|
Signal avg ecg w or without ecg 93278
|
$285.00 |
$285.00 |
$285.00 |
$280.00
|
|
Sincalide 5 mcg solution for injection
|
$157.80 |
$157.80 |
$157.80 |
$307.58
|
|
Sinus CT scan (with and without contrast)
|
$3,491.40 |
$3,491.40 |
$3,491.40 |
$1,790.00
|
|
Sinus CT scan (with contrast)
|
$3,491.40 |
$3,491.40 |
$3,491.40 |
$1,527.60
|
|
Sinus CT scan (without contrast)
|
$3,491.40 |
$3,491.40 |
$3,491.40 |
$1,292.04
|
|
Sinus/juglr venogram s&i
|
$2,220.60 |
$2,220.60 |
$2,220.60 |
$2,489.25
|
|
Skin Biopsy
|
$302.40 |
$302.40 |
$302.40 |
$360.34
|
|
Sleep study attended
|
$2,966.40 |
$2,966.40 |
$2,966.40 |
$1,329.00
|
|
Sleep Study (Polysomnography)
|
$4,430.40 |
$4,430.40 |
$4,430.40 |
$3,607.50
|
|
Sleep study unattended
|
$720.00 |
$720.00 |
$720.00 |
$580.87
|
|
Sling pelv split sam med
|
$307.80 |
$307.80 |
$307.80 |
$150.00
|
|
Slp pure tone screening
|
$109.20 |
$109.20 |
$109.20 |
$60.48
|
|
Slp stdy unatnd w/anal
|
$73.80 |
$73.80 |
$73.80 |
$296.34
|
|
Smear fluorescent and/or acid fast stain
|
$129.00 |
$129.00 |
$129.00 |
$64.20
|
|
Smear gram stain
|
$73.20 |
$73.20 |
$73.20 |
$55.25
|
|
Smear nasal eosinophil
|
$68.40 |
$68.40 |
$68.40 |
$46.20
|
|
Smear special stain inclusion bodies/parasites
|
$111.00 |
$111.00 |
$111.00 |
$73.15
|
|
Smear wet mount
|
$116.40 |
$116.40 |
$116.40 |
$67.49
|
|
Snrpn/ube3a gene
|
$1,674.00 |
$1,674.00 |
$1,674.00 |
$231.85
|
|
Sodium 24 hour urine
|
$124.20 |
$124.20 |
$124.20 |
$48.60
|
|
Sodium serum/plasma/whole blood
|
$82.20 |
$82.20 |
$82.20 |
$45.60
|
|
So neo gsap dna mcrstl ins
|
$8,194.80 |
$8,194.80 |
$8,194.80 |
$2,296.00
|
|
Special physics consult
|
$1,774.20 |
$1,774.20 |
$1,774.20 |
$725.00
|
|
Special radiation dosimetry
|
$289.80 |
$289.80 |
$289.80 |
$392.50
|
|
Special radiation treatment
|
$6,186.60 |
$6,186.60 |
$6,186.60 |
$1,986.00
|
|
Special teletx port plan
|
$2,311.20 |
$2,311.20 |
$2,311.20 |
$1,086.99
|
|
Specific gravity body fluid
|
$27.60 |
$27.60 |
$27.60 |
$22.00
|
|
Specimen fat stain
|
$110.40 |
$110.40 |
$110.40 |
$35.10
|
|
Spinal puncture lumbar diagnostic w/fluoroscopic or CT guidance
|
$1,219.20 |
$1,219.20 |
$1,219.20 |
$1,439.40
|
|
Spirometry bronchodilation responsiveness pre/post bronchodilator administration
|
$846.60 |
$846.60 |
$846.60 |
$543.26
|
|
Splint extn xsm w sof-stretch rolyan
|
$85.20 |
$85.20 |
$85.20 |
$68.25
|
|
Splint func pos polyflex ii med
|
$1,143.00 |
$1,143.00 |
$1,143.00 |
$58.65
|
|
Splint rstrc wrst/cmc right med
|
$585.60 |
$585.60 |
$585.60 |
$99.04
|
|
Srs linear based
|
$17,355.60 |
$17,355.60 |
$17,355.60 |
$13,585.00
|
|
Srs multisource
|
$36,051.00 |
$36,051.00 |
$36,051.00 |
$34,165.20
|
|
St analysis behavior qualitative voice/resonance
|
$358.20 |
$358.20 |
$358.20 |
$297.60
|
|
Staph a dna amp probe
|
$213.00 |
$213.00 |
$213.00 |
$125.00
|
|
St cognitve performance testing healthcare professional each hour
|
$280.20 |
$280.20 |
$280.20 |
$286.00
|
|
St evaluate speech sound production
|
$293.40 |
$293.40 |
$293.40 |
$292.95
|
|
St evaluate speech sound production comprehensive/expressive
|
$406.20 |
$406.20 |
$406.20 |
$377.00
|
|
St evaluation motion fluoroscopic swallow function cine/video
|
$410.40 |
$410.40 |
$410.40 |
$399.60
|
|
St evaluation swallow function
|
$309.60 |
$309.60 |
$309.60 |
$314.40
|
|
Stot/tot hysterectomy after cesaren delivery 59525
|
$4,818.60 |
$4,818.60 |
$4,818.60 |
$2,607.60
|
|
Strapping of ankle and/or ft 29540
|
$162.60 |
$162.60 |
$162.60 |
$223.45
|
|
Strapping of chest
|
$1,023.00 |
$1,023.00 |
$1,023.00 |
$195.33
|
|
Strapping of elbow or wrist 29260
|
$162.60 |
$162.60 |
$162.60 |
$154.70
|
|
Strapping of hand or finger
|
$162.60 |
$162.60 |
$162.60 |
$174.82
|
|
Strapping of knee
|
$162.60 |
$162.60 |
$162.60 |
$205.20
|
|
Strapping of toes 29550
|
$890.40 |
$890.40 |
$890.40 |
$164.70
|
|
Strep a ag ia
|
$111.60 |
$111.60 |
$111.60 |
$75.40
|
|
Strep b dna amp probe
|
$245.40 |
$245.40 |
$245.40 |
$120.90
|
|
Stress test pulmonary
|
$586.80 |
$586.80 |
$586.80 |
$322.85
|
|
Stress tte complete
|
$2,682.60 |
$2,682.60 |
$2,682.60 |
$1,870.50
|
|
Str markers spec anal addl
|
$487.20 |
$487.20 |
$487.20 |
$479.17
|
|
Str markers specimen anal
|
$1,097.40 |
$1,097.40 |
$1,097.40 |
$751.50
|
|
St treatment speech individual
|
$256.80 |
$256.80 |
$256.80 |
$248.84
|
|
St treatment swallow dysfunction/oral
|
$216.00 |
$216.00 |
$216.00 |
$240.31
|
|
Subq i/p critical care pr day age 28 days/less than 99469
|
$733.80 |
$733.80 |
$733.80 |
$717.60
|
|
Subsequent intensive care infant 1500-2500 grams 99479
|
$229.20 |
$229.20 |
$229.20 |
$224.80
|
|
Subsequent intensive care infant 2501-5000 grams 99480
|
$221.40 |
$221.40 |
$221.40 |
$216.00
|
|
Sugars single quant
|
$741.60 |
$741.60 |
$741.60 |
$64.28
|
|
Support clav 29.6-40.5in med
|
$169.20 |
$169.20 |
$169.20 |
$94.19
|
|
Surgical pathology level 1 gross examination only
|
$172.80 |
$172.80 |
$172.80 |
$79.50
|
|
Surgical pathology level 2 gross & microscopic examination
|
$285.60 |
$285.60 |
$285.60 |
$141.94
|
|
Surgical pathology level 3 gross & microscopic examination
|
$351.00 |
$351.00 |
$351.00 |
$181.00
|
|
Surgical pathology level 4 gross & microscopic examination
|
$415.20 |
$415.20 |
$415.20 |
$239.85
|
|
Surgical pathology level 5 gross & microscopic examination
|
$722.40 |
$722.40 |
$722.40 |
$480.00
|
|
Surgical pathology level 6 gross & microscopic examination
|
$1,297.80 |
$1,297.80 |
$1,297.80 |
$718.00
|
|
Susceptibility agar dilution per agent
|
$113.40 |
$113.40 |
$113.40 |
$45.45
|
|
Susceptibility enzyme detection per enzyme
|
$87.00 |
$87.00 |
$87.00 |
$35.70
|
|
Susceptibility mic per plate
|
$72.60 |
$72.60 |
$72.60 |
$106.00
|
|
Svc venogram s&i
|
$2,132.40 |
$2,132.40 |
$2,132.40 |
$1,934.62
|
|
Sweat collection by iontophoresis
|
$141.60 |
$141.60 |
$141.60 |
$125.40
|
|
Syphilis test non-treponemal antibody quantitative rpr
|
$108.60 |
$108.60 |
$108.60 |
$41.60
|
|
T3 (triiodothyronine) free
|
$276.00 |
$276.00 |
$276.00 |
$99.20
|
|
T3 (triiodothyronine) total
|
$244.20 |
$244.20 |
$244.20 |
$93.52
|
|
T4 (thyroxine) free
|
$118.80 |
$118.80 |
$118.80 |
$85.20
|
|
T4 (thyroxine) total
|
$187.20 |
$187.20 |
$187.20 |
$69.00
|
|
Tacrolimus therapeutic drug level
|
$421.20 |
$421.20 |
$421.20 |
$122.40
|
|
Target gsa panel hmtlmph neop
|
$5,058.00 |
$5,058.00 |
$5,058.00 |
$2,246.30
|
|
Target gsa panel organ/hmtlmph neop
|
$3,592.80 |
$3,592.80 |
$3,592.80 |
$3,746.70
|
|
Target gsa panel organ neop
|
$3,091.20 |
$3,091.20 |
$3,091.20 |
$1,655.52
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$299.40 |
$299.40 |
$299.40 |
$177.65
|
|
T cells absolute cd4/cd8 including ratio
|
$318.00 |
$318.00 |
$318.00 |
$176.40
|
|
T cells absolute cd 4 count
|
$283.20 |
$283.20 |
$283.20 |
$111.20
|
|
T cells total count
|
$318.00 |
$318.00 |
$318.00 |
$126.90
|
|
Telehealth original site facility fee
|
$50.40 |
$50.40 |
$50.40 |
$51.00
|
|
Telethx isodose plan cplx
|
$1,590.00 |
$1,590.00 |
$1,590.00 |
$1,526.85
|
|
Telethx isodose plan simple
|
$1,176.00 |
$1,176.00 |
$1,176.00 |
$873.62
|
|
Tert gene targeted seq alys
|
$2,527.80 |
$2,527.80 |
$2,527.80 |
$335.00
|
|
Testicular imaging w/vasc flow
|
$1,240.80 |
$1,240.80 |
$1,240.80 |
$842.56
|
|
Test stress cardiovascular tracing only
|
$1,176.60 |
$1,176.60 |
$1,176.60 |
$949.70
|
|
Tgsap so/hl 51/< rna alys
|
$7,031.40 |
$7,031.40 |
$7,031.40 |
$4,347.00
|
|
Theophylline therapeutic drug level
|
$187.80 |
$187.80 |
$187.80 |
$108.00
|
|
Therapeutic procd strg endur
|
$100.20 |
$100.20 |
$100.20 |
$85.68
|
|
Therapy nutrition individual initial f2f w/patient each 15 minutes
|
$63.00 |
$63.00 |
$63.00 |
$57.31
|
|
Therapy nutrition individual reassessment/intervention f2f w/patient each 15 minutes
|
$63.00 |
$63.00 |
$63.00 |
$50.00
|
|
Ther nma rdctj intus/obstrcj
|
$1,054.20 |
$1,054.20 |
$1,054.20 |
$529.08
|
|
Ther/proph/diag inj ia
|
$178.20 |
$178.20 |
$178.20 |
$240.35
|
|
Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides)
|
$6,170.40 |
$6,170.40 |
$6,170.40 |
$1,687.50
|
