|
Sevelamer carbonate 800 mg tablet
|
$3.00 |
$3.00 |
$3.00 |
$7.14
|
|
Sevelamer carbonate pdr 20mg
|
$7.80 |
$7.80 |
$7.80 |
$21.96
|
|
Shave sgl skin lsn t/a/l 0.6-1.0cm
|
$65.40 |
$65.40 |
$65.40 |
$235.13
|
|
Shoe post-op mens m
|
$984.31 |
$984.31 |
$984.31 |
$52.20
|
|
Shoulder MRI (with and without contrast)
|
$3,183.00 |
$3,183.00 |
$3,183.00 |
$2,713.80
|
|
Shoulder MRI (with contrast)
|
$3,243.60 |
$3,243.60 |
$3,243.60 |
$2,448.60
|
|
Shoulder MRI (without contrast)
|
$3,243.60 |
$3,243.60 |
$3,243.60 |
$2,065.05
|
|
Shoulder X-ray
|
$486.60 |
$486.60 |
$486.60 |
$339.50
|
|
Shunt glaucoma baerveldt 350mm
|
$3,263.40 |
$3,263.40 |
$3,263.40 |
$4,636.80
|
|
Sickling rbc
|
$85.20 |
$85.20 |
$85.20 |
$57.92
|
|
Sincalide 5 mcg solution for injection
|
$545.40 |
$545.40 |
$545.40 |
$307.58
|
|
Sinus CT scan (with and without contrast)
|
$2,276.40 |
$2,276.40 |
$2,276.40 |
$1,790.00
|
|
Sinus CT scan (with contrast)
|
$1,999.80 |
$1,999.80 |
$1,999.80 |
$1,527.60
|
|
Sinus CT scan (without contrast)
|
$1,585.80 |
$1,585.80 |
$1,585.80 |
$1,292.04
|
|
Skin Biopsy
|
$204.00 |
$204.00 |
$204.00 |
$360.34
|
|
Sleep Study (Polysomnography)
|
$330.00 |
$330.00 |
$330.00 |
$3,607.50
|
|
Sleep study unattended
|
$193.80 |
$193.80 |
$193.80 |
$580.87
|
|
Sling suprapubic suburetheral
|
$3,590.89 |
$3,590.89 |
$3,590.89 |
$9,679.96
|
|
Smear fluorescent and/or acid fast stain
|
$201.60 |
$201.60 |
$201.60 |
$64.20
|
|
Smear gram stain
|
$37.20 |
$37.20 |
$37.20 |
$55.25
|
|
Smear special stain inclusion bodies/parasites
|
$132.60 |
$132.60 |
$132.60 |
$73.15
|
|
Sodium 24 hour urine
|
$105.00 |
$105.00 |
$105.00 |
$48.60
|
|
Sodium chloride 0.9 % intravenous solution
|
$20.40 |
$20.40 |
$20.40 |
$48.11
|
|
Sodium chloride 0.9 % IV bolus
|
$23.40 |
$23.40 |
$23.40 |
$46.00
|
|
Sodium chloride 3 % ivpb
|
$52.80 |
$52.80 |
$52.80 |
$40.61
|
|
Sodium ferric gluconate complex in sucrose 62.5 mg/5 ml intravenous
|
$117.60 |
$117.60 |
$117.60 |
$77.77
|
|
Sodium serum/plasma/whole blood
|
$88.20 |
$88.20 |
$88.20 |
$45.60
|
|
Special physics consult
|
$754.80 |
$754.80 |
$754.80 |
$725.00
|
|
Special radiation treatment
|
$1,913.40 |
$1,913.40 |
$1,913.40 |
$1,986.00
|
|
Spinal puncture lumbar diagnostic w/fluoroscopic or CT guidance
|
$927.00 |
$927.00 |
$927.00 |
$1,439.40
|
|
Spirometry bronchodilation responsiveness pre/post bronchodilator administration
|
$468.00 |
$468.00 |
$468.00 |
$543.26
|
|
Srs linear based
|
$11,584.80 |
$11,584.80 |
$11,584.80 |
$13,585.00
|
|
St cognitve performance testing healthcare professional each hour
|
$264.00 |
$264.00 |
$264.00 |
$286.00
|
|
Stent axios caut enh 15x10mm electrocaut
|
$18,299.74 |
$18,299.74 |
$18,299.74 |
$32,403.15
|
|
Stent bili dbl pgtl 10fx5cm
|
$353.77 |
$353.77 |
$353.77 |
$2,520.08
|
|
Stent bili rx wallflx 10x80 uncvr
|
$18,299.74 |
$18,299.74 |
$18,299.74 |
$20,962.50
|
|
Stent bronch dumon sil 10x40mm
|
$7,893.90 |
$7,893.90 |
$7,893.90 |
$4,939.20
|
|
Stereotactic radiation trmt
|
$1,758.00 |
$1,758.00 |
$1,758.00 |
$845.60
|
|
St evaluate speech sound production
|
$450.00 |
$450.00 |
$450.00 |
$292.95
|
|
St evaluate speech sound production comprehensive/expressive
|
$450.00 |
$450.00 |
$450.00 |
$377.00
|
|
St evaluation motion fluoroscopic swallow function cine/video
|
$775.80 |
$775.80 |
$775.80 |
$399.60
|
|
St evaluation swallow function
|
$592.20 |
$592.20 |
$592.20 |
$314.40
|
|
Strapping of hip
|
$203.40 |
$203.40 |
$203.40 |
$164.70
|
|
Strep b dna amp probe
|
$63.00 |
$63.00 |
$63.00 |
$120.90
|
|
Stress test pulmonary
|
$424.80 |
$424.80 |
$424.80 |
$322.85
|
|
St treatment speech individual
|
$277.80 |
$277.80 |
$277.80 |
$248.84
|
|
St treatment swallow dysfunction/oral
|
$232.20 |
$232.20 |
$232.20 |
$240.31
|
|
Subsequent intensive care infant 2501-5000 grams 99480
|
$174.00 |
$174.00 |
$174.00 |
$216.00
|
|
Succinylcholine chloride 20 mg/ml injection solution (wrapper)
|
$64.80 |
$64.80 |
$64.80 |
$52.31
|
|
Sulbactam 1 gram-durlobactam 1 gram (0.5 gram x2) intravenous solution
|
$52,657.80 |
$52,657.80 |
$52,657.80 |
$7,345.98
|
|
Sumatriptan 6 mg/0.5 ml subcutaneous solution
|
$247.20 |
$247.20 |
$247.20 |
$114.88
|
|
Surgical pathology level 1 gross examination only
|
$203.40 |
$203.40 |
$203.40 |
$79.50
|
|
Surgical pathology level 2 gross & microscopic examination
|
$358.20 |
$358.20 |
$358.20 |
$141.94
|
|
Surgical pathology level 3 gross & microscopic examination
|
$107.40 |
$107.40 |
$107.40 |
$181.00
|
|
Surgical pathology level 4 gross & microscopic examination
|
$96.60 |
$96.60 |
$96.60 |
$239.85
|
|
Surgical pathology level 5 gross & microscopic examination
|
$1,059.60 |
$1,059.60 |
$1,059.60 |
$480.00
|
|
Surgical pathology level 6 gross & microscopic examination
|
$4,461.60 |
$4,461.60 |
$4,461.60 |
$718.00
|
|
Susceptibility agar dilution per agent
|
$63.60 |
$63.60 |
$63.60 |
$45.45
|
|
Susceptibility mic per plate
|
$196.20 |
$196.20 |
$196.20 |
$106.00
|
|
Syphilis test non-treponemal antibody quantitative rpr
|
$36.00 |
$36.00 |
$36.00 |
$41.60
|
|
System cardiomems hosp electronics
|
$5,644.80 |
$5,644.80 |
$5,644.80 |
$39,037.95
|
|
System pcmkr dual chamber leadless micra av2 intrdcr cath
|
$10,395.25 |
$10,395.25 |
$10,395.25 |
$12,003.00
|
|
T3 (triiodothyronine) free
|
$348.60 |
$348.60 |
$348.60 |
$99.20
|
|
T3 (triiodothyronine) total
|
$199.80 |
$199.80 |
$199.80 |
$93.52
|
|
T4 (thyroxine) free
|
$185.40 |
$185.40 |
$185.40 |
$85.20
|
|
T4 (thyroxine) total
|
$189.00 |
$189.00 |
$189.00 |
$69.00
|
|
Tacrolimus 1 mg capsule, immediate-release
|
$9.60 |
$9.60 |
$9.60 |
$9.84
|
|
Tacrolimus therapeutic drug level
|
$130.20 |
$130.20 |
$130.20 |
$122.40
|
|
Talymed
|
$318.50 |
$318.50 |
$318.50 |
$3,411.49
|
|
Target gsa panel hmtlmph neop
|
$5,556.60 |
$5,556.60 |
$5,556.60 |
$2,246.30
|
|
Tb test cell mediated immunity antigen response enumeration gamma interferon t-cells
|
$212.40 |
$212.40 |
$212.40 |
$194.35
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$132.60 |
$132.60 |
$132.60 |
$177.65
|
|
Tc-99m bicisate
|
$1,197.60 |
$1,197.60 |
$1,197.60 |
$1,969.45
|
|
Tc-99m labeled rbc
|
$24.60 |
$24.60 |
$24.60 |
$302.40
|
|
Tc-99m maa
|
$130.80 |
$130.80 |
$130.80 |
$292.80
|
|
Tc-99m mebrofenin
|
$96.60 |
$96.60 |
$96.60 |
$157.65
|
|
Tc-99m medronate
|
$19.20 |
$19.20 |
$19.20 |
$111.01
|
|
Tc-99m mertiatide
|
$463.80 |
$463.80 |
$463.80 |
$756.00
|
|
Tc-99m pentetate dtpa
|
$559.80 |
$559.80 |
$559.80 |
$222.60
|
|
Tc-99m pertechnetate per mci
|
$3.60 |
$3.60 |
$3.60 |
$22.10
|
|
Tc-99m pyroph diag per dose up to 25 mci
|
$352.20 |
$352.20 |
$352.20 |
$136.40
|
|
Tc-99m sestamibi p study dose
|
$366.00 |
$366.00 |
$366.00 |
$274.45
|
|
Tc-99m succimer (dmsa)
|
$2,016.00 |
$2,016.00 |
$2,016.00 |
$1,128.40
|
|
Tc-99m sulfur colloid
|
$133.80 |
$133.80 |
$133.80 |
$240.50
|
|
Tc-99m tetrofosmin p study dose
|
$294.60 |
$294.60 |
$294.60 |
$190.80
|
|
Tc-99m tilmanocept diag
|
$921.00 |
$921.00 |
$921.00 |
$955.60
|
|
T cells absolute cd4/cd8 including ratio
|
$266.40 |
$266.40 |
$266.40 |
$176.40
|
|
T cells absolute cd 4 count
|
$28.80 |
$28.80 |
$28.80 |
$111.20
|
|
Tee w or without fol w/cont, mon
|
$1,348.20 |
$1,348.20 |
$1,348.20 |
$1,431.95
|
|
Telehealth original site facility fee
|
$32.40 |
$32.40 |
$32.40 |
$51.00
|
|
Telethx isodose plan cplx
|
$3,268.20 |
$3,268.20 |
$3,268.20 |
$1,526.85
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$21,126.00 |
$21,126.00 |
$21,126.00 |
$15,245.38
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$16.20 |
$16.20 |
$16.20 |
$39.33
|
|
Testicular imaging w/vasc flow
|
$1,213.80 |
$1,213.80 |
$1,213.80 |
$842.56
|
|
Test stress cardiovascular tracing only
|
$540.00 |
$540.00 |
$540.00 |
$949.70
|
|
Tezepelumab-ekko 210 mg/1.91 ml (110 mg/ml) subcutaneous syringe
|
$14,011.20 |
$14,011.20 |
$14,011.20 |
$8,737.05
|
|
Theophylline therapeutic drug level
|
$137.40 |
$137.40 |
$137.40 |
$108.00
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$17.40 |
$17.40 |
$17.40 |
$25.54
|
|
Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides)
|
$2,500.20 |
$2,500.20 |
$2,500.20 |
$1,687.50
|
|
Thrombectmy crnry perq mechanical
|
$7,528.80 |
$7,528.80 |
$7,528.80 |
$3,580.00
|
