|
Scan duplex abd/pelvis/retroperitoneal complete
|
$1,267.50 |
$1,267.50 |
$1,267.50 |
|
|
Scan duplex abd/pelvis/retroperitoneal limited
|
$234.78 |
$234.78 |
$234.78 |
|
|
Scan duplex aorta/ivc/iliac or bypass grafts complete
|
$1,387.62 |
$1,387.62 |
$1,387.62 |
|
|
Scan duplex extracranial arteries unilateral/limited study
|
$209.04 |
$209.04 |
$209.04 |
|
|
Scan duplex extremity veins unilateral/limited study
|
$1,131.00 |
$1,131.00 |
$1,131.00 |
|
|
Scan duplex lower extremity arteries complete bilateral
|
$1,583.40 |
$1,583.40 |
$1,583.40 |
|
|
Scan duplex lower extremity arteries unilateral/limited study left
|
$1,131.00 |
$1,131.00 |
$1,131.00 |
|
|
Scan duplex upper extremity arteries unilateral/limited study left
|
$207.48 |
$207.48 |
$207.48 |
|
|
Screening Mammogram
|
$668.46 |
$668.46 |
$668.46 |
|
|
Sc ther infusion reset pump
|
$151.32 |
$151.32 |
$151.32 |
|
|
Sec abd wall suture evisceration/dehsn 49900
|
$7,942.74 |
$7,942.74 |
$7,942.74 |
|
|
Sedimentation rate erythrocyte automated
|
$75.66 |
$75.66 |
$75.66 |
|
|
Semen analysis w/count
|
$76.44 |
$76.44 |
$76.44 |
|
|
Serial casting application 97139app
|
$151.32 |
$151.32 |
$151.32 |
|
|
Sertraline (zoloft) - sendout
|
$144.30 |
$144.30 |
$144.30 |
|
|
Shave sgl skin lsn s/n/h/f/g 0.5cm/<
|
$351.78 |
$351.78 |
$351.78 |
|
|
Shave sgl skin lsn s/n/h/f/g 1.1-2cm
|
$351.78 |
$351.78 |
$351.78 |
|
|
Shave sgl skin lsn t/a/l 0.5cm/<
|
$306.54 |
$306.54 |
$306.54 |
|
|
Shoulder X-ray
|
$622.44 |
$622.44 |
$622.44 |
|
|
Sialolithotomy 42330
|
$5,548.14 |
$5,548.14 |
$5,548.14 |
|
|
Sickling rbc
|
$25.74 |
$25.74 |
$25.74 |
|
|
Sigmoidoscopy for bleeding
|
$2,111.46 |
$2,111.46 |
$2,111.46 |
|
|
Sinus CT scan (with and without contrast)
|
$2,784.60 |
$2,784.60 |
$2,784.60 |
|
|
Sinus CT scan (with contrast)
|
$2,687.88 |
$2,687.88 |
$2,687.88 |
|
|
Sinus CT scan (without contrast)
|
$1,906.32 |
$1,906.32 |
$1,906.32 |
|
|
Skin Biopsy
|
$372.06 |
$372.06 |
$372.06 |
|
|
Slitting of prepuce
|
$3,616.86 |
$3,616.86 |
$3,616.86 |
|
|
Smear fluorescent and/or acid fast stain
|
$30.42 |
$30.42 |
$30.42 |
|
|
Smear gram stain
|
$141.96 |
$141.96 |
$141.96 |
|
|
Smear special stain inclusion bodies/parasites
|
$46.02 |
$46.02 |
$46.02 |
|
|
Smear wet mount
|
$73.32 |
$73.32 |
$73.32 |
|
|
Sodium 24 hour urine
|
$34.32 |
$34.32 |
$34.32 |
|
|
Sodium chloride 0.9 % intravenous solution
|
$214.50 |
$214.50 |
$214.50 |
|
|
Sodium chloride 0.9 % IV bolus
|
$214.50 |
$214.50 |
$214.50 |
|
|
Sodium chloride 0.9 % IV bolus
|
$214.50 |
$214.50 |
$214.50 |
|
|
Sodium chloride 3 % ivpb
|
$214.50 |
$214.50 |
$214.50 |
|
|
Sodium ferric gluconate complex in sucrose 62.5 mg/5 ml intravenous
|
$191.05 |
$191.05 |
$191.05 |
|
|
Sodium serum/plasma/whole blood
|
$59.28 |
$59.28 |
$59.28 |
|
|
Speech evaluation complex
|
$588.90 |
$588.90 |
$588.90 |
|
|
Spinal puncture lumbar diagnostic w/fluoroscopic or CT guidance
|
$2,006.94 |
$2,006.94 |
$2,006.94 |
|
|
Split atogrft f/s/n/h/f/g/m/d gt 1st 100sqcm/</1 %
|
$7,295.34 |
$7,295.34 |
$7,295.34 |
|
|
St analysis behavior qualitative voice/resonance
|
$3,983.46 |
$3,983.46 |
$3,983.46 |
|
|
Staph a dna amp probe
|
$60.84 |
$60.84 |
$60.84 |
|
|
St cognitve performance testing healthcare professional each hour
|
$666.90 |
$666.90 |
$666.90 |
|
|
St evaluate speech sound production
|
$703.56 |
$703.56 |
$703.56 |
|
|
St evaluate speech sound production comprehensive/expressive
|
$845.52 |
$845.52 |
$845.52 |
|
|
St evaluation swallow function
|
$741.00 |
$741.00 |
$741.00 |
|
|
Strapping of ankle and/or ft 29540
|
$283.92 |
$283.92 |
$283.92 |
|
|
Strapping of chest
|
$283.92 |
$283.92 |
$283.92 |
|
|
Strapping of elbow or wrist 29260
|
$112.32 |
$112.32 |
$112.32 |
|
|
Strapping of hand or finger
|
$112.32 |
$112.32 |
$112.32 |
|
|
Strapping of hip
|
$226.20 |
$226.20 |
$226.20 |
|
|
Strapping of knee
|
$226.20 |
$226.20 |
$226.20 |
|
|
Strapping of toes 29550
|
$112.32 |
$112.32 |
$112.32 |
|
|
Str markers specimen anal
|
$214.50 |
$214.50 |
$214.50 |
|
|
St treatment speech individual
|
$590.46 |
$590.46 |
$590.46 |
|
|
St treatment swallow dysfunction/oral
|
$485.16 |
$485.16 |
$485.16 |
|
|
Succinylcholine chloride 20 mg/ml injection solution (wrapper)
|
$50.70 |
$50.70 |
$50.70 |
|
|
Sugars single quant
|
$81.90 |
$81.90 |
$81.90 |
|
|
Sulfonylurea screen qn-sendout
|
$165.36 |
$165.36 |
$165.36 |
|
|
Sumatriptan 6 mg/0.5 ml subcutaneous solution
|
$405.19 |
$405.19 |
$405.19 |
|
|
Surgical pathology level 4 gross & microscopic examination
|
$216.84 |
$216.84 |
$216.84 |
|
|
Susceptibility enzyme detection per enzyme
|
$53.04 |
$53.04 |
$53.04 |
|
|
Susceptibility mic per plate
|
$443.82 |
$443.82 |
$443.82 |
|
|
Suscept studies macrobroth dilution ea
|
$85.02 |
$85.02 |
$85.02 |
|
|
T3 (triiodothyronine) free
|
$230.88 |
$230.88 |
$230.88 |
|
|
T3 (triiodothyronine) total
|
$187.20 |
$187.20 |
$187.20 |
|
|
T4 (thyroxine) free
|
$148.98 |
$148.98 |
$148.98 |
|
|
T4 (thyroxine) total
|
$116.22 |
$116.22 |
$116.22 |
|
|
Tacrolimus therapeutic drug level
|
$87.36 |
$87.36 |
$87.36 |
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$153.66 |
$153.66 |
$153.66 |
|
|
T cells absolute cd4/cd8 including ratio
|
$81.90 |
$81.90 |
$81.90 |
|
|
T cells total count
|
$81.90 |
$81.90 |
$81.90 |
|
|
Telehealth original site facility fee
|
$84.24 |
$84.24 |
$84.24 |
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$14,835.13 |
$14,835.13 |
$14,835.13 |
|
|
Tenotomy length/rls abductor hallucis musc 28240
|
$5,804.76 |
$5,804.76 |
$5,804.76 |
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$50.70 |
$50.70 |
$50.70 |
|
|
Theophylline therapeutic drug level
|
$27.30 |
$27.30 |
$27.30 |
|
|
Therapy nutrition individual initial f2f w/patient each 15 minutes
|
$67.86 |
$67.86 |
$67.86 |
|
|
Therapy nutrition individual reassessment/intervention f2f w/patient each 15 minutes
|
$63.18 |
$63.18 |
$63.18 |
|
|
Ther/proph/diag inj ia
|
$462.54 |
$462.54 |
$462.54 |
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$50.70 |
$50.70 |
$50.70 |
|
|
Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides)
|
$3,035.76 |
$3,035.76 |
$3,035.76 |
|
|
Thoracotomy w/expl
|
$3,584.10 |
$3,584.10 |
$3,584.10 |
|
|
Thoracotomy with cardiac massage
|
$3,584.10 |
$3,584.10 |
$3,584.10 |
|
|
Thrombin time
|
$60.84 |
$60.84 |
$60.84 |
|
|
Thromboplastin time partial (ptt) substitution fractions each
|
$68.64 |
$68.64 |
$68.64 |
|
|
Thyroglobulin antibody
|
$145.08 |
$145.08 |
$145.08 |
|
|
Thyroid (TSH) Test
|
$206.70 |
$206.70 |
$206.70 |
|
|
Thyroid Ultrasound
|
$946.14 |
$946.14 |
$946.14 |
|
|
Tissue exam koh skin/hair/nails
|
$60.84 |
$60.84 |
$60.84 |
|
|
Tissue transglutaminase iga
|
$45.24 |
$45.24 |
$45.24 |
|
|
Tomosynthesis breast diagnostic left
|
$167.70 |
$167.70 |
$167.70 |
|
|
Tomosynthesis breast screen bilateral
|
$167.70 |
$167.70 |
$167.70 |
|
|
Toxoplasma antibody igg
|
$173.16 |
$173.16 |
$173.16 |
|
|
Toxoplasma antibody igm
|
$17.16 |
$17.16 |
$17.16 |
|
|
Tpmt gene com vrnts
|
$595.14 |
$595.14 |
$595.14 |
|
|
Tracheobrnchsc thru est trachs incisn
|
$2,848.56 |
$2,848.56 |
$2,848.56 |
|
|
Tranexamic acid 1,000 mg/10 ml (100 mg/ml) intravenous solution
|
$89.44 |
$89.44 |
$89.44 |
|
|
Transferrin
|
$163.80 |
$163.80 |
$163.80 |
|