|
Shoulder MRI (with contrast)
|
$645.50 |
$645.50 |
$645.50 |
$2,448.60
|
|
Shoulder MRI (without contrast)
|
$461.50 |
$461.50 |
$461.50 |
$2,065.05
|
|
Shoulder X-ray
|
$398.40 |
$398.40 |
$398.40 |
$339.50
|
|
Sickling rbc
|
$33.60 |
$33.60 |
$33.60 |
$57.92
|
|
Sincalide 5 mcg solution for injection
|
$631.60 |
$631.60 |
$631.60 |
$307.58
|
|
Sinus CT scan (with and without contrast)
|
$568.00 |
$568.00 |
$568.00 |
$1,790.00
|
|
Sinus CT scan (with contrast)
|
$494.00 |
$494.00 |
$494.00 |
$1,527.60
|
|
Sinus CT scan (without contrast)
|
$295.00 |
$295.00 |
$295.00 |
$1,292.04
|
|
Sinus/juglr venogram s&i
|
$6,960.00 |
$6,960.00 |
$6,960.00 |
$2,489.25
|
|
Sleep study unattended
|
$375.20 |
$375.20 |
$375.20 |
$580.87
|
|
Sleeve fing rolyan med
|
$309.60 |
$309.60 |
$309.60 |
$203.58
|
|
Sling arm deluxe w/pad xs
|
$26.40 |
$26.40 |
$26.40 |
$30.35
|
|
Smear fluorescent and/or acid fast stain
|
$22.40 |
$22.40 |
$22.40 |
$64.20
|
|
Smear gram stain
|
$16.80 |
$16.80 |
$16.80 |
$55.25
|
|
Smear nasal eosinophil
|
$24.00 |
$24.00 |
$24.00 |
$46.20
|
|
Smear special stain inclusion bodies/parasites
|
$29.60 |
$29.60 |
$29.60 |
$73.15
|
|
Sodium 24 hour urine
|
$20.80 |
$20.80 |
$20.80 |
$48.60
|
|
Sodium chloride 0.9 % intravenous solution
|
$37.20 |
$37.20 |
$37.20 |
$48.11
|
|
Sodium chloride 3 % ivpb
|
$78.80 |
$78.80 |
$78.80 |
$40.61
|
|
Sodium serum/plasma/whole blood
|
$25.60 |
$25.60 |
$25.60 |
$45.60
|
|
Special physics consult
|
$1,786.40 |
$1,786.40 |
$1,786.40 |
$725.00
|
|
Special radiation dosimetry
|
$1,407.20 |
$1,407.20 |
$1,407.20 |
$392.50
|
|
Special radiation treatment
|
$4,496.80 |
$4,496.80 |
$4,496.80 |
$1,986.00
|
|
Special teletx port plan
|
$2,329.60 |
$2,329.60 |
$2,329.60 |
$1,086.99
|
|
Spinal puncture lumbar diagnostic w/fluoroscopic or CT guidance
|
$1,209.60 |
$1,209.60 |
$1,209.60 |
$1,439.40
|
|
Spirometry bronchodilation responsiveness pre/post bronchodilator administration
|
$841.60 |
$841.60 |
$841.60 |
$543.26
|
|
Splint dorsal bloc wh med perf 3.2mm lf polyflex ii
|
$637.60 |
$637.60 |
$637.60 |
$392.09
|
|
Split blood or products
|
$653.60 |
$653.60 |
$653.60 |
$127.48
|
|
St analysis behavior qualitative voice/resonance
|
$412.80 |
$412.80 |
$412.80 |
$297.60
|
|
Staph a dna amp probe
|
$145.60 |
$145.60 |
$145.60 |
$125.00
|
|
St cognitve performance testing healthcare professional each hour
|
$401.60 |
$401.60 |
$401.60 |
$286.00
|
|
Stent iliac/open or perc/uni/init 37221
|
$22,448.00 |
$22,448.00 |
$22,448.00 |
$14,356.50
|
|
Stent iliac/open/perc/ea ad/ipsila 37223
|
$7,729.60 |
$7,729.60 |
$7,729.60 |
$9,008.54
|
|
Sterile water/saline, 10 ml
|
$38.20 |
$38.20 |
$38.20 |
$13.32
|
|
St evaluate speech sound production
|
$412.80 |
$412.80 |
$412.80 |
$292.95
|
|
St evaluate speech sound production comprehensive/expressive
|
$412.80 |
$412.80 |
$412.80 |
$377.00
|
|
St evaluation motion fluoroscopic swallow function cine/video
|
$750.40 |
$750.40 |
$750.40 |
$399.60
|
|
St evaluation swallow function
|
$446.40 |
$446.40 |
$446.40 |
$314.40
|
|
Strapping of ankle and/or ft 29540
|
$352.80 |
$352.80 |
$352.80 |
$223.45
|
|
Stress test pulmonary
|
$455.20 |
$455.20 |
$455.20 |
$322.85
|
|
St treatment speech individual
|
$412.80 |
$412.80 |
$412.80 |
$248.84
|
|
St treatment swallow dysfunction/oral
|
$296.80 |
$296.80 |
$296.80 |
$240.31
|
|
Sulfamethoxazole 400 mg-trimethoprim 80 mg/5 ml intravenous solution
|
$78.40 |
$78.40 |
$78.40 |
$82.43
|
|
Sumatriptan 6 mg/0.5 ml subcutaneous solution
|
$52.20 |
$52.20 |
$52.20 |
$114.88
|
|
Surgical pathology level 1 gross examination only
|
$104.00 |
$104.00 |
$104.00 |
$79.50
|
|
Surgical pathology level 2 gross & microscopic examination
|
$104.00 |
$104.00 |
$104.00 |
$141.94
|
|
Surgical pathology level 3 gross & microscopic examination
|
$208.80 |
$208.80 |
$208.80 |
$181.00
|
|
Surgical pathology level 4 gross & microscopic examination
|
$218.40 |
$218.40 |
$218.40 |
$239.85
|
|
Surgical pathology level 5 gross & microscopic examination
|
$1,124.00 |
$1,124.00 |
$1,124.00 |
$480.00
|
|
Surgical pathology level 6 gross & microscopic examination
|
$1,920.00 |
$1,920.00 |
$1,920.00 |
$718.00
|
|
Susceptibility enzyme detection per enzyme
|
$20.00 |
$20.00 |
$20.00 |
$35.70
|
|
Susceptibility mic per plate
|
$36.00 |
$36.00 |
$36.00 |
$106.00
|
|
Syphilis test non-treponemal antibody quantitative rpr
|
$18.40 |
$18.40 |
$18.40 |
$41.60
|
|
T3 (triiodothyronine) free
|
$70.40 |
$70.40 |
$70.40 |
$99.20
|
|
T3 (triiodothyronine) total
|
$59.20 |
$59.20 |
$59.20 |
$93.52
|
|
T4 (thyroxine) free
|
$35.00 |
$35.00 |
$35.00 |
$85.20
|
|
T4 (thyroxine) total
|
$28.00 |
$28.00 |
$28.00 |
$69.00
|
|
Tacrolimus 1 mg capsule, immediate-release
|
$9.20 |
$9.20 |
$9.20 |
$9.84
|
|
Tacrolimus therapeutic drug level
|
$50.00 |
$50.00 |
$50.00 |
$122.40
|
|
Target gsa panel hmtlmph neop
|
$3,160.00 |
$3,160.00 |
$3,160.00 |
$2,246.30
|
|
Target gsa panel organ/hmtlmph neop
|
$12,145.60 |
$12,145.60 |
$12,145.60 |
$3,746.70
|
|
Tbo-filgrastim 300 mcg/0.5 ml subcutaneous syringe
|
$727.20 |
$727.20 |
$727.20 |
$937.50
|
|
Tbp gene detc abnor alleles
|
$569.60 |
$569.60 |
$569.60 |
$225.42
|
|
Tbs techl calculation only
|
$398.40 |
$398.40 |
$398.40 |
$153.60
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$257.60 |
$257.60 |
$257.60 |
$177.65
|
|
Tc-99m labeled rbc
|
$941.60 |
$941.60 |
$941.60 |
$302.40
|
|
Tc-99m maa
|
$916.00 |
$916.00 |
$916.00 |
$292.80
|
|
Tc-99m mebrofenin
|
$677.60 |
$677.60 |
$677.60 |
$157.65
|
|
Tc-99m medronate
|
$203.20 |
$203.20 |
$203.20 |
$111.01
|
|
Tc-99m mertiatide
|
$2,139.20 |
$2,139.20 |
$2,139.20 |
$756.00
|
|
Tc-99m non-heu per study dose
|
$17.60 |
$17.60 |
$17.60 |
$6.60
|
|
Tc-99m oxidronate
|
$115.20 |
$115.20 |
$115.20 |
$105.60
|
|
Tc-99m pertechnetate per mci
|
$68.80 |
$68.80 |
$68.80 |
$22.10
|
|
Tc-99m pyroph diag per dose up to 25 mci
|
$294.40 |
$294.40 |
$294.40 |
$136.40
|
|
Tc-99m sestamibi p study dose
|
$788.80 |
$788.80 |
$788.80 |
$274.45
|
|
Tc-99m sulfur colloid
|
$874.40 |
$874.40 |
$874.40 |
$240.50
|
|
Tc-99m tetrofosmin p study dose
|
$747.20 |
$747.20 |
$747.20 |
$190.80
|
|
Tc-99m tilmanocept diag
|
$3,248.80 |
$3,248.80 |
$3,248.80 |
$955.60
|
|
T cells absolute cd4/cd8 including ratio
|
$195.20 |
$195.20 |
$195.20 |
$176.40
|
|
T cells absolute cd 4 count
|
$111.20 |
$111.20 |
$111.20 |
$111.20
|
|
T cells total count
|
$157.60 |
$157.60 |
$157.60 |
$126.90
|
|
Telehealth original site facility fee
|
$46.40 |
$46.40 |
$46.40 |
$51.00
|
|
Telethx isodose plan cplx
|
$2,877.60 |
$2,877.60 |
$2,877.60 |
$1,526.85
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$17,079.40 |
$17,079.40 |
$17,079.40 |
$15,245.38
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$18.40 |
$18.40 |
$18.40 |
$39.33
|
|
Test pathogen(s) for platelets reference
|
$238.40 |
$238.40 |
$238.40 |
$70.00
|
|
Test stress cardiovascular tracing only
|
$2,912.80 |
$2,912.80 |
$2,912.80 |
$949.70
|
|
Tetanus immune globulin inj
|
$3,259.80 |
$3,259.80 |
$3,259.80 |
$1,285.36
|
|
Tgsap so/hl 51/< rna alys
|
$12,145.60 |
$12,145.60 |
$12,145.60 |
$4,347.00
|
|
Theophylline therapeutic drug level
|
$59.20 |
$59.20 |
$59.20 |
$108.00
|
|
Therapeutic procd strg endur
|
$189.60 |
$189.60 |
$189.60 |
$85.68
|
|
Therapy nutrition individual initial f2f w/patient each 15 minutes
|
$39.20 |
$39.20 |
$39.20 |
$57.31
|
|
Therapy nutrition individual reassessment/intervention f2f w/patient each 15 minutes
|
$39.20 |
$39.20 |
$39.20 |
$50.00
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$40.40 |
$40.40 |
$40.40 |
$25.54
|
|
Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides)
|
$2,615.20 |
$2,615.20 |
$2,615.20 |
$1,687.50
|
|
Thrombectmy crnry perq mechanical
|
$586.40 |
$586.40 |
$586.40 |
$3,580.00
|
|
Thrombin time
|
$40.80 |
$40.80 |
$40.80 |
$53.76
|
|
Thromboplastin time partial (ptt) substitution fractions each
|
$26.40 |
$26.40 |
$26.40 |
$61.52
|
|
Thyroglobulin antibody
|
$66.40 |
$66.40 |
$66.40 |
$82.00
|
|
Thyroid mets imag whole body
|
$2,225.60 |
$2,225.60 |
$2,225.60 |
$1,524.99
|
