|
Special radiation treatment
|
$3,086.40 |
$3,086.40 |
$3,086.40 |
$2,052.00
|
|
Special teletx port plan
|
$1,494.40 |
$1,494.40 |
$1,494.40 |
$1,095.05
|
|
Speech and Language Evaluation (comprehensive)
|
$471.20 |
$471.20 |
$471.20 |
$384.80
|
|
Speech Therapy Session (one-on-one)
|
$306.40 |
$306.40 |
$306.40 |
$246.87
|
|
Sperm isolation complex
|
$260.00 |
$260.00 |
$260.00 |
$176.28
|
|
Sperm isolation simple
|
$200.00 |
$200.00 |
$200.00 |
$126.05
|
|
Spinal puncture lumbar diagnostic w/fluoroscopic or CT guidance
|
$1,952.00 |
$1,952.00 |
$1,952.00 |
$1,439.40
|
|
Spine X-ray (single view, one level)
|
$267.20 |
$267.20 |
$267.20 |
$251.00
|
|
Splint dorsal bloc wh med perf 3.2mm lf polyflex ii
|
$781.04 |
$781.04 |
$781.04 |
$388.80
|
|
Splint extn xsm w sof-stretch rolyan
|
$100.93 |
$100.93 |
$100.93 |
$71.44
|
|
Splint finger fold over sm
|
$25.68 |
$25.68 |
$25.68 |
$146.88
|
|
Splint finger frog med
|
$51.79 |
$51.79 |
$51.79 |
$38.08
|
|
Splint func pos polyflex ii med
|
$90.00 |
$90.00 |
$90.00 |
$61.64
|
|
Splint rstrc wrst/cmc right med
|
$146.40 |
$146.40 |
$146.40 |
$99.04
|
|
Split atogrft f/s/n/h/f/g/m/d gt 1st 100sqcm/</1 %
|
$5,944.80 |
$5,944.80 |
$5,944.80 |
$4,703.00
|
|
Srs linear based
|
$12,160.00 |
$12,160.00 |
$12,160.00 |
$14,124.25
|
|
St analysis behavior qualitative voice/resonance
|
$376.00 |
$376.00 |
$376.00 |
$297.60
|
|
St cognitve performance testing healthcare professional each hour
|
$309.60 |
$309.60 |
$309.60 |
$286.00
|
|
Stent axios caut enh 15x10mm electrocaut
|
$34,407.99 |
$34,407.99 |
$34,407.99 |
$32,403.15
|
|
Stent bili dbl pgtl 10fx5cm
|
$3,169.40 |
$3,169.40 |
$3,169.40 |
$2,704.27
|
|
Stent bili rx wallflx 10x80 uncvr
|
$28,695.23 |
$28,695.23 |
$28,695.23 |
$20,962.50
|
|
Stent placemt retro carotid
|
$8,480.00 |
$8,480.00 |
$8,480.00 |
$5,328.00
|
|
Sterile water/saline, 10 ml
|
$17.20 |
$17.20 |
$17.20 |
$13.32
|
|
St evaluate speech sound production
|
$354.40 |
$354.40 |
$354.40 |
$292.95
|
|
St evaluation motion fluoroscopic swallow function cine/video
|
$342.40 |
$342.40 |
$342.40 |
$400.00
|
|
Stomach Emptying Scan (Nuclear Medicine)
|
$1,236.00 |
$1,236.00 |
$1,236.00 |
$1,345.40
|
|
Strapping of ankle and/or ft 29540
|
$252.00 |
$252.00 |
$252.00 |
$223.45
|
|
Strapping of chest
|
$182.40 |
$182.40 |
$182.40 |
$195.33
|
|
Strapping of elbow or wrist 29260
|
$114.40 |
$114.40 |
$114.40 |
$157.46
|
|
Strapping of hand or finger
|
$114.40 |
$114.40 |
$114.40 |
$177.45
|
|
Strapping of hip
|
$146.40 |
$146.40 |
$146.40 |
$164.70
|
|
Strapping of knee
|
$134.40 |
$134.40 |
$134.40 |
$205.20
|
|
Strapping of toes 29550
|
$176.80 |
$176.80 |
$176.80 |
$164.70
|
|
Stress test pulmonary
|
$264.80 |
$264.80 |
$264.80 |
$324.00
|
|
Stress tte complete
|
$2,421.60 |
$2,421.60 |
$2,421.60 |
$1,900.96
|
|
Succinylcholine chloride 20 mg/ml injection solution (wrapper)
|
$61.51 |
$61.51 |
$61.51 |
$54.80
|
|
Sulbactam 1 gram-durlobactam 1 gram (0.5 gram x2) intravenous solution
|
$57.17 |
$57.17 |
$57.17 |
$7,487.55
|
|
Sulfamethoxazole 400 mg-trimethoprim 80 mg/5 ml intravenous solution
|
$52.51 |
$52.51 |
$52.51 |
$82.46
|
|
Sumatriptan 6 mg/0.5 ml subcutaneous solution
|
$55.37 |
$55.37 |
$55.37 |
$129.89
|
|
Support clav 29.6-40.5in med
|
$166.08 |
$166.08 |
$166.08 |
$94.08
|
|
Surgical pathology level 1 gross examination only
|
$120.80 |
$120.80 |
$120.80 |
$81.00
|
|
Surgical pathology level 2 gross & microscopic examination
|
$150.40 |
$150.40 |
$150.40 |
$143.55
|
|
Surgical pathology level 3 gross & microscopic examination
|
$172.00 |
$172.00 |
$172.00 |
$184.21
|
|
Surgical pathology level 4 gross & microscopic examination
|
$176.00 |
$176.00 |
$176.00 |
$250.20
|
|
Surgical pathology level 5 gross & microscopic examination
|
$558.40 |
$558.40 |
$558.40 |
$480.60
|
|
Surgical pathology level 6 gross & microscopic examination
|
$1,336.00 |
$1,336.00 |
$1,336.00 |
$720.75
|
|
Svc venogram s&i
|
$2,295.20 |
$2,295.20 |
$2,295.20 |
$1,990.95
|
|
Swallowing Evaluation (Bedside)
|
$340.80 |
$340.80 |
$340.80 |
$316.80
|
|
Swallowing Therapy Session
|
$287.20 |
$287.20 |
$287.20 |
$232.56
|
|
Synvisc or synvisc-one
|
$506.47 |
$506.47 |
$506.47 |
$1,242.63
|
|
System pacing micra av
|
$29,269.93 |
$29,269.93 |
$29,269.93 |
$24,316.50
|
|
System pcmkr dual chamber leadless micra av2 intrdcr cath
|
$18,720.16 |
$18,720.16 |
$18,720.16 |
$12,003.00
|
|
System sealant biosentry tract
|
$1,029.28 |
$1,029.28 |
$1,029.28 |
$889.35
|
|
Tacrolimus 1 mg capsule, immediate-release
|
$6.08 |
$6.08 |
$6.08 |
$9.93
|
|
Tailbone (Sacrum and Coccyx) X-ray
|
$404.80 |
$404.80 |
$404.80 |
$289.20
|
|
Tc-99m labeled rbc
|
$428.00 |
$428.00 |
$428.00 |
$306.00
|
|
Tc-99m maa
|
$936.80 |
$936.80 |
$936.80 |
$312.06
|
|
Tc-99m mebrofenin
|
$178.40 |
$178.40 |
$178.40 |
$157.65
|
|
Tc-99m medronate
|
$133.60 |
$133.60 |
$133.60 |
$111.01
|
|
Tc-99m mertiatide
|
$756.00 |
$756.00 |
$756.00 |
$756.00
|
|
Tc-99m oxidronate
|
$168.00 |
$168.00 |
$168.00 |
$108.00
|
|
Tc-99m pentetate dtpa
|
$388.80 |
$388.80 |
$388.80 |
$222.60
|
|
Tc-99m pentetate dtpa aerosol
|
$388.80 |
$388.80 |
$388.80 |
$191.50
|
|
Tc-99m pertechnetate per mci
|
$108.00 |
$108.00 |
$108.00 |
$18.67
|
|
Tc-99m sestamibi p study dose
|
$352.00 |
$352.00 |
$352.00 |
$287.20
|
|
Tc-99m sulfur colloid
|
$308.00 |
$308.00 |
$308.00 |
$245.70
|
|
Tc-99m tetrofosmin p study dose
|
$120.00 |
$120.00 |
$120.00 |
$193.28
|
|
Tc-99m tilmanocept diag
|
$1,171.20 |
$1,171.20 |
$1,171.20 |
$985.60
|
|
Telehealth original site facility fee
|
$70.40 |
$70.40 |
$70.40 |
$51.00
|
|
Telethx isodose plan cplx
|
$2,169.60 |
$2,169.60 |
$2,169.60 |
$1,526.85
|
|
Telethx isodose plan simple
|
$1,082.40 |
$1,082.40 |
$1,082.40 |
$880.61
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$7,771.56 |
$7,771.56 |
$7,771.56 |
$14,951.87
|
|
Tenotomy length/rls abductor hallucis musc 28240
|
$4,096.00 |
$4,096.00 |
$4,096.00 |
$3,545.97
|
|
Tenotomy open tndn flxr toe sgl tndn spx
|
$2,426.40 |
$2,426.40 |
$2,426.40 |
$2,175.00
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$49.17 |
$49.17 |
$49.17 |
$39.33
|
|
Test stress cardiovascular tracing only
|
$1,175.20 |
$1,175.20 |
$1,175.20 |
$953.40
|
|
Tetanus immune globulin inj
|
$409.36 |
$409.36 |
$409.36 |
$1,285.36
|
|
Therapeutic procd strg endur
|
$123.20 |
$123.20 |
$123.20 |
$85.68
|
|
Therapy Activity Training (each 15 minutes)
|
$132.80 |
$132.80 |
$132.80 |
$101.38
|
|
Therapy Exercise Session (each 15 minutes)
|
$128.00 |
$128.00 |
$128.00 |
$98.58
|
|
Therapy nutrition individual initial f2f w/patient each 15 minutes
|
$57.60 |
$57.60 |
$57.60 |
$57.50
|
|
Therapy nutrition individual reassessment/intervention f2f w/patient each 15 minutes
|
$54.40 |
$54.40 |
$54.40 |
$50.40
|
|
Ther nma rdctj intus/obstrcj
|
$1,075.20 |
$1,075.20 |
$1,075.20 |
$538.88
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$50.23 |
$50.23 |
$50.23 |
$25.54
|
|
Thigh Bone (Femur) X-ray (both sides)
|
$556.00 |
$556.00 |
$556.00 |
$313.60
|
|
Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides)
|
$1,852.00 |
$1,852.00 |
$1,852.00 |
$1,724.25
|
|
Thoracotomy with cardiac massage
|
$3,353.60 |
$3,353.60 |
$3,353.60 |
$2,138.76
|
|
Three-Phase Bone Scan (Nuclear Medicine)
|
$1,639.20 |
$1,639.20 |
$1,639.20 |
$1,703.45
|
|
Thrombectmy crnry perq mechanical
|
$6,280.00 |
$6,280.00 |
$6,280.00 |
$3,809.40
|
|
Thrombectomy/inf pq dialysis circuit
|
$12,916.00 |
$12,916.00 |
$12,916.00 |
$8,084.00
|
|
Thrombectomy/inf pq dialysis circuit w/pta
|
$22,991.20 |
$22,991.20 |
$22,991.20 |
$14,277.20
|
|
Thrombectomy/inf pq dialysis circuit w/stent plcmnt
|
$38,504.80 |
$38,504.80 |
$38,504.80 |
$21,413.60
|
|
Thromboendarterectomy common femoral
|
$14,885.60 |
$14,885.60 |
$14,885.60 |
$3,987.20
|
|
Thromboendarterectomy sfa
|
$18,961.60 |
$18,961.60 |
$18,961.60 |
$5,472.00
|
|
Thyroid imaging
|
$975.20 |
$975.20 |
$975.20 |
$695.60
|
|
Thyroid Ultrasound
|
$637.60 |
$637.60 |
$637.60 |
$588.50
|
|
Thyroid uptake measurement
|
$887.20 |
$887.20 |
$887.20 |
$591.25
|
|
Tilt table study
|
$1,943.20 |
$1,943.20 |
$1,943.20 |
$1,561.82
|
|
Tissue matrix 1.8x1.8cm collagen dermacell porous 4sq cm cost per sq cm
|
$54.28 |
$54.28 |
$54.28 |
$537.50
|
|
Tissue matrix xcm thk 20x30cm -cost per sq cm
|
$45.36 |
$45.36 |
$45.36 |
$830.41
|
