg/0.5 ml subcutaneous solution
|
$4.22 |
$4.22 |
$4.22 |
$114.88
|
|
Support clav 29.6-40.5in med
|
$17.54 |
$17.54 |
$17.54 |
$94.19
|
|
Surgical pathology level 1 gross examination only
|
$11.84 |
$11.84 |
$11.84 |
$79.50
|
|
Surgical pathology level 2 gross & microscopic examination
|
$26.24 |
$26.24 |
$26.24 |
$141.94
|
|
Surgical pathology level 3 gross & microscopic examination
|
$31.36 |
$31.36 |
$31.36 |
$181.00
|
|
Surgical pathology level 4 gross & microscopic examination
|
$135.68 |
$135.68 |
$135.68 |
$239.85
|
|
Surgical pathology level 5 gross & microscopic examination
|
$205.44 |
$205.44 |
$205.44 |
$480.00
|
|
Surgical pathology level 6 gross & microscopic examination
|
$288.00 |
$288.00 |
$288.00 |
$718.00
|
|
Susceptibility agar dilution per agent
|
$15.36 |
$15.36 |
$15.36 |
$45.45
|
|
Susceptibility enzyme detection per enzyme
|
$15.36 |
$15.36 |
$15.36 |
$35.70
|
|
Susceptibility mic per plate
|
$297.60 |
$297.60 |
$297.60 |
$106.00
|
|
Svc venogram s&i
|
$771.84 |
$771.84 |
$771.84 |
$1,934.62
|
|
Synvisc or synvisc-one
|
$1,493.65 |
$1,493.65 |
$1,493.65 |
$1,274.94
|
|
Syphilis test non-treponemal antibody quantitative rpr
|
$13.12 |
$13.12 |
$13.12 |
$41.60
|
|
System pacing micra av
|
$6,000.00 |
$6,000.00 |
$6,000.00 |
$24,577.07
|
|
System pcmkr dual chamber leadless micra av2 intrdcr cath
|
$7,123.20 |
$7,123.20 |
$7,123.20 |
$12,003.00
|
|
T3 (triiodothyronine) free
|
$54.72 |
$54.72 |
$54.72 |
$99.20
|
|
T3 (triiodothyronine) total
|
$45.76 |
$45.76 |
$45.76 |
$93.52
|
|
T4 (thyroxine) free
|
$29.12 |
$29.12 |
$29.12 |
$85.20
|
|
T4 (thyroxine) total
|
$22.08 |
$22.08 |
$22.08 |
$69.00
|
|
Tacrolimus 1 mg capsule, immediate-release
|
$18.88 |
$18.88 |
$18.88 |
$9.84
|
|
Tacrolimus therapeutic drug level
|
$30.72 |
$30.72 |
$30.72 |
$122.40
|
|
Tafasitamab-cxix 200 mg intravenous solution
|
$1,522.28 |
$1,522.28 |
$1,522.28 |
$2,762.00
|
|
Talquetamab-tgvs 2 mg/ml subcutaneous solution
|
$12,599.28 |
$12,599.28 |
$12,599.28 |
$21,745.13
|
|
Target gsa panel hmtlmph neop
|
$304.00 |
$304.00 |
$304.00 |
$2,246.30
|
|
Tarlatamab-dlle 10 mg intravenous solution
|
$16,358.40 |
$16,358.40 |
$16,358.40 |
$24,217.20
|
|
Tbo-filgrastim 300 mcg/0.5 ml subcutaneous syringe
|
$396.46 |
$396.46 |
$396.46 |
$937.50
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$31.04 |
$31.04 |
$31.04 |
$177.65
|
|
Tc-99m exametazime diag
|
$1,242.22 |
$1,242.22 |
$1,242.22 |
$2,033.20
|
|
Tc-99m labeled rbc
|
$106.91 |
$106.91 |
$106.91 |
$302.40
|
|
Tc-99m maa
|
$95.60 |
$95.60 |
$95.60 |
$292.80
|
|
Tc-99m mebrofenin
|
$40.34 |
$40.34 |
$40.34 |
$157.65
|
|
Tc-99m medronate
|
$43.78 |
$43.78 |
$43.78 |
$111.01
|
|
Tc-99m mertiatide
|
$195.65 |
$195.65 |
$195.65 |
$756.00
|
|
Tc-99m pentetate dtpa
|
$150.57 |
$150.57 |
$150.57 |
$222.60
|
|
Tc-99m pertechnetate per mci
|
$33.75 |
$33.75 |
$33.75 |
$22.10
|
|
Tc-99m pyroph diag per dose up to 25 mci
|
$57.08 |
$57.08 |
$57.08 |
$136.40
|
|
Tc-99m sestamibi p study dose
|
$32.97 |
$32.97 |
$32.97 |
$274.45
|
|
Tc-99m sulfur colloid
|
$111.25 |
$111.25 |
$111.25 |
$240.50
|
|
Tc-99m tetrofosmin p study dose
|
$36.06 |
$36.06 |
$36.06 |
$190.80
|
|
Tc-99m tilmanocept diag
|
$519.43 |
$519.43 |
$519.43 |
$955.60
|
|
T cells absolute cd4/cd8 including ratio
|
$43.20 |
$43.20 |
$43.20 |
$176.40
|
|
T cells total count
|
$34.88 |
$34.88 |
$34.88 |
$126.90
|
|
Tebentafusp-tebn 100 mcg/0.5 ml intravenous solution
|
$22,334.67 |
$22,334.67 |
$22,334.67 |
$40,114.80
|
|
Telavancin injection
|
$557.96 |
$557.96 |
$557.96 |
$1,191.80
|
|
Telehealth original site facility fee
|
$15.36 |
$15.36 |
$15.36 |
$51.00
|
|
Telethx isodose plan cplx
|
$461.76 |
$461.76 |
$461.76 |
$1,526.85
|
|
Telethx isodose plan simple
|
$249.60 |
$249.60 |
$249.60 |
$873.62
|
|
Temozolomide
|
$174.95 |
$174.95 |
$174.95 |
$588.46
|
|
Temozolomide 100 mg intravenous solution
|
$1,093.95 |
$1,093.95 |
$1,093.95 |
$1,867.28
|
|
Temsirolimus 30 mg/3 ml (10 mg/ml) (first dilution) intravenous soln
|
$2,181.47 |
$2,181.47 |
$2,181.47 |
$3,723.60
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$9,048.66 |
$9,048.66 |
$9,048.66 |
$15,245.38
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$36.61 |
$36.61 |
$36.61 |
$39.33
|
|
Test pathogen(s) for platelets reference
|
$33.60 |
$33.60 |
$33.60 |
$70.00
|
|
Test stress cardiovascular tracing only
|
$155.84 |
$155.84 |
$155.84 |
$949.70
|
|
Tetanus immune globulin inj
|
$606.79 |
$606.79 |
$606.79 |
$1,285.36
|
|
Theophylline therapeutic drug level
|
$45.76 |
$45.76 |
$45.76 |
$108.00
|
|
Ther/proph/diag inj ia
|
$104.32 |
$104.32 |
$104.32 |
$240.35
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$11.44 |
$11.44 |
$11.44 |
$25.54
|
|
Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides)
|
$944.64 |
$944.64 |
$944.64 |
$1,687.50
|
|
Thrombectomy/inf pq dialysis circuit
|
$2,068.16 |
$2,068.16 |
$2,068.16 |
$8,084.00
|
|
Thrombectomy/inf pq dialysis circuit w/pta
|
$4,180.48 |
$4,180.48 |
$4,180.48 |
$14,277.20
|
|
Thrombectomy/inf pq dialysis circuit w/stent plcmnt
|
$6,336.32 |
$6,336.32 |
$6,336.32 |
$21,413.60
|
|
Thrombin time
|
$63.04 |
$63.04 |
$63.04 |
$53.76
|
|
Thromboplastin time partial (ptt) substitution fractions each
|
$39.04 |
$39.04 |
$39.04 |
$61.52
|
|
Thyroglobulin antibody
|
$19.84 |
$19.84 |
$19.84 |
$82.00
|
|
Thyroid mets imag whole body
|
$310.08 |
$310.08 |
$310.08 |
$1,524.99
|
