|
Sodium chloride 3 % ivpb
|
$3.60 |
$3.60 |
$3.60 |
$40.61
|
|
Speech and Language Evaluation (comprehensive)
|
$431.20 |
$431.20 |
$431.20 |
$384.80
|
|
Speech Therapy Session (one-on-one)
|
$314.40 |
$314.40 |
$314.40 |
$246.87
|
|
Spinal puncture lumbar diagnostic w/fluoroscopic or CT guidance
|
$1,949.60 |
$1,949.60 |
$1,949.60 |
$1,439.40
|
|
Spine X-ray (single view, one level)
|
$344.00 |
$344.00 |
$344.00 |
$251.00
|
|
Spleen imaging
|
$1,690.40 |
$1,690.40 |
$1,690.40 |
$679.00
|
|
Splint dorsal bloc wh med perf 3.2mm lf polyflex ii
|
$186.40 |
$186.40 |
$186.40 |
$388.80
|
|
Splint func pos polyflex ii med
|
$100.00 |
$100.00 |
$100.00 |
$61.64
|
|
St analysis behavior qualitative voice/resonance
|
$359.20 |
$359.20 |
$359.20 |
$297.60
|
|
St cognitve performance testing healthcare professional each hour
|
$310.40 |
$310.40 |
$310.40 |
$286.00
|
|
Stent axios caut enh 15x10mm electrocaut
|
$10,120.00 |
$10,120.00 |
$10,120.00 |
$32,403.15
|
|
Stent bili dbl pgtl 10fx5cm
|
$1,413.48 |
$1,413.48 |
$1,413.48 |
$2,704.27
|
|
Stent bili rx wallflx 10x80 uncvr
|
$5,070.40 |
$5,070.40 |
$5,070.40 |
$20,962.50
|
|
Stent bronch dumon sil 10x40mm
|
$3,600.00 |
$3,600.00 |
$3,600.00 |
$4,631.82
|
|
Sterile water/saline, 10 ml
|
$3.60 |
$3.60 |
$3.60 |
$13.32
|
|
Sterile water/saline, 500 ml
|
$80.00 |
$80.00 |
$80.00 |
$28.11
|
|
St evaluate speech sound production
|
$341.60 |
$341.60 |
$341.60 |
$292.95
|
|
St evaluation motion fluoroscopic swallow function cine/video
|
$428.00 |
$428.00 |
$428.00 |
$400.00
|
|
Stomach Emptying Scan (Nuclear Medicine)
|
$1,813.60 |
$1,813.60 |
$1,813.60 |
$1,345.40
|
|
Strapping of ankle and/or ft 29540
|
$171.20 |
$171.20 |
$171.20 |
$223.45
|
|
Strapping of hand or finger
|
$137.60 |
$137.60 |
$137.60 |
$177.45
|
|
Strapping of knee
|
$188.00 |
$188.00 |
$188.00 |
$205.20
|
|
Strapping of toes 29550
|
$135.20 |
$135.20 |
$135.20 |
$164.70
|
|
Stress test pulmonary
|
$241.60 |
$241.60 |
$241.60 |
$324.00
|
|
Sulbactam 1 gram-durlobactam 1 gram (0.5 gram x2) intravenous solution
|
$3,404.20 |
$3,404.20 |
$3,404.20 |
$7,487.55
|
|
Support clav 29.6-40.5in med
|
$24.80 |
$24.80 |
$24.80 |
$94.08
|
|
Surgical pathology level 1 gross examination only
|
$96.80 |
$96.80 |
$96.80 |
$81.00
|
|
Surgical pathology level 2 gross & microscopic examination
|
$96.80 |
$96.80 |
$96.80 |
$143.55
|
|
Surgical pathology level 3 gross & microscopic examination
|
$192.00 |
$192.00 |
$192.00 |
$184.21
|
|
Surgical pathology level 4 gross & microscopic examination
|
$269.60 |
$269.60 |
$269.60 |
$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
|
|
Svc venogram s&i
|
$2,840.80 |
$2,840.80 |
$2,840.80 |
$1,990.95
|
|
Swallowing Evaluation (Bedside)
|
$409.60 |
$409.60 |
$409.60 |
$316.80
|
|
Swallowing Therapy Session
|
$258.40 |
$258.40 |
$258.40 |
$232.56
|
|
System pacing micra av
|
$6,241.60 |
$6,241.60 |
$6,241.60 |
$24,316.50
|
|
System pcmkr dual chamber leadless micra av2 intrdcr cath
|
$20,348.00 |
$20,348.00 |
$20,348.00 |
$12,003.00
|
|
Tailbone (Sacrum and Coccyx) X-ray
|
$345.60 |
$345.60 |
$345.60 |
$289.20
|
|
Tc-99m bicisate
|
$3,134.40 |
$3,134.40 |
$3,134.40 |
$2,070.00
|
|
Tc-99m exametazime diag
|
$3,443.20 |
$3,443.20 |
$3,443.20 |
$2,135.70
|
|
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 pyroph diag per dose up to 25 mci
|
$186.40 |
$186.40 |
$186.40 |
$141.00
|
|
Tc-99m sestamibi p study dose
|
$352.00 |
$352.00 |
$352.00 |
$287.20
|
|
Tc-99m succimer (dmsa)
|
$5,364.80 |
$5,364.80 |
$5,364.80 |
$1,128.40
|
|
Tc-99m sulfur colloid
|
$308.00 |
$308.00 |
$308.00 |
$245.70
|
|
Tc-99m tetrofosmin p study dose
|
$120.00 |
$120.00 |
$120.00 |
$193.28
|
|
Tc-99m tilmanocept diag
|
$1,171.20 |
$1,171.20 |
$1,171.20 |
$985.60
|
|
Team conf w/pat by hc prof
|
$118.40 |
$118.40 |
$118.40 |
$107.10
|
|
Telehealth original site facility fee
|
$68.00 |
$68.00 |
$68.00 |
$51.00
|
|
Testicular imaging w/vasc flow
|
$1,096.00 |
$1,096.00 |
$1,096.00 |
$842.56
|
|
Test stress cardiovascular tracing only
|
$1,092.00 |
$1,092.00 |
$1,092.00 |
$953.40
|
|
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)
|
$125.60 |
$125.60 |
$125.60 |
$98.58
|
|
Therapy nutrition individual initial f2f w/patient each 15 minutes
|
$46.40 |
$46.40 |
$46.40 |
$57.50
|
|
Therapy nutrition individual reassessment/intervention f2f w/patient each 15 minutes
|
$46.40 |
$46.40 |
$46.40 |
$50.40
|
|
Ther/proph/diag inj ia
|
$173.60 |
$173.60 |
$173.60 |
$247.33
|
|
Thigh Bone (Femur) X-ray (both sides)
|
$255.20 |
$255.20 |
$255.20 |
$313.60
|
|
Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides)
|
$2,495.20 |
$2,495.20 |
$2,495.20 |
$1,724.25
|
|
Three-Phase Bone Scan (Nuclear Medicine)
|
$2,036.00 |
$2,036.00 |
$2,036.00 |
$1,703.45
|
|
Thrombectmy crnry perq mechanical
|
$4,721.60 |
$4,721.60 |
$4,721.60 |
$3,809.40
|
|
Thrombectomy/inf pq dialysis circuit
|
$12,631.20 |
$12,631.20 |
$12,631.20 |
$8,084.00
|
|
Thrombectomy/inf pq dialysis circuit w/pta
|
$25,091.20 |
$25,091.20 |
$25,091.20 |
$14,277.20
|
|
Thrombectomy/inf pq dialysis circuit w/stent plcmnt
|
$39,336.80 |
$39,336.80 |
$39,336.80 |
$21,413.60
|
|
Thyroid imaging
|
$1,032.00 |
$1,032.00 |
$1,032.00 |
$695.60
|
|
Thyroid mets imag whole body
|
$2,220.80 |
$2,220.80 |
$2,220.80 |
$1,524.99
|
|
Thyroid met uptake
|
$602.40 |
$602.40 |
$602.40 |
$407.40
|
|
Thyroid Ultrasound
|
$741.60 |
$741.60 |
$741.60 |
$588.50
|
|
Thyroid uptake measurement
|
$860.00 |
$860.00 |
$860.00 |
$591.25
|
|
Tilt table study
|
$2,017.60 |
$2,017.60 |
$2,017.60 |
$1,561.82
|
|
Tl-201 thallium diag per mci
|
$78.40 |
$78.40 |
$78.40 |
$80.10
|
|
Toe X-ray (both feet)
|
$273.60 |
$273.60 |
$273.60 |
$258.65
|
|
Tomosynthesis breast screen bilateral
|
$87.20 |
$87.20 |
$87.20 |
$74.10
|
|
Training self management diabetes individual outpatient department per 30 minutes
|
$105.60 |
$105.60 |
$105.60 |
$102.27
|
|
Transcatheter bx s&i
|
$3,017.60 |
$3,017.60 |
$3,017.60 |
$1,950.85
|
|
Transcath occlusion cns
|
$12,474.40 |
$12,474.40 |
$12,474.40 |
$7,337.20
|
|
Transcath occlusion non-cns
|
$6,179.20 |
$6,179.20 |
$6,179.20 |
$10,270.00
|
|
Transvaginal Pelvic Ultrasound (not pregnancy)
|
$743.20 |
$743.20 |
$743.20 |
$561.60
|
|
Transvaginal Pregnancy Ultrasound
|
$615.20 |
$615.20 |
$615.20 |
$499.20
|
|
Trauma partial team response w/critical care services level 4
|
$3,112.80 |
$3,112.80 |
$3,112.80 |
$4,523.04
|
|
Tray bonemarrw oncontrol 102mm
|
$1,493.60 |
$1,493.60 |
$1,493.60 |
$940.80
|
|
Treat clavicle dislocation 23545
|
$459.20 |
$459.20 |
$459.20 |
$692.80
|
|
Treat elbow fracture
|
$1,018.40 |
$1,018.40 |
$1,018.40 |
$2,026.50
|
|
Treat finger fracture each
|
$940.00 |
$940.00 |
$940.00 |
$1,592.00
|
|
Treat foot dislocation
|
$249.60 |
$249.60 |
$249.60 |
$405.60
|
|
Treat foot dislocation
|
$249.60 |
$249.60 |
$249.60 |
$534.05
|
|
Treat foot dislocation
|
$362.40 |
$362.40 |
$362.40 |
$445.80
|
|
Treat fracture of radius
|
$1,039.20 |
$1,039.20 |
$1,039.20 |
$1,790.00
|
|
Treat fracture of radius
|
$1,025.60 |
$1,025.60 |
$1,025.60 |
$1,849.00
|
|
Treat fracture of ulna
|
$1,832.80 |
$1,832.80 |
$1,832.80 |
$731.04
|
|
Treat humerus fracture
|
$1,174.40 |
$1,174.40 |
$1,174.40 |
$1,790.00
|
|
Treat knee dislocation
|
$2,976.80 |
$2,976.80 |
$2,976.80 |
$2,220.89
|
