|
Subsequent intensive care infant 1500-2500 grams 99479
|
$224.80 |
$224.80 |
$316.00 |
$224.80
|
|
Subsequent intensive care infant 2501-5000 grams 99480
|
$216.00 |
$216.00 |
$304.00 |
$216.00
|
|
Subsequent repair of nerve
|
$288.80 |
$288.80 |
$288.80 |
$4,448.60
|
|
Subtalar arthro w/deb
|
$2,239.00 |
$2,239.00 |
$3,296.00 |
$3,839.54
|
|
Subtalar arthro w/exc
|
$2,641.60 |
$2,641.60 |
$2,641.60 |
$7,907.11
|
|
Subtalar arthro w/fb rmvl
|
$3,132.80 |
$3,132.80 |
$3,132.80 |
$3,839.54
|
|
Subtalar arthro w/fusion
|
$4,308.80 |
$4,308.80 |
$4,308.80 |
$13,158.00
|
|
Succinylcholine chloride 20 mg/ml injection solution (wrapper)
|
$14.96 |
$14.96 |
$77.20 |
$54.80
|
|
Suction lipectomy head&neck
|
$575.20 |
$575.20 |
$575.20 |
$4,332.25
|
|
Suction lipectomy lwr extrem
|
$6,080.00 |
$6,080.00 |
$6,080.00 |
$5,661.00
|
|
Suction lipectomy trunk
|
$2,272.00 |
$2,272.00 |
$2,272.00 |
$4,385.50
|
|
Suction lipectomy upr extrem
|
$4,544.00 |
$4,544.00 |
$4,544.00 |
$4,544.00
|
|
Sugars multiple quant
|
$66.24 |
$66.24 |
$66.24 |
$44.19
|
|
Sugars single quant
|
$64.28 |
$64.28 |
$64.28 |
$64.28
|
|
Sulfamethoxazole 400 mg-trimethoprim 80 mg/5 ml intravenous solution
|
$23.00 |
$23.00 |
$23.00 |
$82.46
|
|
Sulfonylurea screen qn-sendout
|
$72.14 |
$72.14 |
$151.45 |
$160.05
|
|
Sumatriptan 6 mg/0.5 ml subcutaneous solution
|
$55.20 |
$55.20 |
$448.80 |
$126.63
|
|
Sup of prep of antigen # of vials 95144
|
$44.80 |
$44.80 |
$44.80 |
$54.60
|
|
Support clav 29.6-40.5in med
|
$94.19 |
$94.19 |
$156.00 |
$94.08
|
|
Supprelin la implant
|
$51,408.00 |
$51,408.00 |
$51,408.00 |
$80,935.72
|
|
Suprv interfacilty transport
|
$139.20 |
$139.20 |
$139.20 |
$112.05
|
|
Suprv interfac trnsport addl
|
$120.80 |
$120.80 |
$120.80 |
$98.69
|
|
Surg dx exam anorectal
|
$264.00 |
$264.00 |
$381.00 |
$3,480.50
|
|
Surg ect salp-oophorectomy 59120
|
$1,955.20 |
$1,955.20 |
$1,955.20 |
$1,632.60
|
|
Surg ect without salp-oophorectomy 59121
|
$1,957.60 |
$1,957.60 |
$1,957.60 |
$1,634.40
|
|
Surgery for urethra pouch
|
$1,068.00 |
$1,068.00 |
$1,068.00 |
$4,627.00
|
|
Surgery to stop leg growth
|
$3,256.00 |
$3,256.00 |
$3,256.00 |
$7,907.11
|
|
Surgery to stop leg growth
|
$3,604.80 |
$3,604.80 |
$3,604.80 |
$7,913.97
|
|
Surgery to stop leg growth
|
$4,521.60 |
$4,521.60 |
$4,521.60 |
$7,907.11
|
|
Surgery to stop leg growth
|
$3,299.20 |
$3,299.20 |
$3,299.20 |
$8,412.89
|
|
Surgical exposure prostate 55860
|
$2,212.00 |
$2,212.00 |
$2,212.00 |
$5,626.86
|
|
Surgical opening of stomach
|
$2,320.80 |
$2,320.80 |
$2,320.80 |
$2,320.80
|
|
Surgical opening of stomach 43500
|
$1,925.60 |
$1,925.60 |
$1,925.60 |
$1,477.80
|
|
Surgical opening of throat
|
$1,870.40 |
$1,870.40 |
$1,870.40 |
$2,133.48
|
|
Surgical pathology level 1 gross examination only
|
$98.56 |
$98.56 |
$118.30 |
$79.50
|
|
Surgical pathology level 2 gross & microscopic examination
|
$98.56 |
$98.56 |
$124.15 |
$141.94
|
|
Surgical pathology level 3 gross & microscopic examination
|
$98.56 |
$98.56 |
$32,113.22 |
$181.31
|
|
Surgical pathology level 4 gross & microscopic examination
|
$164.00 |
$164.00 |
$15,297.86 |
$243.10
|
|
Surgical pathology level 5 gross & microscopic examination
|
$647.20 |
$647.20 |
$780.00 |
$480.60
|
|
Surgical pathology level 6 gross & microscopic examination
|
$942.40 |
$942.40 |
$1,232.40 |
$720.75
|
|
Surgical repair stomach bleedin ulcer 43501
|
$3,304.80 |
$3,304.80 |
$3,304.80 |
$2,415.60
|
|
Surgical repair stomach gastric lac 43502
|
$3,736.80 |
$3,736.80 |
$3,736.80 |
$2,864.40
|
|
Surgical revision intestine
|
$2,607.20 |
$2,607.20 |
$2,607.20 |
$2,366.76
|
|
Surgical trays
|
$45.60 |
$45.60 |
$45.60 |
$694.80
|
|
Surg tx anal fistula 2nd stage 46285
|
$1,352.80 |
$1,352.80 |
$1,352.80 |
$3,245.23
|
|
Susceptibility agar dilution per agent
|
$38.58 |
$38.58 |
$38.58 |
$45.00
|
|
Susceptibility enzyme detection per enzyme
|
$28.60 |
$28.60 |
$38.58 |
$35.70
|
|
Susceptibility mic per plate
|
$38.58 |
$38.58 |
$526.00 |
$104.65
|
|
Suscept studies macrobroth dilution ea
|
$38.58 |
$38.58 |
$38.58 |
$59.28
|
|
Suspension of testis
|
$1,510.40 |
$1,510.40 |
$1,510.40 |
$4,055.01
|
|
Suspension of uterus 58400
|
$1,136.00 |
$1,136.00 |
$1,136.00 |
$856.80
|
|
Sutr lg intestine 1/mult perf without colostomy 44604
|
$2,600.80 |
$2,600.80 |
$3,770.00 |
$1,995.00
|
|
Suture bile duct injury 47900
|
$3,346.40 |
$3,346.40 |
$3,346.40 |
$2,559.60
|
|
Svc venogram s&i
|
$856.84 |
$856.84 |
$5,456.90 |
$1,994.00
|
|
Swallowing Evaluation (Bedside)
|
$217.10 |
$217.10 |
$283.08 |
$314.40
|
|
Swallowing Therapy Session
|
$195.20 |
$195.20 |
$406.25 |
$240.50
|
|
Sweat collection by iontophoresis
|
$70.00 |
$70.00 |
$70.00 |
$121.55
|
|
Sympathectomy cervical
|
$3,934.40 |
$3,934.40 |
$3,934.40 |
$3,934.40
|
|
Sympathectomy digital artery
|
$1,808.80 |
$1,808.80 |
$1,808.80 |
$2,310.83
|
|
Sympathectomy supfc palmar
|
$3,880.00 |
$3,880.00 |
$3,880.00 |
$3,839.54
|
|
Synch audio-only est high 40
|
$265.60 |
$265.60 |
$265.60 |
$190.77
|
|
Synch audio-only est low 20
|
$160.80 |
$160.80 |
$160.80 |
$90.60
|
|
Synch audio-only est mod 30
|
$192.00 |
$192.00 |
$192.00 |
$136.64
|
|
Synch audio-only est sf 10
|
$83.20 |
$83.20 |
$83.20 |
$53.20
|
|
Synch audio-only new high 60
|
$367.20 |
$367.20 |
$367.20 |
$207.64
|
|
Synch audio-only new low 30
|
$189.60 |
$189.60 |
$189.60 |
$117.00
|
|
Synch audio-only new mod 45
|
$289.60 |
$289.60 |
$289.60 |
$166.70
|
|
Synch audio-only new sf 15
|
$133.60 |
$133.60 |
$133.60 |
$67.80
|
|
Synthetic sentence id test
|
$80.80 |
$80.80 |
$80.80 |
$99.32
|
|
Synvisc or synvisc-one
|
$26.40 |
$26.40 |
$272.00 |
$1,242.63
|
|
Syphilis test non-treponemal antibody quantitative rpr
|
$44.85 |
$44.85 |
$48.57 |
$42.24
|
|
System cardiomems hosp electronics
|
$24,023.02 |
$24,023.02 |
$24,023.02 |
$38,234.70
|
|
System pacing micra av
|
$16,760.25 |
$16,760.25 |
$24,701.52 |
$24,293.25
|
|
System pcmkr dual chamber leadless micra av2 intrdcr cath
|
$8,286.08 |
$8,286.08 |
$27,099.09 |
$12,003.00
|
|
System recell skin grafting/harvesting
|
$8,955.20 |
$8,955.20 |
$8,955.20 |
$11,183.00
|
|
System sealant biosentry tract
|
$652.35 |
$652.35 |
$652.35 |
$890.03
|
|
T3 (triiodothyronine) free
|
$55.00 |
$55.00 |
$141.05 |
$100.00
|
|
T3 (triiodothyronine) total
|
$55.00 |
$55.00 |
$118.30 |
$93.52
|
|
T4 (thyroxine) free
|
$55.00 |
$55.00 |
$74.10 |
$87.30
|
|
T4 (thyroxine) total
|
$55.00 |
$55.00 |
$890.00 |
$68.40
|
|
Tacrolimus 1 mg capsule, immediate-release
|
$2.24 |
$2.24 |
$170.70 |
$9.93
|
|
Tacrolimus 5 mg/ml intravenous solution
|
$1,208.10 |
$1,208.10 |
$1,208.10 |
$596.76
|
|
Tacrolimus therapeutic drug level
|
$66.43 |
$66.43 |
$120.25 |
$122.40
|
|
Tafasitamab-cxix 200 mg intravenous solution
|
$22.48 |
$22.48 |
$4,272.00 |
$2,762.00
|
|
Tah rad debulk/lymph remove 58954
|
$5,380.00 |
$5,380.00 |
$5,380.00 |
$5,380.00
|
|
Tah rad dissect for debulk 58953
|
$4,964.80 |
$4,964.80 |
$4,964.80 |
$4,964.80
|
|
Tah w/mmk 58152
|
$3,129.60 |
$3,129.60 |
$3,129.60 |
$2,428.80
|
|
Tailbone (Sacrum and Coccyx) X-ray
|
$142.97 |
$142.97 |
$248.30 |
$288.60
|
|
Talimogene laherparepvec 10exp6 (1 million) pfu/ml susp for injection
|
$88,021.00 |
$88,021.00 |
$88,021.00 |
$1,223.36
|
|
Talquetamab-tgvs 2 mg/ml subcutaneous solution
|
$109.97 |
$109.97 |
$35,941.50 |
$21,745.13
|
|
Tap block bilat cont infusion 64489
|
$691.20 |
$691.20 |
$691.20 |
$1,541.40
|
|
Tap block uni by cont infusion 64487
|
$896.00 |
$896.00 |
$896.00 |
$868.40
|
|
Tape plstc 1inx5yd hosp tb pk
|
$3.04 |
$3.04 |
$3.04 |
$2.06
|
|
Target gsa panel hmtlmph neop
|
$934.05 |
$934.05 |
$1,519.20 |
$2,246.30
|
|
Target gsa panel organ/hmtlmph neop
|
$5,839.20 |
$5,839.20 |
$5,839.20 |
$3,762.00
|
|
Target gsa panel organ neop
|
$1,196.00 |
$1,196.00 |
$1,196.00 |
$1,749.44
|
|
Tarlatamab-dlle 10 mg intravenous solution
|
$46,350.00 |
$46,350.00 |
$46,350.00 |
$24,217.20
|
|
Tas congenital car anomal
|
$1,882.40 |
$1,882.40 |
$1,882.40 |
$6,003.27
|
|
Tattooing/intraderm 6.1-20.0 sq cm 11921
|
$520.00 |
$520.00 |
$520.00 |
$931.50
|
|
Tavr perq femoral
|
$26,190.65 |
$26,190.65 |
$26,190.65 |
$15,454.40
|
