|
Special teletx port plan
|
$272.07 |
$272.07 |
$272.07 |
$1,046.65
|
|
Specific gravity body fluid
|
$23.63 |
$23.63 |
$23.63 |
$23.63
|
|
Spinal puncture lumbar diagnostic w/fluoroscopic or CT guidance
|
$562.35 |
$562.35 |
$562.35 |
$1,502.08
|
|
Spirometry bronchodilation responsiveness pre/post bronchodilator administration
|
$383.07 |
$383.07 |
$383.07 |
$559.96
|
|
Splint dorsal bloc wh med perf 3.2mm lf polyflex ii
|
$278.46 |
$278.46 |
$278.46 |
$366.66
|
|
Splint extn xsm w sof-stretch rolyan
|
$29.93 |
$29.93 |
$29.93 |
$41.58
|
|
Splint finger frog med
|
$19.53 |
$19.53 |
$19.53 |
$21.50
|
|
Sr-89 stront chlor ther / mci
|
$800.10 |
$800.10 |
$800.10 |
$4,588.65
|
|
Srs linear based
|
$4,444.65 |
$4,444.65 |
$4,444.65 |
$14,124.25
|
|
St analysis behavior qualitative voice/resonance
|
$117.75 |
$117.75 |
$117.75 |
$300.00
|
|
Staph a dna amp probe
|
$22.02 |
$22.02 |
$22.02 |
$116.39
|
|
St cognitve performance testing healthcare professional each hour
|
$100.65 |
$100.65 |
$100.65 |
$313.96
|
|
Stent/athrectomy/fem/pop/unilat 37227
|
$11,492.55 |
$11,492.55 |
$11,492.55 |
$23,387.00
|
|
Stent axios caut enh 15x10mm electrocaut
|
$31,950.30 |
$31,950.30 |
$31,950.30 |
$39,270.00
|
|
Stent bili dbl pgtl 10fx5cm
|
$1,308.20 |
$1,308.20 |
$1,308.20 |
$1,206.15
|
|
Stent bili rx wallflx 10x80 uncvr
|
$31,950.30 |
$31,950.30 |
$31,950.30 |
$18,472.24
|
|
Stent bronch dumon sil 10x40mm
|
$4,604.83 |
$4,604.83 |
$4,604.83 |
$6,285.56
|
|
Stent iliac/open or perc/uni/init 37221
|
$5,773.05 |
$5,773.05 |
$5,773.05 |
$17,281.80
|
|
Stent iliac/open/perc/ea ad/ipsila 37223
|
$2,482.50 |
$2,482.50 |
$2,482.50 |
$9,276.80
|
|
Stent/tib/peroneal/unilat/initial 37230
|
$9,808.80 |
$9,808.80 |
$9,808.80 |
$19,765.20
|
|
St evaluate speech sound production
|
$120.75 |
$120.75 |
$120.75 |
$300.00
|
|
St evaluate speech sound production comprehensive/expressive
|
$136.35 |
$136.35 |
$136.35 |
$393.00
|
|
St evaluation motion fluoroscopic swallow function cine/video
|
$148.20 |
$148.20 |
$148.20 |
$406.40
|
|
St evaluation swallow function
|
$116.55 |
$116.55 |
$116.55 |
$336.60
|
|
Strep a ag ia
|
$53.25 |
$53.25 |
$53.25 |
$75.40
|
|
St treatment speech individual
|
$99.00 |
$99.00 |
$99.00 |
$254.15
|
|
St treatment swallow dysfunction/oral
|
$73.95 |
$73.95 |
$73.95 |
$261.60
|
|
Succinylcholine chloride 20 mg/ml injection solution (wrapper)
|
$69.34 |
$69.34 |
$69.34 |
$49.13
|
|
Sugars single quant
|
$9.60 |
$9.60 |
$9.60 |
$52.47
|
|
Sumatriptan 6 mg/0.5 ml subcutaneous solution
|
$32.40 |
$32.40 |
$32.40 |
$91.67
|
|
Support clav 29.6-40.5in med
|
$5.99 |
$5.99 |
$5.99 |
$68.54
|
|
Surgical pathology level 1 gross examination only
|
$58.65 |
$58.65 |
$58.65 |
$92.59
|
|
Surgical pathology level 2 gross & microscopic examination
|
$163.35 |
$163.35 |
$163.35 |
$149.76
|
|
Surgical pathology level 3 gross & microscopic examination
|
$184.50 |
$184.50 |
$184.50 |
$192.00
|
|
Surgical pathology level 4 gross & microscopic examination
|
$212.10 |
$212.10 |
$212.10 |
$253.75
|
|
Surgical pathology level 5 gross & microscopic examination
|
$248.25 |
$248.25 |
$248.25 |
$494.00
|
|
Surgical pathology level 6 gross & microscopic examination
|
$282.15 |
$282.15 |
$282.15 |
$790.00
|
|
Susceptibility mic per plate
|
$49.80 |
$49.80 |
$49.80 |
$94.38
|
|
Svc venogram s&i
|
$522.75 |
$522.75 |
$522.75 |
$1,908.00
|
|
Syphilis test non-treponemal antibody quantitative rpr
|
$30.08 |
$30.08 |
$30.08 |
$44.85
|
|
System pacing micra av
|
$22,733.55 |
$22,733.55 |
$22,733.55 |
$22,733.55
|
|
System pcmkr dual chamber leadless micra av2 intrdcr cath
|
$33,047.60 |
$33,047.60 |
$33,047.60 |
$9,363.28
|
|
T3 (triiodothyronine) free
|
$78.30 |
$78.30 |
$78.30 |
$89.82
|
|
T3 (triiodothyronine) total
|
$55.85 |
$55.85 |
$55.85 |
$94.90
|
|
T4 (thyroxine) free
|
$54.75 |
$54.75 |
$54.75 |
$81.60
|
|
T4 (thyroxine) total
|
$58.80 |
$58.80 |
$58.80 |
$73.64
|
|
Tacrolimus 1 mg capsule, immediate-release
|
$8.31 |
$8.31 |
$8.31 |
$9.99
|
|
Tacrolimus 5 mg/ml intravenous solution
|
$572.65 |
$572.65 |
$572.65 |
$612.11
|
|
Tacrolimus therapeutic drug level
|
$50.26 |
$50.26 |
$50.26 |
$122.40
|
|
Tbo-filgrastim 300 mcg/0.5 ml subcutaneous syringe
|
$10,397.32 |
$10,397.32 |
$10,397.32 |
$959.55
|
|
Tb test cell mediated immunity antigen response enumeration gamma interferon t-cells
|
$63.04 |
$63.04 |
$63.04 |
$200.00
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$43.65 |
$43.65 |
$43.65 |
$166.46
|
|
Tc-99m apcitide diag
|
$157.80 |
$157.80 |
$157.80 |
$1,765.30
|
|
Tc-99m bicisate
|
$436.80 |
$436.80 |
$436.80 |
$1,969.45
|
|
Tc-99m exametazime diag
|
$524.70 |
$524.70 |
$524.70 |
$2,166.26
|
|
Tc-99m labeled rbc
|
$134.82 |
$134.82 |
$134.82 |
$323.01
|
|
Tc-99m maa
|
$155.10 |
$155.10 |
$155.10 |
$312.06
|
|
Tc-99m mebrofenin
|
$157.65 |
$157.65 |
$157.65 |
$169.53
|
|
Tc-99m medronate
|
$132.45 |
$132.45 |
$132.45 |
$122.46
|
|
Tc-99m mertiatide
|
$290.54 |
$290.54 |
$290.54 |
$757.25
|
|
Tc-99m pentetate dtpa
|
$112.80 |
$112.80 |
$112.80 |
$245.85
|
|
Tc-99m pertechnetate per mci
|
$11.25 |
$11.25 |
$11.25 |
$28.08
|
|
Tc-99m pyroph diag per dose up to 25 mci
|
$87.37 |
$87.37 |
$87.37 |
$147.24
|
|
Tc-99m sestamibi p study dose
|
$200.63 |
$200.63 |
$200.63 |
$221.60
|
|
Tc-99m succimer (dmsa)
|
$146.25 |
$146.25 |
$146.25 |
$1,578.33
|
|
Tc-99m sulfur colloid
|
$107.19 |
$107.19 |
$107.19 |
$245.70
|
|
Tc-99m tetrofosmin p study dose
|
$59.25 |
$59.25 |
$59.25 |
$198.05
|
|
T cells absolute cd4/cd8 including ratio
|
$108.75 |
$108.75 |
$108.75 |
$186.00
|
|
T cells absolute cd 4 count
|
$71.46 |
$71.46 |
$71.46 |
$120.25
|
|
T cells total count
|
$17.10 |
$17.10 |
$17.10 |
$124.11
|
|
Telehealth original site facility fee
|
$12.60 |
$12.60 |
$12.60 |
$44.85
|
|
Telethx isodose plan cplx
|
$558.26 |
$558.26 |
$558.26 |
$1,617.00
|
|
Telethx isodose plan simple
|
$206.70 |
$206.70 |
$206.70 |
$848.72
|
|
Temozolomide
|
$540.06 |
$540.06 |
$540.06 |
$438.51
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$22,553.12 |
$22,553.12 |
$22,553.12 |
$17,652.73
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$93.97 |
$93.97 |
$93.97 |
$44.49
|
|
Test for urine cystines
|
$88.65 |
$88.65 |
$88.65 |
$26.00
|
|
Testicular imaging w/vasc flow
|
$286.95 |
$286.95 |
$286.95 |
$780.48
|
|
Test stress cardiovascular tracing only
|
$637.35 |
$637.35 |
$637.35 |
$1,001.55
|
|
Tetanus immune globulin inj
|
$2,187.25 |
$2,187.25 |
$2,187.25 |
$1,395.20
|
|
Tezepelumab-ekko 210 mg/1.91 ml (110 mg/ml) subcutaneous syringe
|
$7,938.24 |
$7,938.24 |
$7,938.24 |
$12,080.29
|
|
Theophylline therapeutic drug level
|
$34.95 |
$34.95 |
$34.95 |
$108.00
|
|
Therapy nutrition individual initial f2f w/patient each 15 minutes
|
$25.56 |
$25.56 |
$25.56 |
$55.00
|
|
Therapy nutrition individual reassessment/intervention f2f w/patient each 15 minutes
|
$18.45 |
$18.45 |
$18.45 |
$50.40
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$385.73 |
$385.73 |
$385.73 |
$38.64
|
|
Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides)
|
$755.10 |
$755.10 |
$755.10 |
$1,804.00
|
|
Thrombectmy crnry perq mechanical
|
$1,044.30 |
$1,044.30 |
$1,044.30 |
$3,580.00
|
|
Thrombectomy/inf pq dialysis circuit
|
$994.50 |
$994.50 |
$994.50 |
$7,828.60
|
|
Thrombin time
|
$23.85 |
$23.85 |
$23.85 |
$48.75
|
|
Thromboplastin time partial (ptt) substitution fractions each
|
$17.55 |
$17.55 |
$17.55 |
$56.93
|
|
Thyroglobulin antibody
|
$45.75 |
$45.75 |
$45.75 |
$84.00
|
|
Thyroid imaging
|
$545.70 |
$545.70 |
$545.70 |
$670.80
|
|
Thyroid met imaging
|
$229.65 |
$229.65 |
$229.65 |
$549.70
|
|
Thyroid mets imag whole body
|
$611.55 |
$611.55 |
$611.55 |
$1,524.99
|
|
Thyroid (TSH) Test
|
$73.35 |
$73.35 |
$73.35 |
$120.00
|
|
Thyroid Ultrasound
|
$522.00 |
$522.00 |
$522.00 |
$589.96
|
|
Thyroid uptake measurement
|
$106.35 |
$106.35 |
$106.35 |
$653.60
|
|
Thyrotropin alfa 0.9 mg intramuscular solution
|
$4,695.46 |
$4,695.46 |
$4,695.46 |
$4,886.55
|
|
Thyroxine binding globulin (tbg)
|
$61.80 |
$61.80 |
$61.80 |
$63.60
|
|
Tib/per revasc stent & ather 37231
|
$10,397.40 |
$10,397.40 |
$10,397.40 |
$21,900.00
|
