|
Sperm antibody test
|
$75.00 |
$75.00 |
$75.00 |
$57.85
|
|
Sphenoid sinus surgery
|
$1,141.80 |
$1,141.80 |
$1,141.80 |
$6,547.81
|
|
Spinal bone allograftstructural 20931
|
$202.80 |
$202.80 |
$202.80 |
$266.40
|
|
Spinal bone autograftlocal 20936
|
$234.00 |
$234.00 |
$234.00 |
$424.20
|
|
Spinal puncture lumbar diagnostic w/fluoroscopic or CT guidance
|
$126.00 |
$126.00 |
$126.00 |
$1,457.50
|
|
Spine X-ray (single view, one level)
|
$142.80 |
$142.80 |
$142.80 |
$251.00
|
|
Splint dorsal bloc wh med perf 3.2mm lf polyflex ii
|
$465.60 |
$465.60 |
$465.60 |
$388.80
|
|
Splint fing stax assort 1-7in
|
$15.00 |
$15.00 |
$15.00 |
$5.60
|
|
Splint rstrc wrst/cmc right med
|
$346.20 |
$346.20 |
$346.20 |
$99.04
|
|
Split atogrft f/s/n/h/f/g/m/d gt 1st 100sqcm/</1 %
|
$1,369.20 |
$1,369.20 |
$1,369.20 |
$4,689.60
|
|
Sputum specimen collection
|
$65.40 |
$65.40 |
$65.40 |
$180.00
|
|
St analysis behavior qualitative voice/resonance
|
$354.60 |
$354.60 |
$354.60 |
$297.60
|
|
Stent axios caut enh 15x10mm electrocaut
|
$3,393.00 |
$3,393.00 |
$3,393.00 |
$32,403.15
|
|
Stent bili dbl pgtl 10fx5cm
|
$75.60 |
$75.60 |
$75.60 |
$2,649.79
|
|
Stent bili rx wallflx 10x80 uncvr
|
$1,333.20 |
$1,333.20 |
$1,333.20 |
$20,962.50
|
|
St evaluate speech sound production
|
$354.60 |
$354.60 |
$354.60 |
$292.95
|
|
St evaluation motion fluoroscopic swallow function cine/video
|
$418.80 |
$418.80 |
$418.80 |
$400.00
|
|
Stomach Emptying Scan (Nuclear Medicine)
|
$1,176.60 |
$1,176.60 |
$1,176.60 |
$1,342.00
|
|
Strapping of ankle and/or ft 29540
|
$307.80 |
$307.80 |
$307.80 |
$223.45
|
|
Strapping of chest
|
$225.00 |
$225.00 |
$225.00 |
$194.46
|
|
Strapping of elbow or wrist 29260
|
$220.20 |
$220.20 |
$220.20 |
$157.46
|
|
Strapping of hand or finger
|
$220.20 |
$220.20 |
$220.20 |
$174.82
|
|
Strapping of hip
|
$59.40 |
$59.40 |
$59.40 |
$164.70
|
|
Strapping of knee
|
$307.80 |
$307.80 |
$307.80 |
$205.20
|
|
Strapping of toes 29550
|
$307.80 |
$307.80 |
$307.80 |
$164.70
|
|
Strep a ag ia
|
$43.20 |
$43.20 |
$43.20 |
$75.40
|
|
Strep b dna amp probe
|
$124.20 |
$124.20 |
$124.20 |
$122.43
|
|
Stress test pulmonary
|
$40.20 |
$40.20 |
$40.20 |
$324.00
|
|
Stress tte complete
|
$916.80 |
$916.80 |
$916.80 |
$1,894.20
|
|
Subtalar arthro w/deb
|
$1,253.40 |
$1,253.40 |
$1,253.40 |
$3,839.54
|
|
Subtalar arthro w/exc
|
$1,069.80 |
$1,069.80 |
$1,069.80 |
$7,907.11
|
|
Succinylcholine chloride 20 mg/ml injection solution (wrapper)
|
$24.00 |
$24.00 |
$24.00 |
$54.80
|
|
Sulbactam 1 gram-durlobactam 1 gram (0.5 gram x2) intravenous solution
|
$5,718.60 |
$5,718.60 |
$5,718.60 |
$7,345.98
|
|
Sumatriptan 6 mg/0.5 ml subcutaneous solution
|
$253.20 |
$253.20 |
$253.20 |
$126.63
|
|
Support clav 29.6-40.5in med
|
$108.00 |
$108.00 |
$108.00 |
$94.08
|
|
Surg dx exam anorectal
|
$150.00 |
$150.00 |
$150.00 |
$3,480.50
|
|
Surgical pathology level 1 gross examination only
|
$52.80 |
$52.80 |
$52.80 |
$81.00
|
|
Surgical pathology level 2 gross & microscopic examination
|
$110.40 |
$110.40 |
$110.40 |
$142.20
|
|
Surgical pathology level 3 gross & microscopic examination
|
$132.60 |
$132.60 |
$132.60 |
$182.25
|
|
Surgical pathology level 4 gross & microscopic examination
|
$169.20 |
$169.20 |
$169.20 |
$248.00
|
|
Surgical pathology level 5 gross & microscopic examination
|
$572.40 |
$572.40 |
$572.40 |
$480.60
|
|
Surgical pathology level 6 gross & microscopic examination
|
$811.20 |
$811.20 |
$811.20 |
$720.75
|
|
Surg tx anal fistula 2nd stage 46285
|
$720.00 |
$720.00 |
$720.00 |
$3,245.23
|
|
Susceptibility mic per plate
|
$61.20 |
$61.20 |
$61.20 |
$105.75
|
|
Swallowing Evaluation (Bedside)
|
$418.80 |
$418.80 |
$418.80 |
$316.55
|
|
Swallowing Therapy Session
|
$272.40 |
$272.40 |
$272.40 |
$240.31
|
|
Sweat collection by iontophoresis
|
$90.00 |
$90.00 |
$90.00 |
$123.78
|
|
Synch audio-only est high 40
|
$149.40 |
$149.40 |
$149.40 |
$190.77
|
|
Synch audio-only est low 20
|
$69.00 |
$69.00 |
$69.00 |
$90.60
|
|
Synch audio-only est mod 30
|
$102.00 |
$102.00 |
$102.00 |
$136.64
|
|
Synch audio-only est sf 10
|
$37.80 |
$37.80 |
$37.80 |
$53.20
|
|
Synch audio-only new high 60
|
$183.60 |
$183.60 |
$183.60 |
$207.64
|
|
Synch audio-only new low 30
|
$89.40 |
$89.40 |
$89.40 |
$117.00
|
|
Synch audio-only new mod 45
|
$140.40 |
$140.40 |
$140.40 |
$166.70
|
|
Synch audio-only new sf 15
|
$51.60 |
$51.60 |
$51.60 |
$67.80
|
|
Synvisc or synvisc-one
|
$29.40 |
$29.40 |
$29.40 |
$1,242.63
|
|
System pacing micra av
|
$3,982.20 |
$3,982.20 |
$3,982.20 |
$24,293.25
|
|
System pcmkr dual chamber leadless micra av2 intrdcr cath
|
$6,752.40 |
$6,752.40 |
$6,752.40 |
$12,003.00
|
|
T3 (triiodothyronine) free
|
$177.60 |
$177.60 |
$177.60 |
$100.32
|
|
T3 (triiodothyronine) total
|
$102.60 |
$102.60 |
$102.60 |
$93.52
|
|
T4 (thyroxine) free
|
$64.20 |
$64.20 |
$64.20 |
$88.44
|
|
T4 (thyroxine) total
|
$49.80 |
$49.80 |
$49.80 |
$69.58
|
|
Tacrolimus 1 mg capsule, immediate-release
|
$4.20 |
$4.20 |
$4.20 |
$9.93
|
|
Tacrolimus therapeutic drug level
|
$175.80 |
$175.80 |
$175.80 |
$122.50
|
|
Tafasitamab-cxix 200 mg intravenous solution
|
$3,475.80 |
$3,475.80 |
$3,475.80 |
$2,762.00
|
|
Tailbone (Sacrum and Coccyx) X-ray
|
$160.80 |
$160.80 |
$160.80 |
$289.90
|
|
Target gsa panel hmtlmph neop
|
$3,256.20 |
$3,256.20 |
$3,256.20 |
$2,246.30
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$280.80 |
$280.80 |
$280.80 |
$180.80
|
|
Tc-99m exametazime diag
|
$1,335.00 |
$1,335.00 |
$1,335.00 |
$2,135.70
|
|
Tc-99m labeled rbc
|
$271.20 |
$271.20 |
$271.20 |
$306.00
|
|
Tc-99m maa
|
$61.20 |
$61.20 |
$61.20 |
$312.06
|
|
Tc-99m mebrofenin
|
$250.80 |
$250.80 |
$250.80 |
$157.65
|
|
Tc-99m medronate
|
$159.00 |
$159.00 |
$159.00 |
$111.01
|
|
Tc-99m mertiatide
|
$587.40 |
$587.40 |
$587.40 |
$756.00
|
|
Tc-99m pentetate dtpa
|
$61.20 |
$61.20 |
$61.20 |
$222.60
|
|
Tc-99m pentetate dtpa aerosol
|
$61.20 |
$61.20 |
$61.20 |
$191.50
|
|
Tc-99m pertechnetate per mci
|
$63.00 |
$63.00 |
$63.00 |
$18.67
|
|
Tc-99m pyroph diag per dose up to 25 mci
|
$118.80 |
$118.80 |
$118.80 |
$141.00
|
|
Tc-99m sestamibi p study dose
|
$528.00 |
$528.00 |
$528.00 |
$287.20
|
|
Tc-99m sulfur colloid
|
$373.80 |
$373.80 |
$373.80 |
$245.70
|
|
Tc-99m tetrofosmin p study dose
|
$103.80 |
$103.80 |
$103.80 |
$193.28
|
|
T cells absolute cd4/cd8 including ratio
|
$207.60 |
$207.60 |
$207.60 |
$185.28
|
|
T cells absolute cd 4 count
|
$111.60 |
$111.60 |
$111.60 |
$111.20
|
|
T cells total count
|
$331.20 |
$331.20 |
$331.20 |
$130.35
|
|
Telehealth original site facility fee
|
$97.80 |
$97.80 |
$97.80 |
$51.00
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$4,500.60 |
$4,500.60 |
$4,500.60 |
$14,951.87
|
|
Tenodesis biceps tdn at elbw
|
$1,089.60 |
$1,089.60 |
$1,089.60 |
$6,653.00
|
|
Tenolysis extensor tendon hand/finger each
|
$1,179.00 |
$1,179.00 |
$1,179.00 |
$2,811.20
|
|
Tenotomy length/rls abductor hallucis musc 28240
|
$551.40 |
$551.40 |
$551.40 |
$3,545.97
|
|
Tenotomy open tndn flxr toe sgl tndn spx
|
$486.60 |
$486.60 |
$486.60 |
$2,175.00
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$40.80 |
$40.80 |
$40.80 |
$39.33
|
|
Testicular imaging w/vasc flow
|
$703.80 |
$703.80 |
$703.80 |
$842.56
|
|
Test stress cardiovascular tracing only
|
$609.00 |
$609.00 |
$609.00 |
$953.40
|
|
Test urine urobilinogen
|
$29.40 |
$29.40 |
$29.40 |
$9.75
|
|
Tetanus immune globulin inj
|
$706.20 |
$706.20 |
$706.20 |
$1,285.36
|
|
Theophylline therapeutic drug level
|
$97.80 |
$97.80 |
$97.80 |
$108.00
|
|
Therapeutic procd strg endur
|
$45.00 |
$45.00 |
$45.00 |
$85.68
|
|
Therapy Activity Training (each 15 minutes)
|
$81.00 |
$81.00 |
$81.00 |
$101.85
|
|
Therapy Exercise Session (each 15 minutes)
|
$76.80 |
$76.80 |
$76.80 |
$98.58
|
|
Therapy nutrition individual initial f2f w/patient each 15 minutes
|
$109.20 |
$109.20 |
$109.20 |
$57.50
|
