|
Semen analysis presence/motility
|
$81.60 |
$81.60 |
$81.60 |
$70.40
|
|
Serial casting application 97139app
|
$255.20 |
$255.20 |
$255.20 |
$78.39
|
|
Shot (Injection into Muscle or Under the Skin)
|
$118.40 |
$118.40 |
$118.40 |
$136.20
|
|
Shoulder AC Joint X-ray (both sides)
|
$380.80 |
$380.80 |
$380.80 |
$270.20
|
|
Shoulder Blade (Scapula) X-ray (both sides)
|
$308.80 |
$308.80 |
$308.80 |
$286.89
|
|
Shoulder MRI (with and without contrast)
|
$3,925.60 |
$3,925.60 |
$3,925.60 |
$2,743.02
|
|
Shoulder MRI (with contrast)
|
$3,516.00 |
$3,516.00 |
$3,516.00 |
$2,476.20
|
|
Shoulder MRI (without contrast)
|
$2,931.20 |
$2,931.20 |
$2,931.20 |
$2,096.84
|
|
Shoulder X-ray
|
$382.40 |
$382.40 |
$382.40 |
$340.10
|
|
Shoulder X-ray (single view, both shoulders)
|
$316.00 |
$316.00 |
$316.00 |
$263.25
|
|
Sickling rbc
|
$80.80 |
$80.80 |
$80.80 |
$59.40
|
|
Sinus CT scan (with and without contrast)
|
$3,063.20 |
$3,063.20 |
$3,063.20 |
$1,796.30
|
|
Sinus CT scan (with contrast)
|
$2,598.40 |
$2,598.40 |
$2,598.40 |
$1,527.60
|
|
Sinus CT scan (without contrast)
|
$2,034.40 |
$2,034.40 |
$2,034.40 |
$1,289.00
|
|
Sinus X-ray (complete)
|
$525.60 |
$525.60 |
$525.60 |
$346.45
|
|
Sinus X-ray (limited)
|
$364.80 |
$364.80 |
$364.80 |
$215.40
|
|
Skull X-ray (1 to 3 views)
|
$417.60 |
$417.60 |
$417.60 |
$294.45
|
|
Skull X-ray (complete)
|
$618.40 |
$618.40 |
$618.40 |
$417.50
|
|
Sleep Study (Polysomnography)
|
$4,370.40 |
$4,370.40 |
$4,370.40 |
$3,734.50
|
|
Sleep study unattended
|
$740.00 |
$740.00 |
$740.00 |
$594.00
|
|
Slp eval non-spch gen comm dev
|
$388.00 |
$388.00 |
$388.00 |
$285.09
|
|
Slp ther svc non-spch gen
|
$307.20 |
$307.20 |
$307.20 |
$188.50
|
|
Small Bowel Barium X-ray (Follow-Through)
|
$836.00 |
$836.00 |
$836.00 |
$557.70
|
|
Smear fluorescent and/or acid fast stain
|
$52.00 |
$52.00 |
$52.00 |
$64.35
|
|
Smear gram stain
|
$38.40 |
$38.40 |
$38.40 |
$55.55
|
|
Smear nasal eosinophil
|
$43.20 |
$43.20 |
$43.20 |
$46.20
|
|
Smear special stain inclusion bodies/parasites
|
$78.40 |
$78.40 |
$78.40 |
$73.50
|
|
Smear wet mount
|
$60.00 |
$60.00 |
$60.00 |
$67.55
|
|
Sodium 24 hour urine
|
$36.80 |
$36.80 |
$36.80 |
$48.98
|
|
Sodium chloride 0.9 % intravenous solution
|
$40.00 |
$40.00 |
$40.00 |
$49.07
|
|
Sodium chloride 0.9 % IV bolus
|
$40.00 |
$40.00 |
$40.00 |
$45.62
|
|
Sodium chloride 0.9 % IV bolus
|
$48.00 |
$48.00 |
$48.00 |
$37.64
|
|
Sodium serum/plasma/whole blood
|
$58.40 |
$58.40 |
$58.40 |
$46.26
|
|
Specimen fat stain
|
$44.80 |
$44.80 |
$44.80 |
$37.40
|
|
Speech and Language Evaluation (comprehensive)
|
$506.40 |
$506.40 |
$506.40 |
$384.80
|
|
Speech Therapy Session (one-on-one)
|
$311.20 |
$311.20 |
$311.20 |
$246.87
|
|
Spine X-ray (single view, one level)
|
$380.80 |
$380.80 |
$380.80 |
$251.00
|
|
Spleen imaging
|
$986.40 |
$986.40 |
$986.40 |
$679.00
|
|
St cognitve performance testing healthcare professional each hour
|
$376.00 |
$376.00 |
$376.00 |
$286.00
|
|
Sterile water/saline, 10 ml
|
$4.80 |
$4.80 |
$4.80 |
$13.32
|
|
St evaluate speech sound production
|
$353.60 |
$353.60 |
$353.60 |
$292.95
|
|
St evaluation motion fluoroscopic swallow function cine/video
|
$530.40 |
$530.40 |
$530.40 |
$400.00
|
|
Stomach Emptying Scan (Nuclear Medicine)
|
$1,882.40 |
$1,882.40 |
$1,882.40 |
$1,345.40
|
|
Strapping of ankle and/or ft 29540
|
$164.80 |
$164.80 |
$164.80 |
$223.45
|
|
Strapping of hand or finger
|
$132.00 |
$132.00 |
$132.00 |
$177.45
|
|
Strapping of knee
|
$181.60 |
$181.60 |
$181.60 |
$205.20
|
|
Strapping of toes 29550
|
$129.60 |
$129.60 |
$129.60 |
$164.70
|
|
Stress test pulmonary
|
$409.60 |
$409.60 |
$409.60 |
$324.00
|
|
Succinylcholine chloride 20 mg/ml injection solution (wrapper)
|
$63.72 |
$63.72 |
$63.72 |
$54.80
|
|
Sumatriptan 6 mg/0.5 ml subcutaneous solution
|
$68.93 |
$68.93 |
$68.93 |
$129.89
|
|
Support clav 29.6-40.5in med
|
$22.40 |
$22.40 |
$22.40 |
$94.08
|
|
Surgical pathology level 1 gross examination only
|
$44.80 |
$44.80 |
$44.80 |
$81.00
|
|
Surgical pathology level 2 gross & microscopic examination
|
$90.40 |
$90.40 |
$90.40 |
$143.55
|
|
Surgical pathology level 3 gross & microscopic examination
|
$108.80 |
$108.80 |
$108.80 |
$184.21
|
|
Surgical pathology level 4 gross & microscopic examination
|
$123.20 |
$123.20 |
$123.20 |
$250.20
|
|
Surgical pathology level 5 gross & microscopic examination
|
$588.00 |
$588.00 |
$588.00 |
$480.60
|
|
Surgical pathology level 6 gross & microscopic examination
|
$829.60 |
$829.60 |
$829.60 |
$720.75
|
|
Susceptibility agar dilution per agent
|
$38.40 |
$38.40 |
$38.40 |
$45.60
|
|
Susceptibility enzyme detection per enzyme
|
$40.80 |
$40.80 |
$40.80 |
$35.89
|
|
Susceptibility mic per plate
|
$72.80 |
$72.80 |
$72.80 |
$106.00
|
|
Swallowing Evaluation (Bedside)
|
$393.60 |
$393.60 |
$393.60 |
$316.80
|
|
Swallowing Therapy Session
|
$338.40 |
$338.40 |
$338.40 |
$232.56
|
|
T3 (triiodothyronine) free
|
$284.00 |
$284.00 |
$284.00 |
$100.32
|
|
T3 (triiodothyronine) total
|
$121.60 |
$121.60 |
$121.60 |
$93.52
|
|
T4 (thyroxine) free
|
$101.60 |
$101.60 |
$101.60 |
$89.60
|
|
T4 (thyroxine) total
|
$92.80 |
$92.80 |
$92.80 |
$70.20
|
|
Tacrolimus therapeutic drug level
|
$265.60 |
$265.60 |
$265.60 |
$122.50
|
|
Tailbone (Sacrum and Coccyx) X-ray
|
$390.40 |
$390.40 |
$390.40 |
$289.20
|
|
Tb test cell mediated immunity antigen response enumeration gamma interferon t-cells
|
$274.40 |
$274.40 |
$274.40 |
$200.00
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$192.80 |
$192.80 |
$192.80 |
$179.95
|
|
Tc-99m labeled rbc
|
$428.00 |
$428.00 |
$428.00 |
$306.00
|
|
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 sestamibi p study dose
|
$352.00 |
$352.00 |
$352.00 |
$287.20
|
|
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
|
|
T cells absolute cd4/cd8 including ratio
|
$159.20 |
$159.20 |
$159.20 |
$184.00
|
|
T cells absolute cd 4 count
|
$190.40 |
$190.40 |
$190.40 |
$111.20
|
|
T cells total count
|
$159.20 |
$159.20 |
$159.20 |
$130.20
|
|
Telehealth original site facility fee
|
$64.80 |
$64.80 |
$64.80 |
$51.00
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$12,366.50 |
$12,366.50 |
$12,366.50 |
$14,951.87
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$63.11 |
$63.11 |
$63.11 |
$39.33
|
|
Testicular imaging w/vasc flow
|
$1,587.20 |
$1,587.20 |
$1,587.20 |
$842.56
|
|
Test stress cardiovascular tracing only
|
$1,078.40 |
$1,078.40 |
$1,078.40 |
$953.40
|
|
Theophylline therapeutic drug level
|
$88.00 |
$88.00 |
$88.00 |
$108.00
|
|
Therapeutic procd strg endur
|
$128.80 |
$128.80 |
$128.80 |
$85.68
|
|
Therapy Activity Training (each 15 minutes)
|
$138.40 |
$138.40 |
$138.40 |
$101.38
|
|
Therapy Exercise Session (each 15 minutes)
|
$121.60 |
$121.60 |
$121.60 |
$98.58
|
|
Therapy nutrition individual initial f2f w/patient each 15 minutes
|
$56.80 |
$56.80 |
$56.80 |
$57.50
|
|
Therapy nutrition individual reassessment/intervention f2f w/patient each 15 minutes
|
$58.40 |
$58.40 |
$58.40 |
$50.40
|
|
Ther/proph/diag inj ia
|
$176.00 |
$176.00 |
$176.00 |
$247.33
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$63.05 |
$63.05 |
$63.05 |
$25.54
|
|
Thigh Bone (Femur) X-ray (both sides)
|
$355.20 |
$355.20 |
$355.20 |
$313.60
|
|
Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides)
|
$1,148.80 |
$1,148.80 |
$1,148.80 |
$1,724.25
|
|
Three-Phase Bone Scan (Nuclear Medicine)
|
$2,248.80 |
$2,248.80 |
$2,248.80 |
$1,703.45
|
|
Thromboplastin time partial (ptt) substitution fractions each
|
$105.60 |
$105.60 |
$105.60 |
$62.01
|
|
Thyroglobulin antibody
|
$85.60 |
$85.60 |
$85.60 |
$82.50
|
|
Thyroid imaging
|
$1,083.20 |
$1,083.20 |
$1,083.20 |
$695.60
|
