|
Succinylcholine chloride 20 mg/ml injection solution (wrapper)
|
$28.35 |
$28.35 |
$28.35 |
$52.31
|
|
Sugars single quant
|
$520.00 |
$520.00 |
$520.00 |
$64.28
|
|
Sulbactam 1 gram-durlobactam 1 gram (0.5 gram x2) intravenous solution
|
$354.50 |
$354.50 |
$354.50 |
$7,345.98
|
|
Supprelin la implant
|
$75,271.50 |
$75,271.50 |
$75,271.50 |
$80,935.72
|
|
Surgical pathology level 1 gross examination only
|
$79.50 |
$79.50 |
$79.50 |
$79.50
|
|
Surgical pathology level 2 gross & microscopic examination
|
$79.50 |
$79.50 |
$79.50 |
$141.94
|
|
Surgical pathology level 3 gross & microscopic examination
|
$123.50 |
$123.50 |
$123.50 |
$181.00
|
|
Surgical pathology level 4 gross & microscopic examination
|
$379.50 |
$379.50 |
$379.50 |
$239.85
|
|
Surgical pathology level 5 gross & microscopic examination
|
$1,345.00 |
$1,345.00 |
$1,345.00 |
$480.00
|
|
Surgical pathology level 6 gross & microscopic examination
|
$1,629.50 |
$1,629.50 |
$1,629.50 |
$718.00
|
|
Susceptibility agar dilution per agent
|
$88.00 |
$88.00 |
$88.00 |
$45.45
|
|
Susceptibility enzyme detection per enzyme
|
$17.00 |
$17.00 |
$17.00 |
$35.70
|
|
Susceptibility mic per plate
|
$479.50 |
$479.50 |
$479.50 |
$106.00
|
|
Synvisc or synvisc-one
|
$30.00 |
$30.00 |
$30.00 |
$1,274.94
|
|
Syphilis test non-treponemal antibody quantitative rpr
|
$19.50 |
$19.50 |
$19.50 |
$41.60
|
|
System pcmkr dual chamber leadless micra av2 intrdcr cath
|
$3,408.50 |
$3,408.50 |
$3,408.50 |
$12,003.00
|
|
T3 (triiodothyronine) free
|
$93.50 |
$93.50 |
$93.50 |
$99.20
|
|
T3 (triiodothyronine) total
|
$72.00 |
$72.00 |
$72.00 |
$93.52
|
|
T4 (thyroxine) free
|
$57.00 |
$57.00 |
$57.00 |
$85.20
|
|
T4 (thyroxine) total
|
$40.00 |
$40.00 |
$40.00 |
$69.00
|
|
Tacrol envarsus ex rel oral
|
$3.50 |
$3.50 |
$3.50 |
$15.60
|
|
Tacrolimus 1 mg capsule, immediate-release
|
$5.50 |
$5.50 |
$5.50 |
$9.84
|
|
Tacrolimus therapeutic drug level
|
$92.00 |
$92.00 |
$92.00 |
$122.40
|
|
Target gsa panel hmtlmph neop
|
$2,600.00 |
$2,600.00 |
$2,600.00 |
$2,246.30
|
|
Target gsa panel organ/hmtlmph neop
|
$1,350.00 |
$1,350.00 |
$1,350.00 |
$3,746.70
|
|
Target gsa panel organ neop
|
$1,100.00 |
$1,100.00 |
$1,100.00 |
$1,655.52
|
|
Tb test cell mediated immunity antigen response enumeration gamma interferon t-cells
|
$139.00 |
$139.00 |
$139.00 |
$194.35
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$314.50 |
$314.50 |
$314.50 |
$177.65
|
|
Tc-99m labeled rbc
|
$531.50 |
$531.50 |
$531.50 |
$302.40
|
|
Tc-99m maa
|
$461.50 |
$461.50 |
$461.50 |
$292.80
|
|
Tc-99m mebrofenin
|
$306.00 |
$306.00 |
$306.00 |
$157.65
|
|
Tc-99m medronate
|
$11.50 |
$11.50 |
$11.50 |
$111.01
|
|
Tc-99m mertiatide
|
$2,939.50 |
$2,939.50 |
$2,939.50 |
$756.00
|
|
Tc-99m pentetate dtpa aerosol
|
$114.50 |
$114.50 |
$114.50 |
$190.80
|
|
Tc-99m pertechnetate per mci
|
$1,098.00 |
$1,098.00 |
$1,098.00 |
$22.10
|
|
Tc-99m sestamibi p study dose
|
$495.50 |
$495.50 |
$495.50 |
$274.45
|
|
Tc-99m sulfur colloid
|
$315.00 |
$315.00 |
$315.00 |
$240.50
|
|
Tc-99m tetrofosmin p study dose
|
$210.00 |
$210.00 |
$210.00 |
$190.80
|
|
T cells absolute cd4/cd8 including ratio
|
$239.00 |
$239.00 |
$239.00 |
$176.40
|
|
T cells absolute cd 4 count
|
$127.50 |
$127.50 |
$127.50 |
$111.20
|
|
T cells total count
|
$192.50 |
$192.50 |
$192.50 |
$126.90
|
|
Telehealth original site facility fee
|
$50.00 |
$50.00 |
$50.00 |
$51.00
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$10,462.15 |
$10,462.15 |
$10,462.15 |
$15,245.38
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$0.70 |
$0.70 |
$0.70 |
$39.33
|
|
Test stress cardiovascular tracing only
|
$611.50 |
$611.50 |
$611.50 |
$949.70
|
|
Tezepelumab-ekko 210 mg/1.91 ml (110 mg/ml) subcutaneous syringe
|
$50.50 |
$50.50 |
$50.50 |
$8,737.05
|
|
Theophylline therapeutic drug level
|
$74.00 |
$74.00 |
$74.00 |
$108.00
|
|
Therapeutic procd strg endur
|
$69.00 |
$69.00 |
$69.00 |
$85.68
|
|
Therapy nutrition individual initial f2f w/patient each 15 minutes
|
$412.00 |
$412.00 |
$412.00 |
$57.31
|
|
Therapy nutrition individual reassessment/intervention f2f w/patient each 15 minutes
|
$94.00 |
$94.00 |
$94.00 |
$50.00
|
|
Ther radiology tx plng intrm
|
$296.50 |
$296.50 |
$296.50 |
$224.00
|
|
Ther radiology tx plng smpl
|
$235.50 |
$235.50 |
$235.50 |
$148.80
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$3.50 |
$3.50 |
$3.50 |
$25.54
|
|
Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides)
|
$1,615.00 |
$1,615.00 |
$1,615.00 |
$1,687.50
|
|
Thrombectmy crnry perq mechanical
|
$3,552.50 |
$3,552.50 |
$3,552.50 |
$3,580.00
|
|
Thrombectomy/inf pq dialysis circuit
|
$4,377.00 |
$4,377.00 |
$4,377.00 |
$8,084.00
|
|
Thrombectomy/inf pq dialysis circuit w/stent plcmnt
|
$9,212.00 |
$9,212.00 |
$9,212.00 |
$21,413.60
|
|
Thrombin time
|
$23.00 |
$23.00 |
$23.00 |
$53.76
|
|
Thromboplastin time partial (ptt) substitution fractions each
|
$33.00 |
$33.00 |
$33.00 |
$61.52
|
|
Thyroglobulin antibody
|
$112.50 |
$112.50 |
$112.50 |
$82.00
|
|
Thyroid (TSH) Test
|
$99.50 |
$99.50 |
$99.50 |
$111.00
|
|
Thyroid Ultrasound
|
$289.00 |
$289.00 |
$289.00 |
$588.50
|
|
Thyrotropin alfa 0.9 mg intramuscular solution
|
$4,550.00 |
$4,550.00 |
$4,550.00 |
$4,112.43
|
|
Thyroxine binding globulin (tbg)
|
$83.00 |
$83.00 |
$83.00 |
$64.35
|
|
Tilt table study
|
$1,211.00 |
$1,211.00 |
$1,211.00 |
$1,507.01
|
|
Tissue culture skin/biopsy
|
$315.00 |
$315.00 |
$315.00 |
$484.00
|
|
Tissue matrix 1.8x1.8cm collagen dermacell porous 4sq cm cost per sq cm
|
$143.50 |
$143.50 |
$143.50 |
$1,134.00
|
|
Tissue transglutaminase iga
|
$36.00 |
$36.00 |
$36.00 |
$44.16
|
|
Tlh w/t/o 250 g or less
|
$32,198.50 |
$32,198.50 |
$32,198.50 |
$12,320.22
|
|
Tlh w/t/o uterus over 250 g
|
$35,708.50 |
$35,708.50 |
$35,708.50 |
$12,320.22
|
|
Tobramycin peak therapeutic drug level
|
$26.00 |
$26.00 |
$26.00 |
$120.60
|
|
Tomosynthesis breast diagnostic left
|
$64.00 |
$64.00 |
$64.00 |
$73.00
|
|
Tomosynthesis breast screen bilateral
|
$80.00 |
$80.00 |
$80.00 |
$72.68
|
|
Total Hip Replacement
|
$27,537.50 |
$27,537.50 |
$27,537.50 |
$9,161.60
|
|
Total Knee Replacement
|
$31,070.50 |
$31,070.50 |
$31,070.50 |
$14,543.50
|
|
Total tau
|
$431.00 |
$431.00 |
$431.00 |
$312.50
|
|
Toxoplasma antibody igg
|
$78.00 |
$78.00 |
$78.00 |
$89.40
|
|
Toxoplasma antibody igm
|
$102.00 |
$102.00 |
$102.00 |
$87.00
|
|
Tp53 gene full gene sequence
|
$126.00 |
$126.00 |
$126.00 |
$709.80
|
|
Tpmt gene com vrnts
|
$175.00 |
$175.00 |
$175.00 |
$371.80
|
|
Transferrin
|
$63.00 |
$63.00 |
$63.00 |
$82.00
|
|
Transfusion blood/blood component(s)
|
$994.00 |
$994.00 |
$994.00 |
$983.00
|
|
Trauma partial team response w/critical care services level 4
|
$1,550.00 |
$1,550.00 |
$1,550.00 |
$4,523.04
|
|
Treat foot dislocation
|
$283.50 |
$283.50 |
$283.50 |
$527.28
|
|
Treat hip dislocation
|
$1,890.50 |
$1,890.50 |
$1,890.50 |
$2,641.60
|
|
Treat hip socket fracture
|
$1,519.50 |
$1,519.50 |
$1,519.50 |
$1,392.00
|
|
Treat knee dislocation
|
$1,890.50 |
$1,890.50 |
$1,890.50 |
$2,220.89
|
|
Treat knee fracture 27530
|
$219.50 |
$219.50 |
$219.50 |
$550.00
|
|
Treatment incomplete abortion completed surgically any trimester
|
$5,679.50 |
$5,679.50 |
$5,679.50 |
$3,916.04
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$408.50 |
$408.50 |
$408.50 |
$224.90
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$109.00 |
$109.00 |
$109.00 |
$145.51
|
|
Treatment inhalation pressurized/nonpressurized acute airway obstruction
|
$466.00 |
$466.00 |
$466.00 |
$203.35
|
|
Treatment of ankle fracture 27786
|
$323.00 |
$323.00 |
$323.00 |
$520.80
|
|
Treatment of fibula fracture 27780
|
$278.00 |
$278.00 |
$278.00 |
$491.50
|
|
Treatment of heel fracture 28400
|
$514.00 |
$514.00 |
$514.00 |
$473.00
|
|
Treatment of thigh fracture
|
$591.50 |
$591.50 |
$591.50 |
$548.90
|
|
Treatment of toe fracture 28510
|
$114.00 |
$114.00 |
$114.00 |
$369.70
|
|
Treat thigh fracture
|
$373.50 |
$373.50 |
$373.50 |
$618.80
|
|
Treponema pallidum antibody
|
$94.00 |
$94.00 |
$94.00 |
$70.40
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$6.25 |
$6.25 |
$6.25 |
$43.21
|
