|
Scan duplex upper extremity arteries unilateral/limited study left
|
$792.00 |
$792.00 |
$792.00 |
$597.35
|
|
Scr c/v cyto,thinlayer,rescr
|
$299.20 |
$299.20 |
$299.20 |
$85.15
|
|
Screening Mammogram
|
$482.40 |
$482.40 |
$482.40 |
$310.20
|
|
Screen pap by tech w md supv
|
$85.60 |
$85.60 |
$85.60 |
$53.46
|
|
Screw cortex 2.0 x 10mm
|
$7,031.20 |
$7,031.20 |
$7,031.20 |
$29,785.18
|
|
Scrotal (Testicle) Ultrasound
|
$733.60 |
$733.60 |
$733.60 |
$611.91
|
|
Self-Care and Home Skills Training (each 15 minutes)
|
$113.60 |
$113.60 |
$113.60 |
$96.00
|
|
Semen analysis presence/motility
|
$70.40 |
$70.40 |
$70.40 |
$70.40
|
|
Serial casting application 97139app
|
$131.20 |
$131.20 |
$131.20 |
$78.39
|
|
Set radiation therapy field
|
$1,281.60 |
$1,281.60 |
$1,281.60 |
$782.61
|
|
Set radiation therapy field
|
$2,047.20 |
$2,047.20 |
$2,047.20 |
$1,159.03
|
|
Set radiation therapy field
|
$2,647.20 |
$2,647.20 |
$2,647.20 |
$1,636.36
|
|
Shot (Injection into Muscle or Under the Skin)
|
$148.80 |
$148.80 |
$148.80 |
$136.20
|
|
Shoulder AC Joint X-ray (both sides)
|
$349.60 |
$349.60 |
$349.60 |
$270.20
|
|
Shoulder Blade (Scapula) X-ray (both sides)
|
$298.40 |
$298.40 |
$298.40 |
$286.89
|
|
Shoulder MRI (with and without contrast)
|
$3,858.40 |
$3,858.40 |
$3,858.40 |
$2,743.02
|
|
Shoulder MRI (with contrast)
|
$3,330.40 |
$3,330.40 |
$3,330.40 |
$2,476.20
|
|
Shoulder MRI (without contrast)
|
$3,016.44 |
$3,016.44 |
$3,016.44 |
$2,096.84
|
|
Shoulder X-ray
|
$283.20 |
$283.20 |
$283.20 |
$340.10
|
|
Shoulder X-ray (single view, both shoulders)
|
$222.40 |
$222.40 |
$222.40 |
$263.25
|
|
Sialography s&i
|
$708.80 |
$708.80 |
$708.80 |
$499.20
|
|
Sincalide 5 mcg solution for injection
|
$424.00 |
$424.00 |
$424.00 |
$309.14
|
|
Sinus CT scan (with and without contrast)
|
$2,745.60 |
$2,745.60 |
$2,745.60 |
$1,796.30
|
|
Sinus CT scan (with contrast)
|
$2,497.60 |
$2,497.60 |
$2,497.60 |
$1,527.60
|
|
Sinus CT scan (without contrast)
|
$2,285.60 |
$2,285.60 |
$2,285.60 |
$1,289.00
|
|
Sinus X-ray (complete)
|
$476.00 |
$476.00 |
$476.00 |
$346.45
|
|
Sinus X-ray (limited)
|
$266.40 |
$266.40 |
$266.40 |
$215.40
|
|
Skull X-ray (1 to 3 views)
|
$391.20 |
$391.20 |
$391.20 |
$294.45
|
|
Skull X-ray (complete)
|
$552.00 |
$552.00 |
$552.00 |
$417.50
|
|
Sleep Study (Polysomnography)
|
$4,378.40 |
$4,378.40 |
$4,378.40 |
$3,734.50
|
|
Sling suprapubic suburetheral
|
$3,692.00 |
$3,692.00 |
$3,692.00 |
$9,679.96
|
|
Slp eval non-spch gen comm dev
|
$247.20 |
$247.20 |
$247.20 |
$285.09
|
|
Slp ther svc non-spch gen
|
$344.80 |
$344.80 |
$344.80 |
$188.50
|
|
Small Bowel Barium X-ray (Follow-Through)
|
$750.40 |
$750.40 |
$750.40 |
$557.70
|
|
Sodium chloride 0.9 % intravenous solution
|
$75.59 |
$75.59 |
$75.59 |
$49.07
|
|
Sodium chloride 0.9 % IV bolus
|
$75.59 |
$75.59 |
$75.59 |
$45.62
|
|
Sodium chloride 0.9 % IV bolus
|
$59.91 |
$59.91 |
$59.91 |
$37.64
|
|
Sodium chloride 3 % ivpb
|
$4.48 |
$4.48 |
$4.48 |
$40.61
|
|
Sodium ferric gluconate complex in sucrose 62.5 mg/5 ml intravenous
|
$66.46 |
$66.46 |
$66.46 |
$80.14
|
|
Sodium thiosulfate 12.5 gram/50 ml (250 mg/ml) intravenous solution
|
$93.33 |
$93.33 |
$93.33 |
$177.52
|
|
Special physics consult
|
$1,398.40 |
$1,398.40 |
$1,398.40 |
$725.00
|
|
Special radiation dosimetry
|
$985.60 |
$985.60 |
$985.60 |
$392.50
|
|
Special radiation treatment
|
$3,699.20 |
$3,699.20 |
$3,699.20 |
$2,052.00
|
|
Special teletx port plan
|
$2,856.00 |
$2,856.00 |
$2,856.00 |
$1,095.05
|
|
Speech and Language Evaluation (comprehensive)
|
$477.60 |
$477.60 |
$477.60 |
$384.80
|
|
Speech Therapy Session (one-on-one)
|
$297.44 |
$297.44 |
$297.44 |
$246.87
|
|
Spine X-ray (single view, one level)
|
$224.00 |
$224.00 |
$224.00 |
$251.00
|
|
Srs linear based
|
$26,032.00 |
$26,032.00 |
$26,032.00 |
$14,124.25
|
|
St analysis behavior qualitative voice/resonance
|
$276.80 |
$276.80 |
$276.80 |
$297.60
|
|
St cognitve performance testing healthcare professional each hour
|
$319.20 |
$319.20 |
$319.20 |
$286.00
|
|
Stent bili dbl pgtl 10fx5cm
|
$255.20 |
$255.20 |
$255.20 |
$2,704.27
|
|
Sterile water/saline, 10 ml
|
$3.60 |
$3.60 |
$3.60 |
$13.32
|
|
Sterile water/saline, 500 ml
|
$75.59 |
$75.59 |
$75.59 |
$28.11
|
|
St evaluate speech sound production
|
$267.20 |
$267.20 |
$267.20 |
$292.95
|
|
St evaluation motion fluoroscopic swallow function cine/video
|
$288.00 |
$288.00 |
$288.00 |
$400.00
|
|
Stomach Emptying Scan (Nuclear Medicine)
|
$1,775.20 |
$1,775.20 |
$1,775.20 |
$1,345.40
|
|
Stress test pulmonary
|
$325.60 |
$325.60 |
$325.60 |
$324.00
|
|
Succinylcholine chloride 20 mg/ml injection solution (wrapper)
|
$68.76 |
$68.76 |
$68.76 |
$54.80
|
|
Sulfamethoxazole 400 mg-trimethoprim 80 mg/5 ml intravenous solution
|
$63.43 |
$63.43 |
$63.43 |
$82.46
|
|
Sumatriptan 6 mg/0.5 ml subcutaneous solution
|
$63.68 |
$63.68 |
$63.68 |
$129.89
|
|
Support clav 29.6-40.5in med
|
$25.60 |
$25.60 |
$25.60 |
$94.08
|
|
Surgical pathology level 1 gross examination only
|
$111.20 |
$111.20 |
$111.20 |
$81.00
|
|
Surgical pathology level 2 gross & microscopic examination
|
$185.60 |
$185.60 |
$185.60 |
$143.55
|
|
Surgical pathology level 3 gross & microscopic examination
|
$248.00 |
$248.00 |
$248.00 |
$184.21
|
|
Surgical pathology level 4 gross & microscopic examination
|
$323.20 |
$323.20 |
$323.20 |
$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
|
|
Swallowing Evaluation (Bedside)
|
$304.80 |
$304.80 |
$304.80 |
$316.80
|
|
Swallowing Therapy Session
|
$193.60 |
$193.60 |
$193.60 |
$232.56
|
|
Synvisc or synvisc-one
|
$713.03 |
$713.03 |
$713.03 |
$1,242.63
|
|
Tacrolimus 1 mg capsule, immediate-release
|
$4.79 |
$4.79 |
$4.79 |
$9.93
|
|
Tailbone (Sacrum and Coccyx) X-ray
|
$283.20 |
$283.20 |
$283.20 |
$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
|
|
Telehealth original site facility fee
|
$48.80 |
$48.80 |
$48.80 |
$51.00
|
|
Telethx isodose plan cplx
|
$6,175.20 |
$6,175.20 |
$6,175.20 |
$1,526.85
|
|
Telethx isodose plan simple
|
$3,511.20 |
$3,511.20 |
$3,511.20 |
$880.61
|
|
Temsirolimus 30 mg/3 ml (10 mg/ml) (first dilution) intravenous soln
|
$4,840.60 |
$4,840.60 |
$4,840.60 |
$3,723.60
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$12,376.10 |
$12,376.10 |
$12,376.10 |
$14,951.87
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$61.18 |
$61.18 |
$61.18 |
$39.33
|
|
Test stress cardiovascular tracing only
|
$1,184.00 |
$1,184.00 |
$1,184.00 |
$953.40
|
|
Tetanus immune globulin inj
|
$899.08 |
$899.08 |
$899.08 |
$1,285.36
|
|
Therapy Activity Training (each 15 minutes)
|
$117.04 |
$117.04 |
$117.04 |
$101.38
|
|
Therapy Exercise Session (each 15 minutes)
|
$124.32 |
$124.32 |
$124.32 |
$98.58
|
|
Therapy nutrition individual initial f2f w/patient each 15 minutes
|
$48.80 |
$48.80 |
$48.80 |
$57.50
|
|
Therapy nutrition individual reassessment/intervention f2f w/patient each 15 minutes
|
$40.00 |
$40.00 |
$40.00 |
$50.40
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$67.38 |
$67.38 |
$67.38 |
$25.54
|
|
Thigh Bone (Femur) X-ray (both sides)
|
$321.60 |
$321.60 |
$321.60 |
$313.60
|
|
Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides)
|
$1,392.00 |
$1,392.00 |
$1,392.00 |
$1,724.25
|
|
Three-Phase Bone Scan (Nuclear Medicine)
|
$2,059.20 |
$2,059.20 |
$2,059.20 |
$1,703.45
|
|
Thyroid imaging
|
$928.80 |
$928.80 |
$928.80 |
$695.60
|
