|
Shoulder MRI (without contrast)
|
$3,237.60 |
$3,237.60 |
$3,237.60 |
$2,096.84
|
|
Shoulder X-ray
|
$384.00 |
$384.00 |
$384.00 |
$340.10
|
|
Shoulder X-ray (single view, both shoulders)
|
$308.80 |
$308.80 |
$308.80 |
$263.25
|
|
Shunt glaucoma baerveldt 350mm
|
$6,000.00 |
$6,000.00 |
$6,000.00 |
$4,538.82
|
|
Sickling rbc
|
$34.40 |
$34.40 |
$34.40 |
$59.40
|
|
Sincalide 5 mcg solution for injection
|
$463.20 |
$463.20 |
$463.20 |
$309.14
|
|
Sinus CT scan (with and without contrast)
|
$2,612.80 |
$2,612.80 |
$2,612.80 |
$1,796.30
|
|
Sinus CT scan (with contrast)
|
$2,328.00 |
$2,328.00 |
$2,328.00 |
$1,527.60
|
|
Sinus CT scan (without contrast)
|
$2,045.60 |
$2,045.60 |
$2,045.60 |
$1,289.00
|
|
Sinus X-ray (complete)
|
$433.60 |
$433.60 |
$433.60 |
$346.45
|
|
Sinus X-ray (limited)
|
$282.40 |
$282.40 |
$282.40 |
$215.40
|
|
Skin Biopsy
|
$430.40 |
$430.40 |
$430.40 |
$360.34
|
|
Skull X-ray (1 to 3 views)
|
$410.40 |
$410.40 |
$410.40 |
$294.45
|
|
Skull X-ray (complete)
|
$551.20 |
$551.20 |
$551.20 |
$417.50
|
|
Skyla, 13.5 mg
|
$745.19 |
$745.19 |
$745.19 |
$1,643.47
|
|
Sleep Study (Polysomnography)
|
$4,175.20 |
$4,175.20 |
$4,175.20 |
$3,734.50
|
|
Sling suprapubic suburetheral
|
$3,372.00 |
$3,372.00 |
$3,372.00 |
$9,679.96
|
|
Small Bowel Barium X-ray (Follow-Through)
|
$760.80 |
$760.80 |
$760.80 |
$557.70
|
|
Smear fluorescent and/or acid fast stain
|
$47.20 |
$47.20 |
$47.20 |
$64.35
|
|
Smear gram stain
|
$55.20 |
$55.20 |
$55.20 |
$55.55
|
|
Smear nasal eosinophil
|
$52.80 |
$52.80 |
$52.80 |
$46.20
|
|
Smear wet mount
|
$63.20 |
$63.20 |
$63.20 |
$67.55
|
|
Sodium 24 hour urine
|
$36.00 |
$36.00 |
$36.00 |
$48.98
|
|
Sodium chloride 0.9 % intravenous solution
|
$86.40 |
$86.40 |
$86.40 |
$49.07
|
|
Sodium chloride 0.9 % IV bolus
|
$194.40 |
$194.40 |
$194.40 |
$45.62
|
|
Sodium chloride 0.9 % IV bolus
|
$324.00 |
$324.00 |
$324.00 |
$37.64
|
|
Sodium ferric gluconate complex in sucrose 62.5 mg/5 ml intravenous
|
$84.80 |
$84.80 |
$84.80 |
$80.14
|
|
Sodium serum/plasma/whole blood
|
$50.40 |
$50.40 |
$50.40 |
$46.26
|
|
Sodium thiosulfate 12.5 gram/50 ml (250 mg/ml) intravenous solution
|
$92.66 |
$92.66 |
$92.66 |
$177.52
|
|
Specific gravity body fluid
|
$25.60 |
$25.60 |
$25.60 |
$22.00
|
|
Specimen fat stain
|
$99.20 |
$99.20 |
$99.20 |
$37.40
|
|
Speech and Language Evaluation (comprehensive)
|
$467.20 |
$467.20 |
$467.20 |
$384.80
|
|
Speech Therapy Session (one-on-one)
|
$315.20 |
$315.20 |
$315.20 |
$246.87
|
|
Spine X-ray (single view, one level)
|
$359.20 |
$359.20 |
$359.20 |
$251.00
|
|
Splint rstrc wrst/cmc right med
|
$175.20 |
$175.20 |
$175.20 |
$99.04
|
|
St analysis behavior qualitative voice/resonance
|
$255.20 |
$255.20 |
$255.20 |
$297.60
|
|
St cognitve performance testing healthcare professional each hour
|
$331.20 |
$331.20 |
$331.20 |
$286.00
|
|
Stent bili dbl pgtl 10fx5cm
|
$294.40 |
$294.40 |
$294.40 |
$2,704.27
|
|
Stent bili rx wallflx 10x80 uncvr
|
$3,120.00 |
$3,120.00 |
$3,120.00 |
$20,962.50
|
|
Sterile water/saline, 10 ml
|
$5.20 |
$5.20 |
$5.20 |
$13.32
|
|
St evaluate speech sound production
|
$243.20 |
$243.20 |
$243.20 |
$292.95
|
|
St evaluation motion fluoroscopic swallow function cine/video
|
$524.00 |
$524.00 |
$524.00 |
$400.00
|
|
Stomach Emptying Scan (Nuclear Medicine)
|
$1,829.60 |
$1,829.60 |
$1,829.60 |
$1,345.40
|
|
Strep b dna amp probe
|
$183.20 |
$183.20 |
$183.20 |
$124.15
|
|
Stress test pulmonary
|
$320.00 |
$320.00 |
$320.00 |
$324.00
|
|
Succinylcholine chloride 20 mg/ml injection solution (wrapper)
|
$63.44 |
$63.44 |
$63.44 |
$54.80
|
|
Sulfamethoxazole 400 mg-trimethoprim 80 mg/5 ml intravenous solution
|
$62.90 |
$62.90 |
$62.90 |
$82.46
|
|
Sulfonylurea screen qn-sendout
|
$109.60 |
$109.60 |
$109.60 |
$158.75
|
|
Sumatriptan 6 mg/0.5 ml subcutaneous solution
|
$114.88 |
$114.88 |
$114.88 |
$129.89
|
|
Support clav 29.6-40.5in med
|
$28.80 |
$28.80 |
$28.80 |
$94.08
|
|
Surgical pathology level 1 gross examination only
|
$34.40 |
$34.40 |
$34.40 |
$81.00
|
|
Surgical pathology level 2 gross & microscopic examination
|
$80.80 |
$80.80 |
$80.80 |
$143.55
|
|
Surgical pathology level 3 gross & microscopic examination
|
$99.20 |
$99.20 |
$99.20 |
$184.21
|
|
Surgical pathology level 4 gross & microscopic examination
|
$115.20 |
$115.20 |
$115.20 |
$250.20
|
|
Surgical pathology level 5 gross & microscopic examination
|
$528.00 |
$528.00 |
$528.00 |
$480.60
|
|
Surgical pathology level 6 gross & microscopic examination
|
$745.60 |
$745.60 |
$745.60 |
$720.75
|
|
Susceptibility agar dilution per agent
|
$56.80 |
$56.80 |
$56.80 |
$45.60
|
|
Susceptibility enzyme detection per enzyme
|
$37.60 |
$37.60 |
$37.60 |
$35.89
|
|
Susceptibility mic per plate
|
$239.20 |
$239.20 |
$239.20 |
$106.00
|
|
Swallowing Evaluation (Bedside)
|
$371.20 |
$371.20 |
$371.20 |
$316.80
|
|
Swallowing Therapy Session
|
$300.00 |
$300.00 |
$300.00 |
$232.56
|
|
Synvisc or synvisc-one
|
$395.25 |
$395.25 |
$395.25 |
$1,242.63
|
|
System pacing micra av
|
$4,507.20 |
$4,507.20 |
$4,507.20 |
$24,316.50
|
|
System pcmkr dual chamber leadless micra av2 intrdcr cath
|
$7,077.60 |
$7,077.60 |
$7,077.60 |
$12,003.00
|
|
T3 (triiodothyronine) free
|
$358.40 |
$358.40 |
$358.40 |
$100.32
|
|
T3 (triiodothyronine) total
|
$156.80 |
$156.80 |
$156.80 |
$93.52
|
|
T4 (thyroxine) free
|
$87.20 |
$87.20 |
$87.20 |
$89.60
|
|
T4 (thyroxine) total
|
$68.80 |
$68.80 |
$68.80 |
$70.20
|
|
Tacrolimus 1 mg capsule, immediate-release
|
$6.60 |
$6.60 |
$6.60 |
$9.93
|
|
Tacrolimus therapeutic drug level
|
$240.00 |
$240.00 |
$240.00 |
$122.50
|
|
Tailbone (Sacrum and Coccyx) X-ray
|
$359.20 |
$359.20 |
$359.20 |
$289.20
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$186.40 |
$186.40 |
$186.40 |
$179.95
|
|
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 pentetate dtpa
|
$388.80 |
$388.80 |
$388.80 |
$222.60
|
|
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
|
|
T cells absolute cd4/cd8 including ratio
|
$228.80 |
$228.80 |
$228.80 |
$184.00
|
|
T cells absolute cd 4 count
|
$103.20 |
$103.20 |
$103.20 |
$111.20
|
|
T cells total count
|
$183.20 |
$183.20 |
$183.20 |
$130.20
|
|
Telehealth original site facility fee
|
$67.20 |
$67.20 |
$67.20 |
$51.00
|
|
Temsirolimus 30 mg/3 ml (10 mg/ml) (first dilution) intravenous soln
|
$2,061.22 |
$2,061.22 |
$2,061.22 |
$3,723.60
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$9,301.73 |
$9,301.73 |
$9,301.73 |
$14,951.87
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$63.16 |
$63.16 |
$63.16 |
$39.33
|
|
Testicular imaging w/vasc flow
|
$1,339.20 |
$1,339.20 |
$1,339.20 |
$842.56
|
|
Test stress cardiovascular tracing only
|
$900.80 |
$900.80 |
$900.80 |
$953.40
|
|
Theophylline therapeutic drug level
|
$121.60 |
$121.60 |
$121.60 |
$108.00
|
|
Therapeutic procd strg endur
|
$129.60 |
$129.60 |
$129.60 |
$85.68
|
|
Therapy Activity Training (each 15 minutes)
|
$125.60 |
$125.60 |
$125.60 |
$101.38
|
|
Therapy Exercise Session (each 15 minutes)
|
$126.40 |
$126.40 |
$126.40 |
$98.58
|
|
Therapy nutrition individual initial f2f w/patient each 15 minutes
|
$41.60 |
$41.60 |
$41.60 |
$57.50
|
|
Therapy nutrition individual reassessment/intervention f2f w/patient each 15 minutes
|
$41.60 |
$41.60 |
$41.60 |
$50.40
|
|
Ther/proph/diag inj ia
|
$172.00 |
$172.00 |
$172.00 |
$247.33
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$64.16 |
$64.16 |
$64.16 |
$25.54
|
|
Thigh Bone (Femur) X-ray (both sides)
|
$329.60 |
$329.60 |
$329.60 |
$313.60
|
|
Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides)
|
$1,907.20 |
$1,907.20 |
$1,907.20 |
$1,724.25
|
