|
Splint finger fold over sm
|
$84.00 |
$84.00 |
$84.00 |
|
|
Splint finger frog med
|
$54.40 |
$54.40 |
$54.40 |
|
|
Splint func pos polyflex ii med
|
$76.00 |
$76.00 |
$100.00 |
|
|
Splint rstrc wrst/cmc right med
|
$110.40 |
$110.40 |
$110.40 |
|
|
Split atogrft f/s/n/h/f/g/m/d gt 1st 100sqcm/</1 %
|
$5,808.00 |
$5,808.00 |
$5,808.00 |
|
|
Splt agrft f/s/n/h/f/g/m ea
|
$2,579.20 |
$2,579.20 |
$2,579.20 |
|
|
Srs linear based
|
$26,032.00 |
$26,032.00 |
$26,032.00 |
|
|
St analysis behavior qualitative voice/resonance
|
$248.00 |
$354.40 |
$395.20 |
|
|
St cognitve performance testing healthcare professional each hour
|
$280.00 |
$310.40 |
$376.00 |
|
|
Stent axios caut enh 15x10mm electrocaut
|
$1,150.40 |
$10,120.00 |
$33,222.40 |
|
|
Stent bili dbl pgtl 10fx5cm
|
$1,413.48 |
$1,413.48 |
$13,986.40 |
|
|
Stent bili rx wallflx 10x80 uncvr
|
$5,070.40 |
$5,070.40 |
$32,201.60 |
|
|
Stent bronch dumon sil 10x40mm
|
$3,600.00 |
$3,600.00 |
$11,432.80 |
|
|
Stent placemt retro carotid
|
$8,369.60 |
$8,369.60 |
$8,369.60 |
|
|
Sterile water/saline, 10 ml
|
$3.40 |
$3.60 |
$4.80 |
|
|
Sterile water/saline, 500 ml
|
$1.40 |
$1.40 |
$80.00 |
|
|
St evaluate speech sound production
|
$331.20 |
$346.40 |
$387.20 |
|
|
St evaluation motion fluoroscopic swallow function cine/video
|
$406.40 |
$496.00 |
$560.00 |
|
|
Stomach Emptying Scan (Nuclear Medicine)
|
$1,629.60 |
$1,813.60 |
$2,326.40 |
|
|
Strapping of ankle and/or ft 29540
|
$161.60 |
$164.80 |
$235.20 |
|
|
Strapping of chest
|
$168.00 |
$168.00 |
$168.00 |
|
|
Strapping of elbow or wrist 29260
|
$188.00 |
$188.00 |
$188.00 |
|
|
Strapping of hand or finger
|
$132.00 |
$163.20 |
$280.80 |
|
|
Strapping of hip
|
$189.60 |
$189.60 |
$189.60 |
|
|
Strapping of knee
|
$178.40 |
$181.60 |
$224.80 |
|
|
Strapping of toes 29550
|
$127.20 |
$129.60 |
$198.40 |
|
|
Strep b dna amp probe
|
$163.20 |
$163.20 |
$163.20 |
|
|
Streptomycin injection
|
$316.63 |
$316.63 |
$316.63 |
|
|
Stress test pulmonary
|
$241.60 |
$325.60 |
$413.60 |
|
|
Succinylcholine chloride 20 mg/ml injection solution (wrapper)
|
$63.72 |
$67.99 |
$325.56 |
|
|
Suction lipectomy trunk
|
$5,507.20 |
$5,507.20 |
$5,507.20 |
|
|
Sulbactam 1 gram-durlobactam 1 gram (0.5 gram x2) intravenous solution
|
$3,404.20 |
$3,404.20 |
$35,842.28 |
|
|
Sulfamethoxazole 400 mg-trimethoprim 80 mg/5 ml intravenous solution
|
$317.06 |
$317.06 |
$317.06 |
|
|
Sulfonylurea screen qn-sendout
|
$104.00 |
$104.00 |
$104.00 |
|
|
Sumatriptan 6 mg/0.5 ml subcutaneous solution
|
$64.46 |
$68.93 |
$323.76 |
|
|
Support clav 29.6-40.5in med
|
$22.40 |
$24.80 |
$110.40 |
|
|
Supprelin la implant
|
$58,640.85 |
$58,640.85 |
$58,640.85 |
|
|
Surgical pathology level 1 gross examination only
|
$32.80 |
$36.00 |
$96.80 |
|
|
Surgical pathology level 2 gross & microscopic examination
|
$77.60 |
$85.60 |
$149.60 |
|
|
Surgical pathology level 3 gross & microscopic examination
|
$104.00 |
$111.20 |
$212.00 |
|
|
Surgical pathology level 4 gross & microscopic examination
|
$107.20 |
$119.20 |
$269.60 |
|
|
Surgical pathology level 5 gross & microscopic examination
|
$555.20 |
$588.00 |
$700.80 |
|
|
Surgical pathology level 6 gross & microscopic examination
|
$740.80 |
$963.20 |
$1,336.00 |
|
|
Susceptibility agar dilution per agent
|
$29.60 |
$38.40 |
$84.00 |
|
|
Susceptibility enzyme detection per enzyme
|
$27.20 |
$40.80 |
$87.20 |
|
|
Susceptibility mic per plate
|
$72.80 |
$110.40 |
$158.40 |
|
|
Svc venogram s&i
|
$2,807.20 |
$2,807.20 |
$2,840.80 |
|
|
Swallowing Evaluation (Bedside)
|
$316.80 |
$378.40 |
$409.60 |
|
|
Swallowing Therapy Session
|
$244.00 |
$279.20 |
$338.40 |
|
|
Synvisc or synvisc-one
|
$997.20 |
$997.20 |
$1,264.28 |
|
|
Syphilis test non-treponemal antibody quantitative rpr
|
$11.20 |
$11.20 |
$12.00 |
|
|
System cardiomems hosp electronics
|
$41,400.00 |
$41,400.00 |
$41,400.00 |
|
|
System pacing micra av
|
$6,241.60 |
$6,241.60 |
$29,269.60 |
|
|
System pcmkr dual chamber leadless micra av2 intrdcr cath
|
$20,289.60 |
$20,289.60 |
$20,348.00 |
|
|
System recell skin grafting/harvesting
|
$15,000.00 |
$15,000.00 |
$15,000.00 |
|
|
System sealant biosentry tract
|
$2,352.80 |
$2,352.80 |
$2,352.80 |
|
|
T3 (triiodothyronine) free
|
$99.20 |
$132.00 |
$284.00 |
|
|
T3 (triiodothyronine) total
|
$68.80 |
$121.60 |
$166.40 |
|
|
T4 (thyroxine) free
|
$60.80 |
$66.40 |
$116.00 |
|
|
T4 (thyroxine) total
|
$28.80 |
$70.40 |
$92.80 |
|
|
Tacrol envarsus ex rel oral
|
$5.16 |
$5.16 |
$5.16 |
|
|
Tacrolimus 1 mg capsule, immediate-release
|
$1.20 |
$1.20 |
$15.57 |
|
|
Tacrolimus 5 mg/ml intravenous solution
|
$417.06 |
$417.06 |
$417.06 |
|
|
Tacrolimus therapeutic drug level
|
$101.60 |
$219.20 |
$315.20 |
|
|
Tailbone (Sacrum and Coccyx) X-ray
|
$248.00 |
$351.20 |
$440.80 |
|
|
Talimogene laherparepvec 10exp6 (1 million) pfu/ml susp for injection
|
$12,797.28 |
$12,797.28 |
$12,797.28 |
|
|
Tas congenital car anomal
|
$7,705.60 |
$7,705.60 |
$7,705.60 |
|
|
Tavr perq femoral
|
$24,583.20 |
$24,583.20 |
$24,583.20 |
|
|
Tbo-filgrastim 300 mcg/0.5 ml subcutaneous syringe
|
$418.87 |
$418.87 |
$418.87 |
|
|
Tb test cell mediated immunity antigen response enumeration gamma interferon t-cells
|
$274.40 |
$301.60 |
$305.60 |
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$140.80 |
$180.80 |
$214.40 |
|
|
Tc-99m bicisate
|
$3,134.40 |
$3,134.40 |
$3,134.40 |
|
|
Tc-99m exametazime diag
|
$3,443.20 |
$3,443.20 |
$3,443.20 |
|
|
Tc-99m labeled rbc
|
$428.00 |
$428.00 |
$428.00 |
|
|
Tc-99m maa
|
$936.80 |
$936.80 |
$936.80 |
|
|
Tc-99m mebrofenin
|
$178.40 |
$178.40 |
$178.40 |
|
|
Tc-99m medronate
|
$133.60 |
$133.60 |
$133.60 |
|
|
Tc-99m mertiatide
|
$756.00 |
$756.00 |
$756.00 |
|
|
Tc-99m oxidronate
|
$168.00 |
$168.00 |
$168.00 |
|
|
Tc-99m pentetate dtpa
|
$388.80 |
$388.80 |
$388.80 |
|
|
Tc-99m pentetate dtpa aerosol
|
$388.80 |
$388.80 |
$388.80 |
|
|
Tc-99m pertechnetate per mci
|
$108.00 |
$108.00 |
$108.00 |
|
|
Tc-99m pyroph diag per dose up to 25 mci
|
$186.40 |
$186.40 |
$186.40 |
|
|
Tc-99m sestamibi p study dose
|
$352.00 |
$352.00 |
$352.00 |
|
|
Tc-99m succimer (dmsa)
|
$5,364.80 |
$5,364.80 |
$5,364.80 |
|
|
Tc-99m sulfur colloid
|
$308.00 |
$308.00 |
$308.00 |
|
|
Tc-99m tetrofosmin p study dose
|
$120.00 |
$120.00 |
$120.00 |
|
|
Tc-99m tilmanocept diag
|
$1,171.20 |
$1,171.20 |
$1,171.20 |
|
|
T cells absolute cd4/cd8 including ratio
|
$131.20 |
$159.20 |
$201.60 |
|
|
T cells absolute cd 4 count
|
$88.80 |
$168.80 |
$204.00 |
|
|
T cells total count
|
$104.80 |
$159.20 |
$188.80 |
|
|
Teaec w/wo patch graft iliofemoral
|
$10,087.20 |
$10,087.20 |
$10,087.20 |
|
|
Team conf w/pat by hc prof
|
$118.40 |
$118.40 |
$118.40 |
|
|
Tee w or without fol w/cont,cong
|
$2,768.80 |
$2,768.80 |
$2,768.80 |
|
|
Tee w or without fol w/cont, mon
|
$2,383.20 |
$2,383.20 |
$2,383.20 |
|
|
Telavancin injection
|
$1,199.40 |
$1,199.40 |
$1,199.40 |
|
|
Telehealth original site facility fee
|
$44.00 |
$64.80 |
$68.00 |
|
|
Telethx isodose plan cplx
|
$6,175.20 |
$6,175.20 |
$6,175.20 |
|
|
Telethx isodose plan simple
|
$3,511.20 |
$3,511.20 |
$3,511.20 |
|
|
Temozolomide
|
$36.87 |
$36.87 |
$36.87 |
|
