|
Scan duplex aorta/ivc/iliac unilateral/limited
|
$325.00 |
$325.00 |
$325.00 |
$509.35
|
|
Scan duplex extracranial arteries unilateral/limited study
|
$250.00 |
$250.00 |
$250.00 |
$589.60
|
|
Scan duplex extremity veins unilateral/limited study
|
$375.00 |
$375.00 |
$375.00 |
$759.20
|
|
Scan duplex lower extremity arteries complete bilateral
|
$500.00 |
$500.00 |
$500.00 |
$1,006.85
|
|
Scan duplex lower extremity arteries unilateral/limited study left
|
$375.00 |
$375.00 |
$375.00 |
$660.00
|
|
Scan duplex upper extremity arteries unilateral/limited study left
|
$375.00 |
$375.00 |
$375.00 |
$601.70
|
|
Sclerotherapy fluid collection pq w/img
|
$600.00 |
$600.00 |
$600.00 |
$2,114.45
|
|
Screening Mammogram
|
$97.50 |
$97.50 |
$97.50 |
$303.55
|
|
Sec art mech thrmbc non-intracranial add-on
|
$750.00 |
$750.00 |
$750.00 |
$4,565.60
|
|
Sedimentation rate erythrocyte automated
|
$25.00 |
$25.00 |
$25.00 |
$44.20
|
|
Semen analysis presence/motility
|
$35.00 |
$35.00 |
$35.00 |
$70.85
|
|
Semen analysis w/count
|
$31.25 |
$31.25 |
$31.25 |
$56.44
|
|
Serpina1 gene
|
$38.25 |
$38.25 |
$38.25 |
$191.73
|
|
Set radiation therapy field
|
$475.00 |
$475.00 |
$475.00 |
$731.50
|
|
Set radiation therapy field
|
$950.00 |
$950.00 |
$950.00 |
$1,636.36
|
|
Shave sgl skin lsn t/a/l 0.5cm/<
|
$112.50 |
$112.50 |
$112.50 |
$311.25
|
|
Shoe post-op mens m
|
$18.50 |
$18.50 |
$18.50 |
$42.87
|
|
Shoulder MRI (with and without contrast)
|
$1,350.00 |
$1,350.00 |
$1,350.00 |
$2,705.30
|
|
Shoulder MRI (with contrast)
|
$1,050.00 |
$1,050.00 |
$1,050.00 |
$2,449.80
|
|
Shoulder MRI (without contrast)
|
$950.00 |
$950.00 |
$950.00 |
$2,051.28
|
|
Shoulder X-ray
|
$137.50 |
$137.50 |
$137.50 |
$367.02
|
|
Shuntogram nonvascular supervision & interpretation
|
$112.50 |
$112.50 |
$112.50 |
$345.00
|
|
Sialidase enzyme assay
|
$32.00 |
$32.00 |
$32.00 |
$49.44
|
|
Sickling rbc
|
$22.50 |
$22.50 |
$22.50 |
$53.55
|
|
Sincalide 5 mcg solution for injection
|
$229.66 |
$229.66 |
$229.66 |
$354.67
|
|
Sinus CT scan (with contrast)
|
$700.00 |
$700.00 |
$700.00 |
$1,519.50
|
|
Sinus CT scan (without contrast)
|
$625.00 |
$625.00 |
$625.00 |
$1,279.50
|
|
Sinus/juglr venogram s&i
|
$1,875.00 |
$1,875.00 |
$1,875.00 |
$2,489.25
|
|
Sipuleucel-t - su
|
$183.77 |
$183.77 |
$183.77 |
$95,750.46
|
|
Sirolimus, oral
|
$8.71 |
$8.71 |
$8.71 |
$42.11
|
|
Skin Biopsy
|
$105.00 |
$105.00 |
$105.00 |
$382.80
|
|
Skyla, 13.5 mg
|
$286.36 |
$286.36 |
$286.36 |
$1,801.20
|
|
Sleep Study (Polysomnography)
|
$1,700.00 |
$1,700.00 |
$1,700.00 |
$3,936.80
|
|
Sleep study unattended
|
$450.00 |
$450.00 |
$450.00 |
$595.50
|
|
Sling arm deluxe w/pad xs
|
$12.16 |
$12.16 |
$12.16 |
$25.55
|
|
Smear fluorescent and/or acid fast stain
|
$22.50 |
$22.50 |
$22.50 |
$64.20
|
|
Smear gram stain
|
$20.00 |
$20.00 |
$20.00 |
$57.85
|
|
Smear special stain inclusion bodies/parasites
|
$22.50 |
$22.50 |
$22.50 |
$64.35
|
|
Smear wet mount
|
$22.50 |
$22.50 |
$22.50 |
$68.63
|
|
Sodium 24 hour urine
|
$22.50 |
$22.50 |
$22.50 |
$48.50
|
|
Sodium chloride 3 % ivpb
|
$3.85 |
$3.85 |
$3.85 |
$48.11
|
|
Sodium ferric gluconate complex in sucrose 62.5 mg/5 ml intravenous
|
$21.30 |
$21.30 |
$21.30 |
$84.80
|
|
Sodium hyaluronate 20 mg/2 ml syringe
|
$210.68 |
$210.68 |
$210.68 |
$539.57
|
|
Sodium serum/plasma/whole blood
|
$20.00 |
$20.00 |
$20.00 |
$42.70
|
|
Sodium thiosulfate 12.5 gram/50 ml (250 mg/ml) intravenous solution
|
$20.84 |
$20.84 |
$20.84 |
$195.48
|
|
Somatropin injection
|
$2,111.06 |
$2,111.06 |
$2,111.06 |
$2,381.48
|
|
Special physics consult
|
$275.00 |
$275.00 |
$275.00 |
$700.74
|
|
Special radiation dosimetry
|
$222.50 |
$222.50 |
$222.50 |
$445.50
|
|
Special radiation treatment
|
$525.00 |
$525.00 |
$525.00 |
$1,934.03
|
|
Special teletx port plan
|
$350.00 |
$350.00 |
$350.00 |
$1,046.65
|
|
Sperm antibody test
|
$32.50 |
$32.50 |
$32.50 |
$56.44
|
|
Spinal puncture lumbar diagnostic w/fluoroscopic or CT guidance
|
$435.00 |
$435.00 |
$435.00 |
$1,502.08
|
|
Spirometry bronchodilation responsiveness pre/post bronchodilator administration
|
$200.00 |
$200.00 |
$200.00 |
$559.96
|
|
Split blood or products
|
$62.50 |
$62.50 |
$62.50 |
$148.98
|
|
Staph a dna amp probe
|
$30.75 |
$30.75 |
$30.75 |
$116.39
|
|
Stent/athrectomy/fem/pop/unilat 37227
|
$6,125.00 |
$6,125.00 |
$6,125.00 |
$23,387.00
|
|
Stent iliac/open or perc/uni/init 37221
|
$3,750.00 |
$3,750.00 |
$3,750.00 |
$17,281.80
|
|
Stent iliac/open/perc/ea ad/ipsila 37223
|
$1,750.00 |
$1,750.00 |
$1,750.00 |
$9,276.80
|
|
Stent/tib/peroneal/unilat/initial 37230
|
$6,125.00 |
$6,125.00 |
$6,125.00 |
$19,765.20
|
|
St evaluate speech sound production
|
$95.00 |
$95.00 |
$95.00 |
$300.00
|
|
St evaluate speech sound production comprehensive/expressive
|
$95.00 |
$95.00 |
$95.00 |
$393.00
|
|
St evaluation motion fluoroscopic swallow function cine/video
|
$85.00 |
$85.00 |
$85.00 |
$406.40
|
|
St evaluation swallow function
|
$85.00 |
$85.00 |
$85.00 |
$336.60
|
|
Strapping of ankle and/or ft 29540
|
$87.50 |
$87.50 |
$87.50 |
$248.05
|
|
Strapping of knee
|
$43.75 |
$43.75 |
$43.75 |
$224.80
|
|
Strapping of toes 29550
|
$75.00 |
$75.00 |
$75.00 |
$185.36
|
|
Streptomycin injection
|
$127.74 |
$127.74 |
$127.74 |
$138.30
|
|
Streptozocin injection
|
$524.91 |
$524.91 |
$524.91 |
$943.23
|
|
Stress test pulmonary
|
$142.50 |
$142.50 |
$142.50 |
$327.20
|
|
Stress tte complete
|
$550.00 |
$550.00 |
$550.00 |
$1,964.95
|
|
St treatment speech individual
|
$85.00 |
$85.00 |
$85.00 |
$254.15
|
|
St treatment swallow dysfunction/oral
|
$85.00 |
$85.00 |
$85.00 |
$261.60
|
|
Succinylcholine chloride 20 mg/ml injection solution (wrapper)
|
$31.22 |
$31.22 |
$31.22 |
$49.13
|
|
Sugars single quant
|
$50.00 |
$50.00 |
$50.00 |
$52.47
|
|
Sulfonylurea screen qn-sendout
|
$25.00 |
$25.00 |
$25.00 |
$184.60
|
|
Sumatriptan 6 mg/0.5 ml subcutaneous solution
|
$221.52 |
$221.52 |
$221.52 |
$151.29
|
|
Supprelin la implant
|
$22,556.05 |
$22,556.05 |
$22,556.05 |
$72,648.14
|
|
Surgical pathology level 1 gross examination only
|
$43.75 |
$43.75 |
$43.75 |
$92.59
|
|
Surgical pathology level 2 gross & microscopic examination
|
$68.75 |
$68.75 |
$68.75 |
$149.76
|
|
Surgical pathology level 3 gross & microscopic examination
|
$87.50 |
$87.50 |
$87.50 |
$192.00
|
|
Surgical pathology level 4 gross & microscopic examination
|
$116.25 |
$116.25 |
$116.25 |
$253.75
|
|
Surgical pathology level 5 gross & microscopic examination
|
$200.00 |
$200.00 |
$200.00 |
$494.00
|
|
Surgical pathology level 6 gross & microscopic examination
|
$250.00 |
$250.00 |
$250.00 |
$790.00
|
|
Susceptibility agar dilution per agent
|
$20.00 |
$20.00 |
$20.00 |
$40.30
|
|
Susceptibility enzyme detection per enzyme
|
$20.00 |
$20.00 |
$20.00 |
$34.48
|
|
Susceptibility mic per plate
|
$46.25 |
$46.25 |
$46.25 |
$94.38
|
|
Svc venogram s&i
|
$625.00 |
$625.00 |
$625.00 |
$1,908.00
|
|
Synvisc or synvisc-one
|
$86.88 |
$86.88 |
$86.88 |
$1,232.66
|
|
Syphilis test non-treponemal antibody quantitative rpr
|
$21.75 |
$21.75 |
$21.75 |
$44.85
|
|
System pacing micra av
|
$6,130.92 |
$6,130.92 |
$6,130.92 |
$24,469.57
|
|
System pcmkr dual chamber leadless micra av2 intrdcr cath
|
$3,710.22 |
$3,710.22 |
$3,710.22 |
$10,980.00
|
|
T3 (triiodothyronine) free
|
$40.00 |
$40.00 |
$40.00 |
$89.82
|
|
T3 (triiodothyronine) total
|
$35.00 |
$35.00 |
$35.00 |
$94.90
|
|
T4 (thyroxine) free
|
$52.50 |
$52.50 |
$52.50 |
$81.60
|
|
T4 (thyroxine) total
|
$31.25 |
$31.25 |
$31.25 |
$73.64
|
|
Tacrol envarsus ex rel oral
|
$7.38 |
$7.38 |
$7.38 |
$15.60
|
|
Tacrolimus 1 mg capsule, immediate-release
|
$2.95 |
$2.95 |
$2.95 |
$12.25
|
|
Tacrolimus 5 mg/ml intravenous solution
|
$188.85 |
$188.85 |
$188.85 |
$612.11
|
|
Tacrolimus therapeutic drug level
|
$35.00 |
$35.00 |
$35.00 |
$122.40
|
|
Tafasitamab-cxix 200 mg intravenous solution
|
$1,679.69 |
$1,679.69 |
$1,679.69 |
$3,817.00
|
