|
Sodium ferric gluconate complex in sucrose 62.5 mg/5 ml intravenous
|
$147.60 |
$147.60 |
$147.60 |
$80.73
|
|
Sodium serum/plasma/whole blood
|
$47.80 |
$47.80 |
$47.80 |
$46.26
|
|
Specific gravity body fluid
|
$52.00 |
$52.00 |
$52.00 |
$22.00
|
|
Speech and Language Evaluation (comprehensive)
|
$375.20 |
$375.20 |
$375.20 |
$385.00
|
|
Speech evaluation complex
|
$1,175.20 |
$1,175.20 |
$1,175.20 |
$527.06
|
|
Speech Therapy Session (one-on-one)
|
$217.60 |
$217.60 |
$217.60 |
$248.30
|
|
Spinal puncture lumbar diagnostic w/fluoroscopic or CT guidance
|
$1,644.80 |
$1,644.80 |
$1,644.80 |
$1,457.50
|
|
Spine X-ray (single view, one level)
|
$374.40 |
$374.40 |
$374.40 |
$251.00
|
|
Splint dorsal bloc wh med perf 3.2mm lf polyflex ii
|
$656.00 |
$656.00 |
$656.00 |
$388.80
|
|
Splint extn xsm w sof-stretch rolyan
|
$130.40 |
$130.40 |
$130.40 |
$71.44
|
|
Splint fing stax assort 1-7in
|
$24.80 |
$24.80 |
$24.80 |
$5.60
|
|
Splint func pos polyflex ii med
|
$169.60 |
$169.60 |
$169.60 |
$61.64
|
|
Splint rstrc wrst/cmc right med
|
$148.00 |
$148.00 |
$148.00 |
$99.04
|
|
Sr-89 stront chlor ther / mci
|
$2,773.60 |
$2,773.60 |
$2,773.60 |
$2,515.15
|
|
St analysis behavior qualitative voice/resonance
|
$375.20 |
$375.20 |
$375.20 |
$297.60
|
|
St cognitve performance testing healthcare professional each hour
|
$474.40 |
$474.40 |
$474.40 |
$286.00
|
|
Stent axios caut enh 15x10mm electrocaut
|
$11,702.40 |
$11,702.40 |
$11,702.40 |
$32,403.15
|
|
Stent bili dbl pgtl 10fx5cm
|
$577.60 |
$577.60 |
$577.60 |
$2,649.79
|
|
Stent bili rx wallflx 10x80 uncvr
|
$7,876.80 |
$7,876.80 |
$7,876.80 |
$20,962.50
|
|
Sterile gauze <= 16 sq in
|
$1.80 |
$1.80 |
$1.80 |
$1.52
|
|
Sterile needle
|
$476.80 |
$476.80 |
$476.80 |
$190.13
|
|
Sterile water/saline, 10 ml
|
$51.20 |
$51.20 |
$51.20 |
$13.32
|
|
Sterile water/saline, 500 ml
|
$3.60 |
$3.60 |
$3.60 |
$28.11
|
|
St evaluate speech sound production
|
$375.20 |
$375.20 |
$375.20 |
$292.95
|
|
St evaluation motion fluoroscopic swallow function cine/video
|
$301.60 |
$301.60 |
$301.60 |
$400.00
|
|
Stomach Emptying Scan (Nuclear Medicine)
|
$1,826.40 |
$1,826.40 |
$1,826.40 |
$1,342.00
|
|
Strapping of ankle and/or ft 29540
|
$315.60 |
$315.60 |
$315.60 |
$223.45
|
|
Strapping of elbow or wrist 29260
|
$569.60 |
$569.60 |
$569.60 |
$157.46
|
|
Strapping of knee
|
$295.20 |
$295.20 |
$295.20 |
$205.20
|
|
Strapping of toes 29550
|
$28.20 |
$28.20 |
$28.20 |
$164.70
|
|
Strep a ag ia
|
$92.80 |
$92.80 |
$92.80 |
$75.40
|
|
Strep b dna amp probe
|
$129.60 |
$129.60 |
$129.60 |
$122.43
|
|
Stress test pulmonary
|
$789.60 |
$789.60 |
$789.60 |
$324.00
|
|
Stress tte complete
|
$2,406.40 |
$2,406.40 |
$2,406.40 |
$1,894.20
|
|
Succinylcholine chloride 20 mg/ml injection solution (wrapper)
|
$69.60 |
$69.60 |
$69.60 |
$54.80
|
|
Sulbactam 1 gram-durlobactam 1 gram (0.5 gram x2) intravenous solution
|
$208.00 |
$208.00 |
$208.00 |
$7,345.98
|
|
Sulfamethoxazole 400 mg-trimethoprim 80 mg/5 ml intravenous solution
|
$0.40 |
$0.40 |
$0.40 |
$82.46
|
|
Sumatriptan 6 mg/0.5 ml subcutaneous solution
|
$148.00 |
$148.00 |
$148.00 |
$126.63
|
|
Supp non-insulin inf cath/wk
|
$66.60 |
$66.60 |
$66.60 |
$8.45
|
|
Support clav 29.6-40.5in med
|
$218.40 |
$218.40 |
$218.40 |
$94.08
|
|
Surgical pathology level 1 gross examination only
|
$58.20 |
$58.20 |
$58.20 |
$81.00
|
|
Surgical pathology level 2 gross & microscopic examination
|
$228.80 |
$228.80 |
$228.80 |
$142.20
|
|
Surgical pathology level 3 gross & microscopic examination
|
$256.80 |
$256.80 |
$256.80 |
$182.25
|
|
Surgical pathology level 4 gross & microscopic examination
|
$302.40 |
$302.40 |
$302.40 |
$248.00
|
|
Surgical pathology level 5 gross & microscopic examination
|
$493.60 |
$493.60 |
$493.60 |
$480.60
|
|
Surgical pathology level 6 gross & microscopic examination
|
$748.80 |
$748.80 |
$748.80 |
$720.75
|
|
Susceptibility agar dilution per agent
|
$111.20 |
$111.20 |
$111.20 |
$45.45
|
|
Susceptibility enzyme detection per enzyme
|
$20.40 |
$20.40 |
$20.40 |
$35.75
|
|
Susceptibility mic per plate
|
$224.80 |
$224.80 |
$224.80 |
$105.75
|
|
Suscept studies macrobroth dilution ea
|
$104.80 |
$104.80 |
$104.80 |
$59.28
|
|
Swallowing Evaluation (Bedside)
|
$301.60 |
$301.60 |
$301.60 |
$316.55
|
|
Swallowing Therapy Session
|
$216.80 |
$216.80 |
$216.80 |
$240.31
|
|
Synvisc or synvisc-one
|
$72.00 |
$72.00 |
$72.00 |
$1,242.63
|
|
Syphilis test non-treponemal antibody quantitative rpr
|
$92.80 |
$92.80 |
$92.80 |
$41.60
|
|
System pcmkr dual chamber leadless micra av2 intrdcr cath
|
$8,429.60 |
$8,429.60 |
$8,429.60 |
$12,003.00
|
|
T3 (triiodothyronine) free
|
$166.40 |
$166.40 |
$166.40 |
$100.32
|
|
T3 (triiodothyronine) total
|
$268.80 |
$268.80 |
$268.80 |
$93.52
|
|
T4 (thyroxine) free
|
$362.40 |
$362.40 |
$362.40 |
$88.44
|
|
T4 (thyroxine) total
|
$100.00 |
$100.00 |
$100.00 |
$69.58
|
|
Tacrol envarsus ex rel oral
|
$3.40 |
$3.40 |
$3.40 |
$15.60
|
|
Tacrolimus 1 mg capsule, immediate-release
|
$27.60 |
$27.60 |
$27.60 |
$9.93
|
|
Tacrolimus 5 mg/ml intravenous solution
|
$1,588.00 |
$1,588.00 |
$1,588.00 |
$596.76
|
|
Tacrolimus therapeutic drug level
|
$333.60 |
$333.60 |
$333.60 |
$122.50
|
|
Tailbone (Sacrum and Coccyx) X-ray
|
$468.80 |
$468.80 |
$468.80 |
$289.90
|
|
Tamoxifen 10 mg tabs 60 each bottle
|
$14.80 |
$14.80 |
$14.80 |
$14.62
|
|
Target gsa panel hmtlmph neop
|
$3,743.20 |
$3,743.20 |
$3,743.20 |
$2,246.30
|
|
Target gsa panel organ/hmtlmph neop
|
$5,631.60 |
$5,631.60 |
$5,631.60 |
$3,746.70
|
|
Tb test cell mediated immunity antigen response enumeration gamma interferon t-cells
|
$797.40 |
$797.40 |
$797.40 |
$200.00
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$252.80 |
$252.80 |
$252.80 |
$180.80
|
|
Tc-99m apcitide diag
|
$2,130.40 |
$2,130.40 |
$2,130.40 |
$1,181.70
|
|
Tc-99m arcitumomab
|
$3,364.00 |
$3,364.00 |
$3,364.00 |
$2,085.68
|
|
Tc-99m bicisate
|
$844.00 |
$844.00 |
$844.00 |
$2,070.00
|
|
Tc-99m depreotide
|
$252.80 |
$252.80 |
$252.80 |
$1,486.80
|
|
Tc-99m disofenin
|
$72.40 |
$72.40 |
$72.40 |
$124.32
|
|
Tc-99m exametazime diag
|
$867.20 |
$867.20 |
$867.20 |
$2,135.70
|
|
Tc-99m fanolesomab diag
|
$4,710.40 |
$4,710.40 |
$4,710.40 |
$2,115.12
|
|
Tc-99m labeled rbc
|
$177.60 |
$177.60 |
$177.60 |
$306.00
|
|
Tc-99m maa
|
$161.60 |
$161.60 |
$161.60 |
$312.06
|
|
Tc-99m mebrofenin
|
$353.60 |
$353.60 |
$353.60 |
$157.65
|
|
Tc-99m medronate
|
$47.80 |
$47.80 |
$47.80 |
$111.01
|
|
Tc-99m mertiatide
|
$857.60 |
$857.60 |
$857.60 |
$756.00
|
|
Tc-99m non-heu per study dose
|
$20.00 |
$20.00 |
$20.00 |
$6.50
|
|
Tc-99m oxidronate
|
$54.20 |
$54.20 |
$54.20 |
$108.00
|
|
Tc-99m pentetate dtpa
|
$67.40 |
$67.40 |
$67.40 |
$222.60
|
|
Tc-99m pentetate dtpa aerosol
|
$236.80 |
$236.80 |
$236.80 |
$191.50
|
|
Tc-99m pertechnetate per mci
|
$72.40 |
$72.40 |
$72.40 |
$18.67
|
|
Tc-99m pyroph diag per dose up to 25 mci
|
$152.00 |
$152.00 |
$152.00 |
$141.00
|
|
Tc-99m sestamibi p study dose
|
$287.20 |
$287.20 |
$287.20 |
$287.20
|
|
Tc-99m succimer (dmsa)
|
$672.80 |
$672.80 |
$672.80 |
$1,128.40
|
|
Tc-99m sulfur colloid
|
$191.20 |
$191.20 |
$191.20 |
$245.70
|
|
Tc-99m tetrofosmin p study dose
|
$617.60 |
$617.60 |
$617.60 |
$193.28
|
|
T cells absolute cd4/cd8 including ratio
|
$136.00 |
$136.00 |
$136.00 |
$185.28
|
|
T cells absolute cd 4 count
|
$174.40 |
$174.40 |
$174.40 |
$111.20
|
|
T cells total count
|
$136.00 |
$136.00 |
$136.00 |
$130.35
|
|
Telehealth original site facility fee
|
$120.00 |
$120.00 |
$120.00 |
$51.00
|
|
Temsirolimus 30 mg/3 ml (10 mg/ml) (first dilution) intravenous soln
|
$8,196.60 |
$8,196.60 |
$8,196.60 |
$3,723.60
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$27,148.20 |
$27,148.20 |
$27,148.20 |
$14,951.87
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$111.20 |
$111.20 |
$111.20 |
$39.33
|
|
Testicular imaging w/vasc flow
|
$1,443.20 |
$1,443.20 |
$1,443.20 |
$842.56
|
|
Test stress cardiovascular tracing only
|
$1,957.60 |
$1,957.60 |
$1,957.60 |
$953.40
|
