|
Sinus CT scan (with and without contrast)
|
$5,462.00 |
$5,462.00 |
$9,300.49 |
$1,815.00
|
|
Sinus CT scan (with contrast)
|
$6,088.00 |
$6,088.00 |
$8,255.49 |
$1,519.50
|
|
Sinus CT scan (without contrast)
|
$6,269.99 |
$6,269.99 |
$6,637.00 |
$1,279.50
|
|
Sinus/juglr venogram s&i
|
$16,469.00 |
$16,469.00 |
$16,469.00 |
$2,489.25
|
|
Sirolimus, oral
|
$96.00 |
$96.00 |
$96.00 |
$31.60
|
|
Skin Biopsy
|
$2,671.28 |
$2,671.28 |
$2,671.28 |
$382.80
|
|
Sleep Study (Polysomnography)
|
$14,284.29 |
$14,284.29 |
$14,284.29 |
$3,936.80
|
|
Sleep study unattended
|
$1,582.46 |
$1,582.46 |
$1,582.46 |
$595.50
|
|
Smear fluorescent and/or acid fast stain
|
$67.81 |
$67.81 |
$67.81 |
$64.20
|
|
Smear gram stain
|
$205.45 |
$205.45 |
$205.45 |
$57.85
|
|
Smear nasal eosinophil
|
$393.00 |
$393.00 |
$393.00 |
$49.50
|
|
Smear special stain inclusion bodies/parasites
|
$140.13 |
$140.13 |
$140.13 |
$64.35
|
|
Smear wet mount
|
$265.09 |
$265.09 |
$265.09 |
$68.63
|
|
Sodium 24 hour urine
|
$202.69 |
$202.69 |
$519.00 |
$48.50
|
|
Sodium chloride 0.9 % intravenous solution
|
$42.98 |
$42.98 |
$42.98 |
$46.43
|
|
Sodium chloride 0.9 % IV bolus
|
$226.92 |
$226.92 |
$226.92 |
$51.51
|
|
Sodium chloride 3 % ivpb
|
$260.46 |
$260.46 |
$260.46 |
$65.33
|
|
Sodium ferric gluconate complex in sucrose 62.5 mg/5 ml intravenous
|
$260.00 |
$260.00 |
$829.46 |
$104.00
|
|
Sodium hyaluronate 20 mg/2 ml syringe
|
$2,024.74 |
$2,024.74 |
$2,024.74 |
$651.32
|
|
Sodium serum/plasma/whole blood
|
$158.00 |
$158.00 |
$163.23 |
$42.70
|
|
Special physics consult
|
$1,738.17 |
$1,738.17 |
$1,738.17 |
$700.74
|
|
Special radiation dosimetry
|
$985.60 |
$985.60 |
$985.60 |
$445.50
|
|
Special radiation treatment
|
$2,293.49 |
$2,293.49 |
$2,293.49 |
$1,934.03
|
|
Specific gravity body fluid
|
$72.00 |
$72.00 |
$72.00 |
$23.63
|
|
Specimen fat stain
|
$675.00 |
$675.00 |
$675.00 |
$32.76
|
|
Sperm antibody test
|
$174.00 |
$174.00 |
$174.00 |
$56.44
|
|
Sperm isolation simple
|
$207.00 |
$207.00 |
$207.00 |
$104.80
|
|
Spinal puncture lumbar diagnostic w/fluoroscopic or CT guidance
|
$4,489.43 |
$4,489.43 |
$4,489.43 |
$1,502.08
|
|
Spirometry bronchodilation responsiveness pre/post bronchodilator administration
|
$891.00 |
$891.00 |
$1,430.32 |
$559.96
|
|
Splint dorsal bloc wh med perf 3.2mm lf polyflex ii
|
$1,885.73 |
$1,885.73 |
$1,885.73 |
$366.66
|
|
Splint extn xsm w sof-stretch rolyan
|
$349.95 |
$349.95 |
$349.95 |
$41.58
|
|
Splint finger fold over sm
|
$583.23 |
$583.23 |
$583.23 |
$57.33
|
|
Splint finger frog med
|
$229.04 |
$229.04 |
$229.04 |
$21.50
|
|
Sputum specimen collection
|
$409.00 |
$409.00 |
$409.00 |
$180.00
|
|
Srs linear based
|
$36,772.77 |
$36,772.77 |
$36,772.77 |
$14,124.25
|
|
St analysis behavior qualitative voice/resonance
|
$318.72 |
$318.72 |
$592.00 |
$300.00
|
|
Staph a dna amp probe
|
$441.45 |
$441.45 |
$441.45 |
$116.39
|
|
St cognitve performance testing healthcare professional each hour
|
$430.93 |
$430.93 |
$430.93 |
$313.96
|
|
Stent/athrectomy/fem/pop/unilat 37227
|
$43,808.56 |
$43,808.56 |
$43,808.56 |
$23,387.00
|
|
Stent iliac/open or perc/uni/init 37221
|
$19,794.56 |
$19,794.56 |
$19,794.56 |
$17,281.80
|
|
Stent iliac/open/perc/ea ad/ipsila 37223
|
$13,155.35 |
$13,155.35 |
$13,155.35 |
$9,276.80
|
|
Stent/tib/peroneal/unilat/initial 37230
|
$27,928.50 |
$27,928.50 |
$27,928.50 |
$19,765.20
|
|
St evaluate speech sound production
|
$323.34 |
$323.34 |
$563.00 |
$300.00
|
|
St evaluate speech sound production comprehensive/expressive
|
$659.40 |
$659.40 |
$1,169.00 |
$393.00
|
|
St evaluation motion fluoroscopic swallow function cine/video
|
$1,329.00 |
$1,329.00 |
$1,397.50 |
$406.40
|
|
St evaluation swallow function
|
$680.00 |
$680.00 |
$752.31 |
$336.60
|
|
Strapping of ankle and/or ft 29540
|
$2,185.40 |
$2,185.40 |
$2,185.40 |
$248.05
|
|
Strapping of elbow or wrist 29260
|
$840.59 |
$840.59 |
$840.59 |
$171.00
|
|
Strapping of hand or finger
|
$840.59 |
$840.59 |
$840.59 |
$194.40
|
|
Strapping of knee
|
$1,570.74 |
$1,570.74 |
$1,570.74 |
$224.80
|
|
Strapping of toes 29550
|
$840.90 |
$840.90 |
$840.90 |
$185.36
|
|
Strep a ag ia
|
$252.00 |
$252.00 |
$252.00 |
$75.40
|
|
Strep b dna amp probe
|
$441.45 |
$441.45 |
$441.45 |
$139.20
|
|
Streptomycin injection
|
$107.00 |
$107.00 |
$107.00 |
$100.00
|
|
Stress test pulmonary
|
$542.00 |
$542.00 |
$1,570.74 |
$327.20
|
|
Stress tte complete
|
$4,772.00 |
$4,772.00 |
$6,467.35 |
$1,964.95
|
|
St treatment speech individual
|
$220.74 |
$220.74 |
$492.00 |
$254.15
|
|
St treatment swallow dysfunction/oral
|
$243.99 |
$243.99 |
$538.00 |
$261.60
|
|
Succinylcholine chloride 20 mg/ml injection solution (wrapper)
|
$251.87 |
$251.87 |
$251.87 |
$49.13
|
|
Sugars single quant
|
$130.99 |
$130.99 |
$130.99 |
$52.47
|
|
Sulfamethoxazole 400 mg-trimethoprim 80 mg/5 ml intravenous solution
|
$64.12 |
$64.12 |
$64.12 |
$71.09
|
|
Sulfonylurea screen qn-sendout
|
$290.94 |
$290.94 |
$290.94 |
$184.60
|
|
Sumatriptan 6 mg/0.5 ml subcutaneous solution
|
$145.66 |
$145.66 |
$794.00 |
$91.67
|
|
Surgical pathology level 1 gross examination only
|
$95.00 |
$95.00 |
$188.25 |
$92.59
|
|
Surgical pathology level 2 gross & microscopic examination
|
$135.00 |
$135.00 |
$402.19 |
$149.76
|
|
Surgical pathology level 3 gross & microscopic examination
|
$174.00 |
$174.00 |
$519.90 |
$192.00
|
|
Surgical pathology level 4 gross & microscopic examination
|
$614.01 |
$614.01 |
$614.01 |
$253.75
|
|
Surgical pathology level 5 gross & microscopic examination
|
$907.62 |
$907.62 |
$1,200.00 |
$494.00
|
|
Surgical pathology level 6 gross & microscopic examination
|
$856.00 |
$856.00 |
$2,288.26 |
$790.00
|
|
Susceptibility agar dilution per agent
|
$59.76 |
$59.76 |
$59.76 |
$40.30
|
|
Susceptibility enzyme detection per enzyme
|
$59.76 |
$59.76 |
$77.00 |
$34.48
|
|
Susceptibility mic per plate
|
$2,743.26 |
$2,743.26 |
$2,743.26 |
$94.38
|
|
Suscept studies macrobroth dilution ea
|
$67.00 |
$67.00 |
$83.54 |
$48.30
|
|
Svc venogram s&i
|
$14,155.30 |
$14,155.30 |
$14,155.30 |
$1,908.00
|
|
Sweat collection by iontophoresis
|
$304.00 |
$304.00 |
$304.00 |
$105.21
|
|
Synvisc or synvisc-one
|
$2,432.19 |
$2,432.19 |
$2,432.19 |
$1,415.99
|
|
Syphilis test non-treponemal antibody quantitative rpr
|
$48.51 |
$48.51 |
$48.51 |
$44.85
|
|
T3 (triiodothyronine) free
|
$338.40 |
$338.40 |
$460.00 |
$89.82
|
|
T3 (triiodothyronine) total
|
$48.33 |
$48.33 |
$765.00 |
$94.90
|
|
T4 (thyroxine) free
|
$256.19 |
$256.19 |
$725.00 |
$81.60
|
|
T4 (thyroxine) total
|
$188.08 |
$188.08 |
$859.00 |
$73.64
|
|
Tacrolimus therapeutic drug level
|
$45.41 |
$45.41 |
$422.00 |
$122.40
|
|
Target gsa panel hmtlmph neop
|
$2,512.15 |
$2,512.15 |
$2,512.15 |
$1,928.40
|
|
Tbo-filgrastim 300 mcg/0.5 ml subcutaneous syringe
|
$4,505.93 |
$4,505.93 |
$4,505.93 |
$959.55
|
|
Tbs techl calculation only
|
$256.28 |
$256.28 |
$256.28 |
$123.30
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$34.00 |
$34.00 |
$220.00 |
$166.46
|
|
Tc-99m exametazime diag
|
$8,623.00 |
$8,623.00 |
$8,623.00 |
$2,166.26
|
|
Tc-99m labeled rbc
|
$808.00 |
$808.00 |
$808.00 |
$323.01
|
|
Tc-99m maa
|
$156.00 |
$156.00 |
$156.00 |
$312.06
|
|
Tc-99m mebrofenin
|
$442.00 |
$442.00 |
$442.00 |
$169.53
|
|
Tc-99m medronate
|
$2,925.00 |
$2,925.00 |
$2,925.00 |
$122.46
|
|
Tc-99m mertiatide
|
$1,680.00 |
$1,680.00 |
$1,680.00 |
$757.25
|
|
Tc-99m pentetate dtpa
|
$314.00 |
$314.00 |
$314.00 |
$245.85
|
|
Tc-99m pentetate dtpa aerosol
|
$547.00 |
$547.00 |
$547.00 |
$244.02
|
|
Tc-99m pertechnetate per mci
|
$172.00 |
$172.00 |
$172.00 |
$28.08
|
|
Tc-99m pyroph diag per dose up to 25 mci
|
$861.00 |
$861.00 |
$861.00 |
$147.24
|
|
Tc-99m sestamibi p study dose
|
$4,424.00 |
$4,424.00 |
$4,424.00 |
$221.60
|
|
Tc-99m sulfur colloid
|
$506.00 |
$506.00 |
$506.00 |
$245.70
|
|
Tc-99m tetrofosmin p study dose
|
$1,716.00 |
$1,716.00 |
$1,716.00 |
$198.05
|
|
T cells absolute cd4/cd8 including ratio
|
$140.94 |
$140.94 |
$140.94 |
$186.00
|
