|
Smear special stain inclusion bodies/parasites
|
$17.80 |
$17.80 |
$17.80 |
$73.15
|
|
Smear wet mount
|
$17.60 |
$17.60 |
$17.60 |
$67.49
|
|
Sodium 24 hour urine
|
$33.20 |
$33.20 |
$33.20 |
$48.60
|
|
Sodium chloride 0.9 % intravenous solution
|
$119.60 |
$119.60 |
$119.60 |
$48.11
|
|
Sodium chloride 0.9 % IV bolus
|
$110.40 |
$110.40 |
$110.40 |
$46.00
|
|
Sodium chloride 0.9 % IV bolus
|
$41.40 |
$41.40 |
$41.40 |
$37.50
|
|
Sodium chloride 3 % ivpb
|
$8.25 |
$8.25 |
$8.25 |
$40.61
|
|
Sodium ferric gluconate complex in sucrose 62.5 mg/5 ml intravenous
|
$12.06 |
$12.06 |
$12.06 |
$77.77
|
|
Sodium serum/plasma/whole blood
|
$33.20 |
$33.20 |
$33.20 |
$45.60
|
|
Sodium thiosulfate 12.5 gram/50 ml (250 mg/ml) intravenous solution
|
$148.50 |
$148.50 |
$148.50 |
$177.52
|
|
Special physics consult
|
$255.00 |
$255.00 |
$255.00 |
$725.00
|
|
Special radiation dosimetry
|
$79.60 |
$79.60 |
$79.60 |
$392.50
|
|
Special radiation treatment
|
$792.40 |
$792.40 |
$792.40 |
$1,986.00
|
|
Special teletx port plan
|
$246.60 |
$246.60 |
$246.60 |
$1,086.99
|
|
Specimen fat stain
|
$25.20 |
$25.20 |
$25.20 |
$35.10
|
|
Spirometry bronchodilation responsiveness pre/post bronchodilator administration
|
$126.00 |
$126.00 |
$126.00 |
$543.26
|
|
Sputum specimen collection
|
$57.20 |
$57.20 |
$57.20 |
$180.00
|
|
Srs linear based
|
$3,365.60 |
$3,365.60 |
$3,365.60 |
$13,585.00
|
|
St analysis behavior qualitative voice/resonance
|
$57.60 |
$57.60 |
$57.60 |
$297.60
|
|
Staph a dna amp probe
|
$30.40 |
$30.40 |
$30.40 |
$125.00
|
|
St cognitve performance testing healthcare professional each hour
|
$64.20 |
$64.20 |
$64.20 |
$286.00
|
|
Stent/athrectomy/fem/pop/unilat 37227
|
$14,711.20 |
$14,711.20 |
$14,711.20 |
$21,626.50
|
|
Stent iliac/open or perc/uni/init 37221
|
$9,743.80 |
$9,743.80 |
$9,743.80 |
$14,356.50
|
|
Stent iliac/open/perc/ea ad/ipsila 37223
|
$7,982.80 |
$7,982.80 |
$7,982.80 |
$9,008.54
|
|
Stent/tib/peroneal/unilat/initial 37230
|
$9,790.60 |
$9,790.60 |
$9,790.60 |
$17,271.50
|
|
St evaluate speech sound production
|
$56.20 |
$56.20 |
$56.20 |
$292.95
|
|
St evaluate speech sound production comprehensive/expressive
|
$115.60 |
$115.60 |
$115.60 |
$377.00
|
|
St evaluation motion fluoroscopic swallow function cine/video
|
$158.20 |
$158.20 |
$158.20 |
$399.60
|
|
St evaluation swallow function
|
$110.00 |
$110.00 |
$110.00 |
$314.40
|
|
Stimulants synthetic
|
$14.60 |
$14.60 |
$14.60 |
$80.08
|
|
Strapping of ankle and/or ft 29540
|
$36.00 |
$36.00 |
$36.00 |
$223.45
|
|
Strapping of chest
|
$42.00 |
$42.00 |
$42.00 |
$195.33
|
|
Strapping of hand or finger
|
$28.20 |
$28.20 |
$28.20 |
$174.82
|
|
Strapping of knee
|
$30.00 |
$30.00 |
$30.00 |
$205.20
|
|
Strapping of toes 29550
|
$28.20 |
$28.20 |
$28.20 |
$164.70
|
|
Streptomycin injection
|
$58.19 |
$58.19 |
$58.19 |
$138.30
|
|
Stress test pulmonary
|
$43.00 |
$43.00 |
$43.00 |
$322.85
|
|
St treatment speech individual
|
$151.40 |
$151.40 |
$151.40 |
$248.84
|
|
St treatment swallow dysfunction/oral
|
$151.40 |
$151.40 |
$151.40 |
$240.31
|
|
Succinylcholine chloride 20 mg/ml injection solution (wrapper)
|
$41.85 |
$41.85 |
$41.85 |
$52.31
|
|
Sulfonylurea screen qn-sendout
|
$61.80 |
$61.80 |
$61.80 |
$156.16
|
|
Sumatriptan 6 mg/0.5 ml subcutaneous solution
|
$34.70 |
$34.70 |
$34.70 |
$114.88
|
|
Surgical pathology level 1 gross examination only
|
$7.40 |
$7.40 |
$7.40 |
$79.50
|
|
Surgical pathology level 2 gross & microscopic examination
|
$12.20 |
$12.20 |
$12.20 |
$141.94
|
|
Surgical pathology level 3 gross & microscopic examination
|
$26.80 |
$26.80 |
$26.80 |
$181.00
|
|
Surgical pathology level 4 gross & microscopic examination
|
$64.00 |
$64.00 |
$64.00 |
$239.85
|
|
Surgical pathology level 5 gross & microscopic examination
|
$98.80 |
$98.80 |
$98.80 |
$480.00
|
|
Surgical pathology level 6 gross & microscopic examination
|
$208.00 |
$208.00 |
$208.00 |
$718.00
|
|
Susceptibility mic per plate
|
$40.80 |
$40.80 |
$40.80 |
$106.00
|
|
Suscept studies macrobroth dilution ea
|
$4.20 |
$4.20 |
$4.20 |
$59.28
|
|
Svc venogram s&i
|
$557.80 |
$557.80 |
$557.80 |
$1,934.62
|
|
Sweat collection by iontophoresis
|
$32.40 |
$32.40 |
$32.40 |
$125.40
|
|
Syphilis test non-treponemal antibody quantitative rpr
|
$36.80 |
$36.80 |
$36.80 |
$41.60
|
|
T3 (triiodothyronine) free
|
$111.20 |
$111.20 |
$111.20 |
$99.20
|
|
T3 (triiodothyronine) total
|
$46.80 |
$46.80 |
$46.80 |
$93.52
|
|
T4 (thyroxine) free
|
$40.00 |
$40.00 |
$40.00 |
$85.20
|
|
T4 (thyroxine) total
|
$33.20 |
$33.20 |
$33.20 |
$69.00
|
|
Tacrolimus 1 mg capsule, immediate-release
|
$2.61 |
$2.61 |
$2.61 |
$9.84
|
|
Tacrolimus therapeutic drug level
|
$64.00 |
$64.00 |
$64.00 |
$122.40
|
|
Tafasitamab-cxix 200 mg intravenous solution
|
$821.10 |
$821.10 |
$821.10 |
$2,762.00
|
|
Target gsa panel hmtlmph neop
|
$298.80 |
$298.80 |
$298.80 |
$2,246.30
|
|
Target gsa panel organ/hmtlmph neop
|
$1,105.20 |
$1,105.20 |
$1,105.20 |
$3,746.70
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$126.80 |
$126.80 |
$126.80 |
$177.65
|
|
Tc-99m disofenin
|
$89.68 |
$89.68 |
$89.68 |
$124.32
|
|
Tc-99m labeled rbc
|
$61.40 |
$61.40 |
$61.40 |
$302.40
|
|
Tc-99m maa
|
$48.60 |
$48.60 |
$48.60 |
$292.80
|
|
Tc-99m mebrofenin
|
$31.50 |
$31.50 |
$31.50 |
$157.65
|
|
Tc-99m medronate
|
$25.32 |
$25.32 |
$25.32 |
$111.01
|
|
Tc-99m mertiatide
|
$211.20 |
$211.20 |
$211.20 |
$756.00
|
|
Tc-99m oxidronate
|
$12.00 |
$12.00 |
$12.00 |
$105.60
|
|
Tc-99m pentetate dtpa aerosol
|
$42.60 |
$42.60 |
$42.60 |
$190.80
|
|
Tc-99m pertechnetate per mci
|
$0.22 |
$0.22 |
$0.22 |
$22.10
|
|
Tc-99m pyroph diag per dose up to 25 mci
|
$95.93 |
$95.93 |
$95.93 |
$136.40
|
|
Tc-99m sestamibi p study dose
|
$43.22 |
$43.22 |
$43.22 |
$274.45
|
|
Tc-99m sulfur colloid
|
$39.40 |
$39.40 |
$39.40 |
$240.50
|
|
Tc-99m tetrofosmin p study dose
|
$31.40 |
$31.40 |
$31.40 |
$190.80
|
|
Tc-99m tilmanocept diag
|
$313.20 |
$313.20 |
$313.20 |
$955.60
|
|
T cells absolute cd4/cd8 including ratio
|
$38.80 |
$38.80 |
$38.80 |
$176.40
|
|
T cells absolute cd 4 count
|
$87.40 |
$87.40 |
$87.40 |
$111.20
|
|
T cells total count
|
$31.80 |
$31.80 |
$31.80 |
$126.90
|
|
Telehealth original site facility fee
|
$13.20 |
$13.20 |
$13.20 |
$51.00
|
|
Telethx isodose plan cplx
|
$485.80 |
$485.80 |
$485.80 |
$1,526.85
|
|
Telethx isodose plan simple
|
$390.60 |
$390.60 |
$390.60 |
$873.62
|
|
Temozolomide
|
$116.83 |
$116.83 |
$116.83 |
$588.46
|
|
Temsirolimus 30 mg/3 ml (10 mg/ml) (first dilution) intravenous soln
|
$795.52 |
$795.52 |
$795.52 |
$3,723.60
|
|
Tenotomy open tndn flxr toe sgl tndn spx
|
$851.20 |
$851.20 |
$851.20 |
$2,139.67
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$7.50 |
$7.50 |
$7.50 |
$39.33
|
|
Test for chlorohydrocarbons
|
$95.00 |
$95.00 |
$95.00 |
$65.00
|
|
Test for urine cystines
|
$13.40 |
$13.40 |
$13.40 |
$26.00
|
|
Test stress cardiovascular tracing only
|
$151.00 |
$151.00 |
$151.00 |
$949.70
|
|
Test urine for porphyrins
|
$83.20 |
$83.20 |
$83.20 |
$49.98
|
|
Tgsap hl neo 5-50 rna alys
|
$493.00 |
$493.00 |
$493.00 |
$879.20
|
|
Tgsap so/hl 51/< rna alys
|
$1,894.60 |
$1,894.60 |
$1,894.60 |
$4,347.00
|
|
Tgsap so neo 5-50 rna alys
|
$388.20 |
$388.20 |
$388.20 |
$1,019.60
|
|
Theophylline therapeutic drug level
|
$65.40 |
$65.40 |
$65.40 |
$108.00
|
|
Therapeutic procd strg endur
|
$16.20 |
$16.20 |
$16.20 |
$85.68
|
|
Ther/proph/diag inj ia
|
$58.00 |
$58.00 |
$58.00 |
$240.35
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$13.81 |
$13.81 |
$13.81 |
$25.54
|
|
Thiotepa injection
|
$1,304.39 |
$1,304.39 |
$1,304.39 |
$1,485.00
|
|
Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides)
|
$436.40 |
$436.40 |
$436.40 |
$1,687.50
|
