|
Rmvl foreign body upper arm/elbow subcutaneous
|
$3,830.40 |
$3,830.40 |
$3,830.40 |
$1,876.00
|
|
Rmvl icd gen w/rplc icd gen sgl lead sys
|
$20,667.20 |
$20,667.20 |
$20,667.20 |
$25,899.70
|
|
Rmvl perm pm pulse gen
|
$7,312.80 |
$7,312.80 |
$7,312.80 |
$6,256.66
|
|
Rmvl pm gen w/rplc pm gen mlt lead sys
|
$16,727.20 |
$16,727.20 |
$16,727.20 |
$15,400.00
|
|
Rp loclzj tum spect w/ct 1
|
$3,235.20 |
$3,235.20 |
$3,235.20 |
$2,531.25
|
|
Rp loclzj tum spect w/ct 2
|
$4,852.00 |
$4,852.00 |
$4,852.00 |
$3,136.90
|
|
Rsv assay w/optic
|
$180.00 |
$180.00 |
$180.00 |
$82.68
|
|
Rtm 1st set-up&pt educaj eqp
|
$313.60 |
$313.60 |
$313.60 |
$172.20
|
|
Rtm dev sply mscskl 16-30 d
|
$90.40 |
$90.40 |
$90.40 |
$96.85
|
|
Rtm dev sply resp sys 16-30d
|
$90.40 |
$90.40 |
$90.40 |
$67.80
|
|
Rubella antibody igg
|
$237.60 |
$237.60 |
$237.60 |
$76.86
|
|
Rubeola antibody igg
|
$160.80 |
$160.80 |
$160.80 |
$80.00
|
|
Russell viper venom diluted
|
$324.00 |
$324.00 |
$324.00 |
$68.64
|
|
Rx metab gen seq alys pnl 6
|
$3,208.00 |
$3,208.00 |
$3,208.00 |
$917.08
|
|
Sarscov coronavirus ag ia
|
$77.60 |
$77.60 |
$77.60 |
$59.25
|
|
Sarscov & inf vir a&b ag ia
|
$392.80 |
$392.80 |
$392.80 |
$105.00
|
|
Scan duplex abd/pelvis/retroperitoneal complete
|
$1,612.80 |
$1,612.80 |
$1,612.80 |
$966.55
|
|
Scan duplex abd/pelvis/retroperitoneal limited
|
$1,082.40 |
$1,082.40 |
$1,082.40 |
$653.40
|
|
Scan duplex aorta/ivc/iliac or bypass grafts complete
|
$1,376.00 |
$1,376.00 |
$1,376.00 |
$744.47
|
|
Scan duplex extracranial arteries unilateral/limited study
|
$1,167.20 |
$1,167.20 |
$1,167.20 |
$583.00
|
|
Scan duplex extremity veins unilateral/limited study
|
$1,383.20 |
$1,383.20 |
$1,383.20 |
$709.76
|
|
Scan duplex lower extremity arteries complete bilateral
|
$1,649.60 |
$1,649.60 |
$1,649.60 |
$985.20
|
|
Scan duplex lower extremity arteries unilateral/limited study left
|
$919.20 |
$919.20 |
$919.20 |
$645.21
|
|
Scan duplex upper extremity arteries unilateral/limited study left
|
$919.20 |
$919.20 |
$919.20 |
$567.00
|
|
Scr c/v cyto,thinlayer,rescr
|
$223.20 |
$223.20 |
$223.20 |
$83.40
|
|
Screening Mammogram
|
$468.80 |
$468.80 |
$468.80 |
$310.20
|
|
Screening prostate cancer PSA
|
$235.20 |
$235.20 |
$235.20 |
$98.28
|
|
Screen pap by tech w md supv
|
$105.60 |
$105.60 |
$105.60 |
$53.46
|
|
Sedimentation rate erythrocyte automated
|
$101.60 |
$101.60 |
$101.60 |
$44.20
|
|
Shoe post-op mens m
|
$1,524.00 |
$1,524.00 |
$1,524.00 |
$49.25
|
|
Shoulder MRI (with and without contrast)
|
$6,654.40 |
$6,654.40 |
$6,654.40 |
$2,743.02
|
|
Shoulder MRI (with contrast)
|
$6,654.40 |
$6,654.40 |
$6,654.40 |
$2,476.20
|
|
Shoulder MRI (without contrast)
|
$5,815.20 |
$5,815.20 |
$5,815.20 |
$2,110.00
|
|
Shoulder X-ray
|
$876.00 |
$876.00 |
$876.00 |
$343.70
|
|
Shrinker prosth above knee
|
$780.80 |
$780.80 |
$780.80 |
$168.89
|
|
Sickling rbc
|
$116.80 |
$116.80 |
$116.80 |
$54.00
|
|
Sincalide 5 mcg solution for injection
|
$192.00 |
$192.00 |
$192.00 |
$309.14
|
|
Sinus CT scan (with and without contrast)
|
$3,640.00 |
$3,640.00 |
$3,640.00 |
$1,800.90
|
|
Sinus CT scan (with contrast)
|
$2,765.60 |
$2,765.60 |
$2,765.60 |
$1,562.50
|
|
Sinus CT scan (without contrast)
|
$3,517.60 |
$3,517.60 |
$3,517.60 |
$1,281.80
|
|
Sinus/juglr venogram s&i
|
$2,589.60 |
$2,589.60 |
$2,589.60 |
$2,517.48
|
|
Skin Biopsy
|
$326.40 |
$326.40 |
$326.40 |
$357.00
|
|
Sleep Study (Polysomnography)
|
$3,922.40 |
$3,922.40 |
$3,922.40 |
$3,659.20
|
|
Sleep study unattended
|
$1,000.80 |
$1,000.80 |
$1,000.80 |
$576.54
|
|
Sling pelv split sam med
|
$410.40 |
$410.40 |
$410.40 |
$144.21
|
|
Slp stdy unatnd w/anal
|
$107.20 |
$107.20 |
$107.20 |
$212.50
|
|
Slp ther svc non-spch gen
|
$440.00 |
$440.00 |
$440.00 |
$187.75
|
|
Smear fluorescent and/or acid fast stain
|
$181.60 |
$181.60 |
$181.60 |
$64.35
|
|
Smear gram stain
|
$172.00 |
$172.00 |
$172.00 |
$55.35
|
|
Smear nasal eosinophil
|
$96.00 |
$96.00 |
$96.00 |
$45.57
|
|
Smear special stain inclusion bodies/parasites
|
$228.00 |
$228.00 |
$228.00 |
$68.85
|
|
Smear wet mount
|
$222.40 |
$222.40 |
$222.40 |
$66.30
|
|
Snrpn/ube3a gene
|
$1,836.80 |
$1,836.80 |
$1,836.80 |
$228.80
|
|
Sodium 24 hour urine
|
$124.80 |
$124.80 |
$124.80 |
$48.60
|
|
Sodium serum/plasma/whole blood
|
$68.00 |
$68.00 |
$68.00 |
$45.00
|
|
So neo gsap dna mcrstl ins
|
$10,926.40 |
$10,926.40 |
$10,926.40 |
$2,332.88
|
|
Specific gravity body fluid
|
$432.00 |
$432.00 |
$432.00 |
$21.55
|
|
Spinal puncture lumbar diagnostic w/fluoroscopic or CT guidance
|
$1,637.60 |
$1,637.60 |
$1,637.60 |
$1,439.40
|
|
Spirometry bronchodilation responsiveness pre/post bronchodilator administration
|
$910.40 |
$910.40 |
$910.40 |
$536.34
|
|
Splint extn xsm w sof-stretch rolyan
|
$113.60 |
$113.60 |
$113.60 |
$67.76
|
|
Splint func pos polyflex ii med
|
$1,524.00 |
$1,524.00 |
$1,524.00 |
$48.10
|
|
Splint rstrc wrst/cmc right med
|
$780.80 |
$780.80 |
$780.80 |
$96.88
|
|
St analysis behavior qualitative voice/resonance
|
$477.60 |
$477.60 |
$477.60 |
$295.10
|
|
St cognitve performance testing healthcare professional each hour
|
$373.60 |
$373.60 |
$373.60 |
$284.65
|
|
St evaluate speech sound production
|
$391.20 |
$391.20 |
$391.20 |
$288.75
|
|
St evaluate speech sound production comprehensive/expressive
|
$541.60 |
$541.60 |
$541.60 |
$376.84
|
|
St evaluation motion fluoroscopic swallow function cine/video
|
$547.20 |
$547.20 |
$547.20 |
$373.50
|
|
St evaluation swallow function
|
$412.80 |
$412.80 |
$412.80 |
$311.36
|
|
Strapping of ankle and/or ft 29540
|
$914.40 |
$914.40 |
$914.40 |
$205.38
|
|
Strapping of chest
|
$1,379.20 |
$1,379.20 |
$1,379.20 |
$196.93
|
|
Strapping of elbow or wrist 29260
|
$1,248.80 |
$1,248.80 |
$1,248.80 |
$157.46
|
|
Strapping of hand or finger
|
$1,204.00 |
$1,204.00 |
$1,204.00 |
$177.45
|
|
Strapping of knee
|
$1,368.00 |
$1,368.00 |
$1,368.00 |
$205.20
|
|
Strapping of toes 29550
|
$1,200.80 |
$1,200.80 |
$1,200.80 |
$164.70
|
|
Strep a ag ia
|
$150.40 |
$150.40 |
$150.40 |
$75.40
|
|
Strep b dna amp probe
|
$339.20 |
$339.20 |
$339.20 |
$122.43
|
|
Stress test pulmonary
|
$487.20 |
$487.20 |
$487.20 |
$311.40
|
|
Stress tte complete
|
$3,180.00 |
$3,180.00 |
$3,180.00 |
$1,784.25
|
|
Str markers spec anal addl
|
$707.20 |
$707.20 |
$707.20 |
$479.17
|
|
Str markers specimen anal
|
$1,589.60 |
$1,589.60 |
$1,589.60 |
$751.50
|
|
St treatment speech individual
|
$342.40 |
$342.40 |
$342.40 |
$253.80
|
|
St treatment swallow dysfunction/oral
|
$288.00 |
$288.00 |
$288.00 |
$245.50
|
|
Sugars single quant
|
$399.20 |
$399.20 |
$399.20 |
$64.28
|
|
Support clav 29.6-40.5in med
|
$225.60 |
$225.60 |
$225.60 |
$94.19
|
|
Surgical pathology level 1 gross examination only
|
$155.20 |
$155.20 |
$155.20 |
$80.60
|
|
Surgical pathology level 2 gross & microscopic examination
|
$352.00 |
$352.00 |
$352.00 |
$146.30
|
|
Surgical pathology level 3 gross & microscopic examination
|
$449.60 |
$449.60 |
$449.60 |
$184.50
|
|
Surgical pathology level 4 gross & microscopic examination
|
$552.00 |
$552.00 |
$552.00 |
$250.20
|
|
Surgical pathology level 5 gross & microscopic examination
|
$682.40 |
$682.40 |
$682.40 |
$489.00
|
|
Surgical pathology level 6 gross & microscopic examination
|
$1,478.40 |
$1,478.40 |
$1,478.40 |
$730.20
|
|
Susceptibility agar dilution per agent
|
$138.40 |
$138.40 |
$138.40 |
$42.70
|
|
Susceptibility enzyme detection per enzyme
|
$85.60 |
$85.60 |
$85.60 |
$35.10
|
|
Susceptibility mic per plate
|
$80.80 |
$80.80 |
$80.80 |
$104.00
|
|
Syphilis test non-treponemal antibody quantitative rpr
|
$96.00 |
$96.00 |
$96.00 |
$40.11
|
|
T3 (triiodothyronine) free
|
$261.60 |
$261.60 |
$261.60 |
$99.20
|
|
T3 (triiodothyronine) total
|
$202.40 |
$202.40 |
$202.40 |
$93.52
|
|
T4 (thyroxine) free
|
$132.80 |
$132.80 |
$132.80 |
$85.20
|
|
T4 (thyroxine) total
|
$128.80 |
$128.80 |
$128.80 |
$67.80
|
|
Tacrolimus therapeutic drug level
|
$536.80 |
$536.80 |
$536.80 |
$120.60
|
|
Target gsa panel hmtlmph neop
|
$7,714.40 |
$7,714.40 |
$7,714.40 |
$2,160.00
|
