|
Scan duplex abd/pelvis/retroperitoneal limited
|
$374.40 |
$374.40 |
$374.40 |
$662.40
|
|
Scan duplex extracranial arteries unilateral/limited study
|
$374.40 |
$374.40 |
$374.40 |
$586.30
|
|
Scan duplex extremity veins unilateral/limited study
|
$855.40 |
$855.40 |
$855.40 |
$691.07
|
|
Scan duplex lower extremity arteries complete bilateral
|
$419.90 |
$419.90 |
$419.90 |
$957.18
|
|
Scan duplex lower extremity arteries unilateral/limited study left
|
$374.40 |
$374.40 |
$374.40 |
$612.00
|
|
Scan duplex upper extremity arteries unilateral/limited study left
|
$374.40 |
$374.40 |
$374.40 |
$527.80
|
|
Screening Mammogram
|
$199.55 |
$199.55 |
$199.55 |
$287.12
|
|
Sedimentation rate erythrocyte automated
|
$48.75 |
$48.75 |
$48.75 |
$37.80
|
|
Semen analysis presence/motility
|
$70.85 |
$70.85 |
$70.85 |
$79.92
|
|
Set radiation therapy field
|
$2,543.45 |
$2,543.45 |
$2,543.45 |
$709.00
|
|
Set radiation therapy field
|
$942.50 |
$942.50 |
$942.50 |
$1,029.00
|
|
Set radiation therapy field
|
$1,984.45 |
$1,984.45 |
$1,984.45 |
$1,601.60
|
|
Sho arthrs srg bicp tenodsis
|
$17,742.28 |
$17,742.28 |
$17,742.28 |
$4,523.20
|
|
Sho arthrs srg lmtd dbrdmt
|
$17,717.06 |
$17,717.06 |
$17,717.06 |
$3,594.44
|
|
Sho arthrs srg lss&rescj ads
|
$14,528.98 |
$14,528.98 |
$14,528.98 |
$3,594.44
|
|
Shoulder Arthroscopy (Rotator Cuff Repair)
|
$21,220.48 |
$21,220.48 |
$21,220.48 |
$5,272.00
|
|
Shoulder MRI (with and without contrast)
|
$3,831.10 |
$3,831.10 |
$3,831.10 |
$2,628.75
|
|
Shoulder MRI (with contrast)
|
$3,608.15 |
$3,608.15 |
$3,608.15 |
$2,353.60
|
|
Shoulder MRI (without contrast)
|
$3,029.65 |
$3,029.65 |
$3,029.65 |
$1,938.28
|
|
Shoulder X-ray
|
$493.35 |
$493.35 |
$493.35 |
$307.20
|
|
Sickling rbc
|
$59.15 |
$59.15 |
$59.15 |
$53.40
|
|
Sigmoidoscopy and biopsy
|
$2,222.68 |
$2,222.68 |
$2,222.68 |
$1,351.63
|
|
Sigmoidoscopy/submucosal injection 45335
|
$2,208.19 |
$2,208.19 |
$2,208.19 |
$1,278.72
|
|
Sigmoidoscopy w/tumr remove
|
$2,431.79 |
$2,431.79 |
$2,431.79 |
$1,350.83
|
|
Sigmoid/rmv tumor/polyp/hot bx for 45333
|
$2,208.19 |
$2,208.19 |
$2,208.19 |
$1,183.20
|
|
Sildenafil citrate, 25 mg
|
$5.29 |
$5.29 |
$5.29 |
$4.87
|
|
Sinus CT scan (with and without contrast)
|
$2,358.20 |
$2,358.20 |
$2,358.20 |
$1,610.70
|
|
Sinus CT scan (with contrast)
|
$2,102.75 |
$2,102.75 |
$2,102.75 |
$1,419.18
|
|
Sinus CT scan (without contrast)
|
$1,934.40 |
$1,934.40 |
$1,934.40 |
$1,151.00
|
|
Skin Biopsy
|
$452.40 |
$452.40 |
$452.40 |
$362.40
|
|
Skyla, 13.5 mg
|
$4,820.82 |
$4,820.82 |
$4,820.82 |
$3,739.59
|
|
Sleep Study (Polysomnography)
|
$2,145.00 |
$2,145.00 |
$2,145.00 |
$4,043.20
|
|
Sleep study unattended
|
$221.00 |
$221.00 |
$221.00 |
$631.55
|
|
Smear fluorescent and/or acid fast stain
|
$39.65 |
$39.65 |
$39.65 |
$50.70
|
|
Smear gram stain
|
$53.30 |
$53.30 |
$53.30 |
$48.00
|
|
Smear special stain inclusion bodies/parasites
|
$92.95 |
$92.95 |
$92.95 |
$60.00
|
|
Smear wet mount
|
$66.30 |
$66.30 |
$66.30 |
$56.13
|
|
Sodium 24 hour urine
|
$63.70 |
$63.70 |
$63.70 |
$47.25
|
|
Sodium chloride 0.9 % intravenous solution
|
$25.35 |
$25.35 |
$25.35 |
$46.35
|
|
Sodium chloride 0.9 % IV bolus
|
$23.40 |
$23.40 |
$23.40 |
$42.25
|
|
Sodium chloride 0.9 % IV bolus
|
$23.40 |
$23.40 |
$23.40 |
$42.25
|
|
Sodium chloride 3 % ivpb
|
$23.40 |
$23.40 |
$23.40 |
$37.50
|
|
Sodium serum/plasma/whole blood
|
$27.30 |
$27.30 |
$27.30 |
$42.43
|
|
Sodium thiosulfate 12.5 gram/50 ml (250 mg/ml) intravenous solution
|
$12.17 |
$12.17 |
$12.17 |
$8.89
|
|
Special physics consult
|
$14,370.20 |
$14,370.20 |
$14,370.20 |
$688.05
|
|
Special radiation dosimetry
|
$588.25 |
$588.25 |
$588.25 |
$482.08
|
|
Special radiation treatment
|
$1,491.10 |
$1,491.10 |
$1,491.10 |
$1,945.00
|
|
Spirometry bronchodilation responsiveness pre/post bronchodilator administration
|
$334.10 |
$334.10 |
$334.10 |
$526.80
|
|
Srs linear based
|
$14,370.20 |
$14,370.20 |
$14,370.20 |
$14,124.25
|
|
St analysis behavior qualitative voice/resonance
|
$403.65 |
$403.65 |
$403.65 |
$295.10
|
|
St cognitve performance testing healthcare professional each hour
|
$103.35 |
$103.35 |
$103.35 |
$313.96
|
|
St evaluate speech sound production
|
$403.65 |
$403.65 |
$403.65 |
$298.41
|
|
St evaluate speech sound production comprehensive/expressive
|
$516.10 |
$516.10 |
$516.10 |
$387.00
|
|
St evaluation motion fluoroscopic swallow function cine/video
|
$295.10 |
$295.10 |
$295.10 |
$336.00
|
|
St evaluation swallow function
|
$196.95 |
$196.95 |
$196.95 |
$323.72
|
|
Strep b dna amp probe
|
$168.35 |
$168.35 |
$168.35 |
$124.20
|
|
Stress test pulmonary
|
$273.00 |
$273.00 |
$273.00 |
$330.63
|
|
Stress tte complete
|
$999.05 |
$999.05 |
$999.05 |
$1,989.60
|
|
St treatment speech individual
|
$165.75 |
$165.75 |
$165.75 |
$246.87
|
|
St treatment swallow dysfunction/oral
|
$117.00 |
$117.00 |
$117.00 |
$221.00
|
|
Succinylcholine chloride 20 mg/ml injection solution (wrapper)
|
$7.15 |
$7.15 |
$7.15 |
$22.19
|
|
Sulfamethoxazole 400 mg-trimethoprim 80 mg/5 ml intravenous solution
|
$51.38 |
$51.38 |
$51.38 |
$0.60
|
|
Sumatriptan 6 mg/0.5 ml subcutaneous solution
|
$207.02 |
$207.02 |
$207.02 |
$52.49
|
|
Surgical exposure prostate 55860
|
$18,545.42 |
$18,545.42 |
$18,545.42 |
$3,891.34
|
|
Surgical pathology level 1 gross examination only
|
$11,553.12 |
$11,553.12 |
$11,553.12 |
$81.00
|
|
Surgical pathology level 2 gross & microscopic examination
|
$13,411.71 |
$13,411.71 |
$13,411.71 |
$138.00
|
|
Surgical pathology level 3 gross & microscopic examination
|
$13,695.27 |
$13,695.27 |
$13,695.27 |
$181.00
|
|
Surgical pathology level 4 gross & microscopic examination
|
$4,832.00 |
$4,832.00 |
$4,832.00 |
$239.85
|
|
Surgical pathology level 5 gross & microscopic examination
|
$17,057.25 |
$17,057.25 |
$17,057.25 |
$489.00
|
|
Surgical pathology level 6 gross & microscopic examination
|
$19,264.21 |
$19,264.21 |
$19,264.21 |
$720.75
|
|
Susceptibility agar dilution per agent
|
$13.00 |
$13.00 |
$13.00 |
$38.58
|
|
Susceptibility enzyme detection per enzyme
|
$13.00 |
$13.00 |
$13.00 |
$31.85
|
|
Susceptibility mic per plate
|
$71.50 |
$71.50 |
$71.50 |
$89.70
|
|
Synvisc or synvisc-one
|
$3,115.89 |
$3,115.89 |
$3,115.89 |
$1,053.54
|
|
Syphilis test non-treponemal antibody quantitative rpr
|
$65.65 |
$65.65 |
$65.65 |
$45.70
|
|
T3 (triiodothyronine) free
|
$178.10 |
$178.10 |
$178.10 |
$91.20
|
|
T3 (triiodothyronine) total
|
$117.65 |
$117.65 |
$117.65 |
$88.00
|
|
T4 (thyroxine) free
|
$113.10 |
$113.10 |
$113.10 |
$65.00
|
|
T4 (thyroxine) total
|
$59.15 |
$59.15 |
$59.15 |
$62.40
|
|
Tacrolimus 1 mg capsule, immediate-release
|
$4.87 |
$4.87 |
$4.87 |
$4.87
|
|
Tacrolimus therapeutic drug level
|
$160.55 |
$160.55 |
$160.55 |
$137.15
|
|
Tamoxifen 10 mg tabs 60 each bottle
|
$35.75 |
$35.75 |
$35.75 |
$35.75
|
|
Tbo-filgrastim 300 mcg/0.5 ml subcutaneous syringe
|
$909.75 |
$909.75 |
$909.75 |
$760.95
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$245.05 |
$245.05 |
$245.05 |
$178.40
|
|
Tc-99m labeled rbc
|
$400.40 |
$400.40 |
$400.40 |
$312.70
|
|
Tc-99m maa
|
$167.70 |
$167.70 |
$167.70 |
$306.60
|
|
Tc-99m mebrofenin
|
$172.25 |
$172.25 |
$172.25 |
$169.53
|
|
Tc-99m medronate
|
$841.10 |
$841.10 |
$841.10 |
$120.35
|
|
Tc-99m mertiatide
|
$757.25 |
$757.25 |
$757.25 |
$757.25
|
|
Tc-99m oxidronate
|
$213.20 |
$213.20 |
$213.20 |
$132.05
|
|
Tc-99m sestamibi p study dose
|
$570.05 |
$570.05 |
$570.05 |
$221.60
|
|
Tc-99m sulfur colloid
|
$132.60 |
$132.60 |
$132.60 |
$240.50
|
|
Tc-99m tetrofosmin p study dose
|
$213.20 |
$213.20 |
$213.20 |
$198.05
|
|
Tc-99m tilmanocept diag
|
$1,517.75 |
$1,517.75 |
$1,517.75 |
$1,007.79
|
|
T cells absolute cd4/cd8 including ratio
|
$220.35 |
$220.35 |
$220.35 |
$189.60
|
|
T cells absolute cd 4 count
|
$164.45 |
$164.45 |
$164.45 |
$120.25
|
|
T cells total count
|
$116.35 |
$116.35 |
$116.35 |
$126.90
|
|
Telehealth original site facility fee
|
$32.50 |
$32.50 |
$32.50 |
$55.65
|
|
Telethx isodose plan cplx
|
$22,692.15 |
$22,692.15 |
$22,692.15 |
$1,526.85
|
|
Telethx isodose plan simple
|
$674.05 |
$674.05 |
$674.05 |
$848.72
|
