|
Scan duplex lower extremity arteries complete bilateral
|
$1,751.79 |
$1,751.79 |
$1,751.79 |
$1,006.85
|
|
Scan duplex lower extremity arteries unilateral/limited study left
|
$1,350.03 |
$1,350.03 |
$1,350.03 |
$660.00
|
|
Scan duplex upper extremity arteries unilateral/limited study left
|
$1,285.20 |
$1,285.20 |
$1,285.20 |
$601.70
|
|
Screening Mammogram
|
$498.60 |
$498.60 |
$498.60 |
$303.55
|
|
Screening pap smear by phys
|
$36.12 |
$36.12 |
$36.12 |
$40.59
|
|
Sedimentation rate erythrocyte automated
|
$107.50 |
$107.50 |
$107.50 |
$44.20
|
|
Shave sgl skin lsn f/e/e/n/l/m 1.1-2cm
|
$2,253.74 |
$2,253.74 |
$2,253.74 |
$442.61
|
|
Shave sgl skin lsn t/a/l 0.5cm/<
|
$2,253.74 |
$2,253.74 |
$2,253.74 |
$311.25
|
|
Shoulder MRI (without contrast)
|
$5,058.83 |
$5,058.83 |
$5,058.83 |
$2,051.28
|
|
Shoulder X-ray
|
$395.22 |
$395.22 |
$395.22 |
$367.02
|
|
Sickling rbc
|
$173.78 |
$173.78 |
$173.78 |
$53.55
|
|
Sinus CT scan (with contrast)
|
$3,161.76 |
$3,161.76 |
$3,161.76 |
$1,519.50
|
|
Sinus CT scan (without contrast)
|
$2,845.58 |
$2,845.58 |
$2,845.58 |
$1,279.50
|
|
Smear fluorescent and/or acid fast stain
|
$288.35 |
$288.35 |
$288.35 |
$64.20
|
|
Smear gram stain
|
$98.47 |
$98.47 |
$98.47 |
$57.85
|
|
Smear wet mount
|
$129.55 |
$129.55 |
$129.55 |
$68.63
|
|
Sodium 24 hour urine
|
$113.82 |
$113.82 |
$113.82 |
$48.50
|
|
Sodium chloride 0.9 % intravenous solution
|
$23.39 |
$23.39 |
$23.39 |
$46.43
|
|
Sodium chloride 3 % ivpb
|
$44.34 |
$44.34 |
$44.34 |
$65.33
|
|
Sodium ferric gluconate complex in sucrose 62.5 mg/5 ml intravenous
|
$1,261.71 |
$1,261.71 |
$1,261.71 |
$104.00
|
|
Sodium hyaluronate 20 mg/2 ml syringe
|
$386.51 |
$386.51 |
$386.51 |
$651.32
|
|
Sodium serum/plasma/whole blood
|
$205.52 |
$205.52 |
$205.52 |
$42.70
|
|
Srs multisource
|
$98,343.21 |
$98,343.21 |
$98,343.21 |
$31,800.00
|
|
St analysis behavior qualitative voice/resonance
|
$508.89 |
$508.89 |
$508.89 |
$300.00
|
|
St cognitve performance testing healthcare professional each hour
|
$486.20 |
$486.20 |
$486.20 |
$313.96
|
|
St evaluate speech sound production
|
$505.67 |
$505.67 |
$505.67 |
$300.00
|
|
St evaluate speech sound production comprehensive/expressive
|
$491.72 |
$491.72 |
$491.72 |
$393.00
|
|
St evaluation swallow function
|
$508.89 |
$508.89 |
$508.89 |
$336.60
|
|
Strapping of ankle and/or ft 29540
|
$955.13 |
$955.13 |
$955.13 |
$248.05
|
|
Strapping of knee
|
$117.90 |
$117.90 |
$117.90 |
$224.80
|
|
Strapping of toes 29550
|
$530.51 |
$530.51 |
$530.51 |
$185.36
|
|
Stress test pulmonary
|
$1,094.56 |
$1,094.56 |
$1,094.56 |
$327.20
|
|
St treatment speech individual
|
$405.17 |
$405.17 |
$405.17 |
$254.15
|
|
St treatment swallow dysfunction/oral
|
$405.72 |
$405.72 |
$405.72 |
$261.60
|
|
Succinylcholine chloride 20 mg/ml injection solution (wrapper)
|
$76.49 |
$76.49 |
$76.49 |
$49.13
|
|
Sumatriptan 6 mg/0.5 ml subcutaneous solution
|
$42.40 |
$42.40 |
$42.40 |
$91.67
|
|
Surgical pathology level 1 gross examination only
|
$370.29 |
$370.29 |
$370.29 |
$92.59
|
|
Surgical pathology level 3 gross & microscopic examination
|
$376.78 |
$376.78 |
$376.78 |
$192.00
|
|
Surgical pathology level 4 gross & microscopic examination
|
$549.65 |
$549.65 |
$549.65 |
$253.75
|
|
Surgical pathology level 5 gross & microscopic examination
|
$1,648.97 |
$1,648.97 |
$1,648.97 |
$494.00
|
|
Susceptibility agar dilution per agent
|
$76.99 |
$76.99 |
$76.99 |
$40.30
|
|
Susceptibility enzyme detection per enzyme
|
$102.76 |
$102.76 |
$102.76 |
$34.48
|
|
Susceptibility mic per plate
|
$329.88 |
$329.88 |
$329.88 |
$94.38
|
|
Synvisc or synvisc-one
|
$461.77 |
$461.77 |
$461.77 |
$1,415.99
|
|
Syphilis test non-treponemal antibody quantitative rpr
|
$234.34 |
$234.34 |
$234.34 |
$44.85
|
|
T3 (triiodothyronine) free
|
$297.73 |
$297.73 |
$297.73 |
$89.82
|
|
T3 (triiodothyronine) total
|
$187.68 |
$187.68 |
$187.68 |
$94.90
|
|
T4 (thyroxine) free
|
$251.77 |
$251.77 |
$251.77 |
$81.60
|
|
T4 (thyroxine) total
|
$145.37 |
$145.37 |
$145.37 |
$73.64
|
|
Tacrolimus therapeutic drug level
|
$303.45 |
$303.45 |
$303.45 |
$122.40
|
|
Tbo-filgrastim 300 mcg/0.5 ml subcutaneous syringe
|
$844.82 |
$844.82 |
$844.82 |
$959.55
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$260.81 |
$260.81 |
$260.81 |
$166.46
|
|
Telethx isodose plan cplx
|
$5,299.39 |
$5,299.39 |
$5,299.39 |
$1,617.00
|
|
Telethx isodose plan simple
|
$502.07 |
$502.07 |
$502.07 |
$848.72
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$21.64 |
$21.64 |
$21.64 |
$44.49
|
|
Test stress cardiovascular tracing only
|
$1,118.65 |
$1,118.65 |
$1,118.65 |
$1,001.55
|
|
Tezepelumab-ekko 210 mg/1.91 ml (110 mg/ml) subcutaneous syringe
|
$9,411.21 |
$9,411.21 |
$9,411.21 |
$12,080.29
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$56.29 |
$56.29 |
$56.29 |
$38.64
|
|
Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides)
|
$3,168.96 |
$3,168.96 |
$3,168.96 |
$1,804.00
|
|
Thyroglobulin antibody
|
$195.14 |
$195.14 |
$195.14 |
$84.00
|
|
Thyroid (TSH) Test
|
$317.17 |
$317.17 |
$317.17 |
$120.00
|
|
Thyroid Ultrasound
|
$900.94 |
$900.94 |
$900.94 |
$589.96
|
|
Tissue culture skin/biopsy
|
$176.00 |
$176.00 |
$176.00 |
$558.87
|
|
Tissue exam koh skin/hair/nails
|
$84.80 |
$84.80 |
$84.80 |
$47.40
|
|
Tissue transglutaminase iga
|
$290.88 |
$290.88 |
$290.88 |
$48.57
|
|
Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr
|
$41.51 |
$41.51 |
$41.51 |
$125.87
|
|
Tocilizumab 162 mg/0.9 ml subcutaneous pen injector
|
$1,702.87 |
$1,702.87 |
$1,702.87 |
$5,790.85
|
|
Topotecan 4 mg/4 ml (1 mg/ml) intravenous solution
|
$134.57 |
$134.57 |
$134.57 |
$303.88
|
|
Transferrin
|
$225.36 |
$225.36 |
$225.36 |
$87.30
|
|
Transfusion blood/blood component(s)
|
$2,323.89 |
$2,323.89 |
$2,323.89 |
$988.24
|
|
Trauma partial team response w/critical care services level 4
|
$5,701.54 |
$5,701.54 |
$5,701.54 |
$5,941.07
|
|
Treat fracture of radius
|
$8,794.01 |
$8,794.01 |
$8,794.01 |
$2,030.33
|
|
Treat knuckle dislocation
|
$8,794.01 |
$8,794.01 |
$8,794.01 |
$1,893.86
|
|
Treatment inhalation pressurized/nonpressurized acute airway obstruction
|
$957.84 |
$957.84 |
$957.84 |
$210.00
|
|
Treatment radiation delivery level 2
|
$1,913.64 |
$1,913.64 |
$1,913.64 |
$735.00
|
|
Treat wrist dislocation
|
$1,849.58 |
$1,849.58 |
$1,849.58 |
$760.00
|
|
Tremelimumab-actl 20 mg/ml intravenous solution
|
$114,113.41 |
$114,113.41 |
$114,113.41 |
$120,541.18
|
|
Treponema pallidum antibody
|
$291.14 |
$291.14 |
$291.14 |
$72.80
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$93.51 |
$93.51 |
$93.51 |
$48.22
|
|
#tricyclicantidprssnt
|
$128.74 |
$128.74 |
$128.74 |
$57.08
|
|
Triglycerides
|
$174.16 |
$174.16 |
$174.16 |
$54.60
|
|
Trimethobenzamide hcl inj
|
$232.36 |
$232.36 |
$232.36 |
$154.09
|
|
Trim nondyst nails
|
$107.11 |
$107.11 |
$107.11 |
$124.22
|
|
Troponin quantitative
|
$417.87 |
$417.87 |
$417.87 |
$123.75
|
|
Ultrasound abdomen aorta screening study aaa
|
$950.10 |
$950.10 |
$950.10 |
$403.26
|
|
Ultrasound breast complete
|
$889.74 |
$889.74 |
$889.74 |
$519.75
|
|
Ultrasound breast unilateral limited (both sides)
|
$736.64 |
$736.64 |
$736.64 |
$449.35
|
|
Ultrasound chest
|
$802.25 |
$802.25 |
$802.25 |
$459.55
|
|
Ultrasound dx ophth b-scan
|
$870.69 |
$870.69 |
$870.69 |
$330.40
|
|
Ultrasound joint complete left
|
$572.82 |
$572.82 |
$572.82 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$811.40 |
$811.40 |
$811.40 |
$448.50
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$876.34 |
$876.34 |
$876.34 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$810.52 |
$810.52 |
$810.52 |
$485.48
|
|
Ultrasound retroperitoneal limited
|
$1,256.80 |
$1,256.80 |
$1,256.80 |
$498.00
|
|
Ultrasound scrotum and contents
|
$881.62 |
$881.62 |
$881.62 |
$617.28
|
|
Ultrasound transvaginal non obstetric
|
$949.62 |
$949.62 |
$949.62 |
$567.44
|
|
Unlisted transfusion med px
|
$319.88 |
$319.88 |
$319.88 |
$141.35
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$7,450.60 |
$7,450.60 |
$7,450.60 |
$2,916.00
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$5,147.81 |
$5,147.81 |
$5,147.81 |
$2,013.08
|
|
Urea nitrogen
|
$144.66 |
$144.66 |
$144.66 |
$45.10
|