|
Shoe post-op mens m
|
$1,143.00 |
$1,143.00 |
$1,143.00 |
$52.20
|
|
Shoulder MRI (with and without contrast)
|
$6,254.40 |
$6,254.40 |
$6,254.40 |
$2,713.80
|
|
Shoulder MRI (with contrast)
|
$5,496.60 |
$5,496.60 |
$5,496.60 |
$2,448.60
|
|
Shoulder MRI (without contrast)
|
$3,946.20 |
$3,946.20 |
$3,946.20 |
$2,065.05
|
|
Shoulder X-ray
|
$531.60 |
$531.60 |
$531.60 |
$339.50
|
|
Shrinker prosth above knee
|
$585.60 |
$585.60 |
$585.60 |
$168.89
|
|
Sialography s&i
|
$840.60 |
$840.60 |
$840.60 |
$499.20
|
|
Sickling rbc
|
$88.80 |
$88.80 |
$88.80 |
$57.92
|
|
Sincalide 5 mcg solution for injection
|
$172.80 |
$172.80 |
$172.80 |
$307.58
|
|
Sinus CT scan (with and without contrast)
|
$2,938.80 |
$2,938.80 |
$2,938.80 |
$1,790.00
|
|
Sinus CT scan (with contrast)
|
$2,311.80 |
$2,311.80 |
$2,311.80 |
$1,527.60
|
|
Sinus CT scan (without contrast)
|
$2,035.80 |
$2,035.80 |
$2,035.80 |
$1,292.04
|
|
Sinus/juglr venogram s&i
|
$1,983.00 |
$1,983.00 |
$1,983.00 |
$2,489.25
|
|
Skin Biopsy
|
$250.80 |
$250.80 |
$250.80 |
$360.34
|
|
Sleep study attended
|
$3,004.20 |
$3,004.20 |
$3,004.20 |
$1,329.00
|
|
Sleep Study (Polysomnography)
|
$3,400.20 |
$3,400.20 |
$3,400.20 |
$3,607.50
|
|
Sleep study unattended
|
$729.00 |
$729.00 |
$729.00 |
$580.87
|
|
Sling pelv split sam med
|
$307.80 |
$307.80 |
$307.80 |
$150.00
|
|
Slp stdy unatnd w/anal
|
$75.00 |
$75.00 |
$75.00 |
$296.34
|
|
Smear fluorescent and/or acid fast stain
|
$119.40 |
$119.40 |
$119.40 |
$64.20
|
|
Smear gram stain
|
$73.20 |
$73.20 |
$73.20 |
$55.25
|
|
Smear nasal eosinophil
|
$83.40 |
$83.40 |
$83.40 |
$46.20
|
|
Smear special stain inclusion bodies/parasites
|
$49.20 |
$49.20 |
$49.20 |
$73.15
|
|
Smear wet mount
|
$73.20 |
$73.20 |
$73.20 |
$67.49
|
|
Snrpn/ube3a gene
|
$1,648.20 |
$1,648.20 |
$1,648.20 |
$231.85
|
|
Sodium 24 hour urine
|
$102.60 |
$102.60 |
$102.60 |
$48.60
|
|
Sodium serum/plasma/whole blood
|
$102.00 |
$102.00 |
$102.00 |
$45.60
|
|
Somatosensory testing
|
$781.20 |
$781.20 |
$781.20 |
$816.00
|
|
So neo gsap dna mcrstl ins
|
$8,194.80 |
$8,194.80 |
$8,194.80 |
$2,296.00
|
|
Special physics consult
|
$1,452.60 |
$1,452.60 |
$1,452.60 |
$725.00
|
|
Special radiation dosimetry
|
$358.80 |
$358.80 |
$358.80 |
$392.50
|
|
Special radiation treatment
|
$4,299.60 |
$4,299.60 |
$4,299.60 |
$1,986.00
|
|
Special teletx port plan
|
$1,606.80 |
$1,606.80 |
$1,606.80 |
$1,086.99
|
|
Specific gravity body fluid
|
$45.00 |
$45.00 |
$45.00 |
$22.00
|
|
Speech audiometry complete
|
$43.20 |
$43.20 |
$43.20 |
$109.20
|
|
Speech evaluation complex
|
$988.20 |
$988.20 |
$988.20 |
$527.06
|
|
Spinal puncture lumbar diagnostic w/fluoroscopic or CT guidance
|
$476.40 |
$476.40 |
$476.40 |
$1,439.40
|
|
Spirometry bronchodilation responsiveness pre/post bronchodilator administration
|
$553.80 |
$553.80 |
$553.80 |
$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
|
$16,381.20 |
$16,381.20 |
$16,381.20 |
$13,585.00
|
|
Srs multisource
|
$34,026.60 |
$34,026.60 |
$34,026.60 |
$34,165.20
|
|
St analysis behavior qualitative voice/resonance
|
$358.20 |
$358.20 |
$358.20 |
$297.60
|
|
Staph a dna amp probe
|
$163.80 |
$163.80 |
$163.80 |
$125.00
|
|
St cognitve performance testing healthcare professional each hour
|
$280.20 |
$280.20 |
$280.20 |
$286.00
|
|
Stereotactic radiation trmt
|
$3,505.80 |
$3,505.80 |
$3,505.80 |
$845.60
|
|
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
|
|
Strapping of ankle and/or ft 29540
|
$99.60 |
$99.60 |
$99.60 |
$223.45
|
|
Strapping of elbow or wrist 29260
|
$87.60 |
$87.60 |
$87.60 |
$154.70
|
|
Strapping of hand or finger
|
$85.80 |
$85.80 |
$85.80 |
$174.82
|
|
Strapping of knee
|
$87.60 |
$87.60 |
$87.60 |
$205.20
|
|
Stress test pulmonary
|
$221.40 |
$221.40 |
$221.40 |
$322.85
|
|
Stress tte complete
|
$2,716.80 |
$2,716.80 |
$2,716.80 |
$1,870.50
|
|
Str markers spec anal addl
|
$480.00 |
$480.00 |
$480.00 |
$479.17
|
|
Str markers specimen anal
|
$1,079.40 |
$1,079.40 |
$1,079.40 |
$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
|
|
Sugars single quant
|
$271.80 |
$271.80 |
$271.80 |
$64.28
|
|
Support clav 29.6-40.5in med
|
$169.20 |
$169.20 |
$169.20 |
$94.19
|
|
Surgical pathology level 1 gross examination only
|
$216.60 |
$216.60 |
$216.60 |
$79.50
|
|
Surgical pathology level 2 gross & microscopic examination
|
$248.40 |
$248.40 |
$248.40 |
$141.94
|
|
Surgical pathology level 3 gross & microscopic examination
|
$264.60 |
$264.60 |
$264.60 |
$181.00
|
|
Surgical pathology level 4 gross & microscopic examination
|
$331.80 |
$331.80 |
$331.80 |
$239.85
|
|
Surgical pathology level 5 gross & microscopic examination
|
$421.80 |
$421.80 |
$421.80 |
$480.00
|
|
Surgical pathology level 6 gross & microscopic examination
|
$1,044.60 |
$1,044.60 |
$1,044.60 |
$718.00
|
|
Susceptibility agar dilution per agent
|
$94.80 |
$94.80 |
$94.80 |
$45.45
|
|
Susceptibility enzyme detection per enzyme
|
$74.40 |
$74.40 |
$74.40 |
$35.70
|
|
Susceptibility mic per plate
|
$70.80 |
$70.80 |
$70.80 |
$106.00
|
|
Sweat collection by iontophoresis
|
$113.40 |
$113.40 |
$113.40 |
$125.40
|
|
Synch audio-only est high 40
|
$160.20 |
$160.20 |
$160.20 |
$189.40
|
|
Synch audio-only est low 20
|
$73.20 |
$73.20 |
$73.20 |
$90.60
|
|
Synch audio-only est mod 30
|
$108.60 |
$108.60 |
$108.60 |
$136.64
|
|
Synch audio-only est sf 10
|
$40.20 |
$40.20 |
$40.20 |
$53.20
|
|
Synch audio-only new high 60
|
$196.20 |
$196.20 |
$196.20 |
$200.30
|
|
Synch audio-only new low 30
|
$94.80 |
$94.80 |
$94.80 |
$117.00
|
|
Synch audio-only new mod 45
|
$150.00 |
$150.00 |
$150.00 |
$163.38
|
|
Synch audio-only new sf 15
|
$54.60 |
$54.60 |
$54.60 |
$67.80
|
|
Syphilis test non-treponemal antibody quantitative rpr
|
$78.00 |
$78.00 |
$78.00 |
$41.60
|
|
T3 (triiodothyronine) free
|
$75.00 |
$75.00 |
$75.00 |
$99.20
|
|
T3 (triiodothyronine) total
|
$63.60 |
$63.60 |
$63.60 |
$93.52
|
|
T4 (thyroxine) free
|
$117.00 |
$117.00 |
$117.00 |
$85.20
|
|
T4 (thyroxine) total
|
$231.60 |
$231.60 |
$231.60 |
$69.00
|
|
Tacrolimus therapeutic drug level
|
$63.00 |
$63.00 |
$63.00 |
$122.40
|
|
Target gsa panel hmtlmph neop
|
$5,242.80 |
$5,242.80 |
$5,242.80 |
$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
|
$3,203.40 |
$3,203.40 |
$3,203.40 |
$1,655.52
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$163.20 |
$163.20 |
$163.20 |
$177.65
|
|
T cells absolute cd4/cd8 including ratio
|
$253.20 |
$253.20 |
$253.20 |
$176.40
|
|
T cells total count
|
$227.40 |
$227.40 |
$227.40 |
$126.90
|
|
Telehealth original site facility fee
|
$51.00 |
$51.00 |
$51.00 |
$51.00
|
|
Telethx isodose plan cplx
|
$1,039.80 |
$1,039.80 |
$1,039.80 |
$1,526.85
|
|
Telethx isodose plan simple
|
$979.80 |
$979.80 |
$979.80 |
$873.62
|
|
Tenotomy open tndn flxr toe sgl tndn spx
|
$3,885.00 |
$3,885.00 |
$3,885.00 |
$2,139.67
|
|
Tert gene targeted seq alys
|
$2,338.80 |
$2,338.80 |
$2,338.80 |
$335.00
|
|
Testicular imaging w/vasc flow
|
$1,256.40 |
$1,256.40 |
$1,256.40 |
$842.56
|
|
Test stress cardiovascular tracing only
|
$945.00 |
$945.00 |
$945.00 |
$949.70
|
