|
Sodium thiosulfate 12.5 gram/50 ml (250 mg/ml) intravenous solution
|
$188.50 |
$188.50 |
$188.50 |
$177.52
|
|
Somatosensory testing
|
$1,148.80 |
$1,148.80 |
$1,148.80 |
$816.00
|
|
So vest canvas/web pre ots
|
$273.60 |
$273.60 |
$273.60 |
$256.54
|
|
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)
|
$467.20 |
$467.20 |
$467.20 |
$385.00
|
|
Speech audiometry complete
|
$152.00 |
$152.00 |
$152.00 |
$109.20
|
|
Speech recep thresh
|
$107.20 |
$107.20 |
$107.20 |
$82.88
|
|
Speech Therapy Session (one-on-one)
|
$312.00 |
$312.00 |
$312.00 |
$248.30
|
|
Spinal puncture lumbar diagnostic w/fluoroscopic or CT guidance
|
$1,927.20 |
$1,927.20 |
$1,927.20 |
$1,457.50
|
|
Spine X-ray (single view, one level)
|
$388.80 |
$388.80 |
$388.80 |
$251.00
|
|
Spleen imaging
|
$2,154.40 |
$2,154.40 |
$2,154.40 |
$679.00
|
|
Splint dorsal bloc wh med perf 3.2mm lf polyflex ii
|
$498.40 |
$498.40 |
$498.40 |
$388.80
|
|
Splint extn xsm w sof-stretch rolyan
|
$83.20 |
$83.20 |
$83.20 |
$71.44
|
|
Splint finger fold over sm
|
$84.00 |
$84.00 |
$84.00 |
$146.88
|
|
Splint finger frog med
|
$54.40 |
$54.40 |
$54.40 |
$38.08
|
|
Splint func pos polyflex ii med
|
$76.00 |
$76.00 |
$76.00 |
$61.64
|
|
Splint rstrc wrst/cmc right med
|
$110.40 |
$110.40 |
$110.40 |
$99.04
|
|
Split atogrft f/s/n/h/f/g/m/d gt 1st 100sqcm/</1 %
|
$5,808.00 |
$5,808.00 |
$5,808.00 |
$4,689.60
|
|
Splt agrft f/s/n/h/f/g/m ea
|
$2,579.20 |
$2,579.20 |
$2,579.20 |
$1,612.78
|
|
Srs linear based
|
$26,032.00 |
$26,032.00 |
$26,032.00 |
$14,124.25
|
|
St analysis behavior qualitative voice/resonance
|
$395.20 |
$395.20 |
$395.20 |
$297.60
|
|
St cognitve performance testing healthcare professional each hour
|
$285.60 |
$285.60 |
$285.60 |
$286.00
|
|
Stent axios caut enh 15x10mm electrocaut
|
$33,222.40 |
$33,222.40 |
$33,222.40 |
$32,403.15
|
|
Stent bili dbl pgtl 10fx5cm
|
$13,986.40 |
$13,986.40 |
$13,986.40 |
$2,649.79
|
|
Stent bili rx wallflx 10x80 uncvr
|
$32,201.60 |
$32,201.60 |
$32,201.60 |
$20,962.50
|
|
Stent bronch dumon sil 10x40mm
|
$11,432.80 |
$11,432.80 |
$11,432.80 |
$4,631.82
|
|
Stent placemt retro carotid
|
$8,369.60 |
$8,369.60 |
$8,369.60 |
$5,328.00
|
|
St evaluate speech sound production
|
$387.20 |
$387.20 |
$387.20 |
$292.95
|
|
St evaluation motion fluoroscopic swallow function cine/video
|
$560.00 |
$560.00 |
$560.00 |
$400.00
|
|
Stomach Emptying Scan (Nuclear Medicine)
|
$2,326.40 |
$2,326.40 |
$2,326.40 |
$1,342.00
|
|
Strapping of ankle and/or ft 29540
|
$235.20 |
$235.20 |
$235.20 |
$223.45
|
|
Strapping of hand or finger
|
$280.80 |
$280.80 |
$280.80 |
$174.82
|
|
Strapping of knee
|
$224.80 |
$224.80 |
$224.80 |
$205.20
|
|
Strapping of toes 29550
|
$198.40 |
$198.40 |
$198.40 |
$164.70
|
|
Streptomycin injection
|
$316.63 |
$316.63 |
$316.63 |
$138.30
|
|
Stress test pulmonary
|
$327.20 |
$327.20 |
$327.20 |
$324.00
|
|
Succinylcholine chloride 20 mg/ml injection solution (wrapper)
|
$325.56 |
$325.56 |
$325.56 |
$54.80
|
|
Suction lipectomy trunk
|
$5,507.20 |
$5,507.20 |
$5,507.20 |
$4,385.50
|
|
Sulbactam 1 gram-durlobactam 1 gram (0.5 gram x2) intravenous solution
|
$35,842.28 |
$35,842.28 |
$35,842.28 |
$7,345.98
|
|
Sulfamethoxazole 400 mg-trimethoprim 80 mg/5 ml intravenous solution
|
$317.06 |
$317.06 |
$317.06 |
$82.46
|
|
Sumatriptan 6 mg/0.5 ml subcutaneous solution
|
$323.76 |
$323.76 |
$323.76 |
$126.63
|
|
Support clav 29.6-40.5in med
|
$110.40 |
$110.40 |
$110.40 |
$94.08
|
|
Supprelin la implant
|
$58,640.85 |
$58,640.85 |
$58,640.85 |
$80,935.72
|
|
Surgical pathology level 1 gross examination only
|
$34.40 |
$34.40 |
$34.40 |
$81.00
|
|
Surgical pathology level 2 gross & microscopic examination
|
$83.20 |
$83.20 |
$83.20 |
$142.20
|
|
Surgical pathology level 3 gross & microscopic examination
|
$111.20 |
$111.20 |
$111.20 |
$182.25
|
|
Surgical pathology level 4 gross & microscopic examination
|
$114.40 |
$114.40 |
$114.40 |
$248.00
|
|
Surgical pathology level 5 gross & microscopic examination
|
$700.80 |
$700.80 |
$700.80 |
$480.60
|
|
Surgical pathology level 6 gross & microscopic examination
|
$996.80 |
$996.80 |
$996.80 |
$720.75
|
|
Svc venogram s&i
|
$2,807.20 |
$2,807.20 |
$2,807.20 |
$1,994.00
|
|
Swallowing Evaluation (Bedside)
|
$380.00 |
$380.00 |
$380.00 |
$316.55
|
|
Swallowing Therapy Session
|
$279.20 |
$279.20 |
$279.20 |
$240.31
|
|
Synvisc or synvisc-one
|
$1,264.28 |
$1,264.28 |
$1,264.28 |
$1,242.63
|
|
System cardiomems hosp electronics
|
$41,400.00 |
$41,400.00 |
$41,400.00 |
$38,234.70
|
|
System pacing micra av
|
$29,269.60 |
$29,269.60 |
$29,269.60 |
$24,293.25
|
|
System pcmkr dual chamber leadless micra av2 intrdcr cath
|
$20,289.60 |
$20,289.60 |
$20,289.60 |
$12,003.00
|
|
System recell skin grafting/harvesting
|
$15,000.00 |
$15,000.00 |
$15,000.00 |
$11,183.00
|
|
System sealant biosentry tract
|
$2,352.80 |
$2,352.80 |
$2,352.80 |
$889.35
|
|
Tacrol envarsus ex rel oral
|
$5.16 |
$5.16 |
$5.16 |
$15.60
|
|
Tacrolimus 1 mg capsule, immediate-release
|
$15.57 |
$15.57 |
$15.57 |
$9.93
|
|
Tacrolimus 5 mg/ml intravenous solution
|
$417.06 |
$417.06 |
$417.06 |
$596.76
|
|
Tailbone (Sacrum and Coccyx) X-ray
|
$440.80 |
$440.80 |
$440.80 |
$289.90
|
|
Talimogene laherparepvec 10exp6 (1 million) pfu/ml susp for injection
|
$12,797.28 |
$12,797.28 |
$12,797.28 |
$1,223.36
|
|
Tas congenital car anomal
|
$7,705.60 |
$7,705.60 |
$7,705.60 |
$6,003.27
|
|
Tavr perq femoral
|
$24,583.20 |
$24,583.20 |
$24,583.20 |
$15,454.40
|
|
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 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
|
|
Teaec w/wo patch graft iliofemoral
|
$10,087.20 |
$10,087.20 |
$10,087.20 |
$6,120.00
|
|
Tee w or without fol w/cont,cong
|
$2,768.80 |
$2,768.80 |
$2,768.80 |
$2,101.65
|
|
Tee w or without fol w/cont, mon
|
$2,383.20 |
$2,383.20 |
$2,383.20 |
$1,692.44
|
|
Telavancin injection
|
$1,199.40 |
$1,199.40 |
$1,199.40 |
$1,191.80
|
|
Telehealth original site facility fee
|
$44.00 |
$44.00 |
$44.00 |
$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 |
$877.09
|
|
Temozolomide
|
$36.87 |
$36.87 |
$36.87 |
$540.06
|
|
Temsirolimus 30 mg/3 ml (10 mg/ml) (first dilution) intravenous soln
|
$3,710.78 |
$3,710.78 |
$3,710.78 |
$3,723.60
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$21,656.37 |
$21,656.37 |
$21,656.37 |
$14,951.87
|
|
Tenolysis extensor tendon hand/finger each
|
$3,210.40 |
$3,210.40 |
$3,210.40 |
$2,811.20
|
|
Tenosynovectomy radic 26145
|
$3,613.60 |
$3,613.60 |
$3,613.60 |
$1,893.86
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$312.38 |
$312.38 |
$312.38 |
$39.33
|
|
Testicular imaging w/vasc flow
|
$1,188.80 |
$1,188.80 |
$1,188.80 |
$842.56
|
|
Test pathogen(s) for platelets reference
|
$142.40 |
$142.40 |
$142.40 |
$70.00
|
|
Test stress cardiovascular tracing only
|
$1,515.20 |
$1,515.20 |
$1,515.20 |
$953.40
|
