|
So airplane w/wo joint cf
|
$588.75 |
$588.75 |
$588.75 |
$1,276.80
|
|
So cap design without jnts cf
|
$190.20 |
$190.20 |
$190.20 |
$606.35
|
|
Sodium 24 hour urine
|
$8.70 |
$8.70 |
$8.70 |
$48.60
|
|
Sodium chloride 0.9 % intravenous solution
|
$7.26 |
$7.26 |
$7.26 |
$48.11
|
|
Sodium chloride 0.9 % IV bolus
|
$7.26 |
$7.26 |
$7.26 |
$46.00
|
|
Sodium chloride 0.9 % IV bolus
|
$7.26 |
$7.26 |
$7.26 |
$37.50
|
|
Sodium ferric gluconate complex in sucrose 62.5 mg/5 ml intravenous
|
$77.77 |
$77.77 |
$77.77 |
$77.77
|
|
Sodium serum/plasma/whole blood
|
$8.55 |
$8.55 |
$8.55 |
$45.60
|
|
Special physics consult
|
$175.05 |
$175.05 |
$175.05 |
$725.00
|
|
Special radiation dosimetry
|
$116.55 |
$116.55 |
$116.55 |
$392.50
|
|
Special radiation treatment
|
$560.40 |
$560.40 |
$560.40 |
$1,986.00
|
|
Special teletx port plan
|
$285.90 |
$285.90 |
$285.90 |
$1,086.99
|
|
Specific gravity body fluid
|
$4.20 |
$4.20 |
$4.20 |
$22.00
|
|
Spinal puncture lumbar diagnostic w/fluoroscopic or CT guidance
|
$310.05 |
$310.05 |
$310.05 |
$1,439.40
|
|
Spirometry bronchodilation responsiveness pre/post bronchodilator administration
|
$194.55 |
$194.55 |
$194.55 |
$543.26
|
|
Splint dorsal bloc wh med perf 3.2mm lf polyflex ii
|
$122.25 |
$122.25 |
$122.25 |
$392.09
|
|
Splint extn xsm w sof-stretch rolyan
|
$11.25 |
$11.25 |
$11.25 |
$68.25
|
|
Splint finger fold over sm
|
$98.70 |
$98.70 |
$98.70 |
$146.88
|
|
Splint finger frog med
|
$7.05 |
$7.05 |
$7.05 |
$38.08
|
|
Splint rstrc wrst/cmc right med
|
$18.45 |
$18.45 |
$18.45 |
$99.04
|
|
Split blood or products
|
$38.55 |
$38.55 |
$38.55 |
$127.48
|
|
Sputum specimen collection
|
$47.40 |
$47.40 |
$47.40 |
$180.00
|
|
Sr-89 stront chlor ther / mci
|
$529.65 |
$529.65 |
$529.65 |
$2,667.94
|
|
Srs linear based
|
$4,102.20 |
$4,102.20 |
$4,102.20 |
$13,585.00
|
|
Srs multisource
|
$3,100.20 |
$3,100.20 |
$3,100.20 |
$34,165.20
|
|
St analysis behavior qualitative voice/resonance
|
$92.55 |
$92.55 |
$92.55 |
$297.60
|
|
Staph a dna amp probe
|
$61.50 |
$61.50 |
$61.50 |
$125.00
|
|
St cognitve performance testing healthcare professional each hour
|
$46.05 |
$46.05 |
$46.05 |
$286.00
|
|
Stent/athrectomy/fem/pop/unilat 37227
|
$7,137.15 |
$7,137.15 |
$7,137.15 |
$21,626.50
|
|
Stent iliac/open or perc/uni/init 37221
|
$3,725.40 |
$3,725.40 |
$3,725.40 |
$14,356.50
|
|
Stent iliac/open/perc/ea ad/ipsila 37223
|
$2,004.00 |
$2,004.00 |
$2,004.00 |
$9,008.54
|
|
Stent/tib/peroneal/unilat/initial 37230
|
$4,533.30 |
$4,533.30 |
$4,533.30 |
$17,271.50
|
|
St evaluate speech sound production
|
$89.85 |
$89.85 |
$89.85 |
$292.95
|
|
St evaluate speech sound production comprehensive/expressive
|
$185.85 |
$185.85 |
$185.85 |
$377.00
|
|
St evaluation motion fluoroscopic swallow function cine/video
|
$83.70 |
$83.70 |
$83.70 |
$399.60
|
|
St evaluation swallow function
|
$82.20 |
$82.20 |
$82.20 |
$314.40
|
|
Stimulants synthetic
|
$21.60 |
$21.60 |
$21.60 |
$80.08
|
|
Strapping of ankle and/or ft 29540
|
$51.60 |
$51.60 |
$51.60 |
$223.45
|
|
Strapping of elbow or wrist 29260
|
$37.35 |
$37.35 |
$37.35 |
$154.70
|
|
Strapping of hand or finger
|
$56.70 |
$56.70 |
$56.70 |
$174.82
|
|
Strapping of knee
|
$56.85 |
$56.85 |
$56.85 |
$205.20
|
|
Strapping of toes 29550
|
$51.60 |
$51.60 |
$51.60 |
$164.70
|
|
Strep b assay w/optic
|
$20.10 |
$20.10 |
$20.10 |
$80.16
|
|
Strep b dna amp probe
|
$61.50 |
$61.50 |
$61.50 |
$120.90
|
|
Stress test pulmonary
|
$91.80 |
$91.80 |
$91.80 |
$322.85
|
|
Stress tte complete
|
$448.35 |
$448.35 |
$448.35 |
$1,870.50
|
|
St treatment speech individual
|
$77.40 |
$77.40 |
$77.40 |
$248.84
|
|
St treatment swallow dysfunction/oral
|
$84.00 |
$84.00 |
$84.00 |
$240.31
|
|
Succinylcholine chloride 20 mg/ml injection solution (wrapper)
|
$46.90 |
$46.90 |
$46.90 |
$52.31
|
|
Sugars multiple quant
|
$12.30 |
$12.30 |
$12.30 |
$44.19
|
|
Sulfonylurea screen qn-sendout
|
$18.75 |
$18.75 |
$18.75 |
$156.16
|
|
Sumatriptan 6 mg/0.5 ml subcutaneous solution
|
$54.87 |
$54.87 |
$54.87 |
$114.88
|
|
Surgical pathology level 1 gross examination only
|
$19.20 |
$19.20 |
$19.20 |
$79.50
|
|
Surgical pathology level 2 gross & microscopic examination
|
$39.60 |
$39.60 |
$39.60 |
$141.94
|
|
Surgical pathology level 3 gross & microscopic examination
|
$45.15 |
$45.15 |
$45.15 |
$181.00
|
|
Surgical pathology level 4 gross & microscopic examination
|
$75.45 |
$75.45 |
$75.45 |
$239.85
|
|
Surgical pathology level 5 gross & microscopic examination
|
$235.20 |
$235.20 |
$235.20 |
$480.00
|
|
Surgical pathology level 6 gross & microscopic examination
|
$333.45 |
$333.45 |
$333.45 |
$718.00
|
|
Susceptibility agar dilution per agent
|
$8.40 |
$8.40 |
$8.40 |
$45.45
|
|
Susceptibility enzyme detection per enzyme
|
$3.75 |
$3.75 |
$3.75 |
$35.70
|
|
Susceptibility mic per plate
|
$15.30 |
$15.30 |
$15.30 |
$106.00
|
|
Suscept studies macrobroth dilution ea
|
$7.20 |
$7.20 |
$7.20 |
$59.28
|
|
Svc venogram s&i
|
$429.15 |
$429.15 |
$429.15 |
$1,934.62
|
|
Sweat collection by iontophoresis
|
$23.40 |
$23.40 |
$23.40 |
$125.40
|
|
Syphilis test non-treponemal antibody quantitative rpr
|
$7.65 |
$7.65 |
$7.65 |
$41.60
|
|
T3 (triiodothyronine) free
|
$29.55 |
$29.55 |
$29.55 |
$99.20
|
|
T3 (triiodothyronine) total
|
$24.90 |
$24.90 |
$24.90 |
$93.52
|
|
T4 (thyroxine) free
|
$15.75 |
$15.75 |
$15.75 |
$85.20
|
|
T4 (thyroxine) total
|
$12.15 |
$12.15 |
$12.15 |
$69.00
|
|
Tacrolimus 1 mg capsule, immediate-release
|
$0.20 |
$0.20 |
$0.20 |
$9.84
|
|
Tacrolimus therapeutic drug level
|
$24.00 |
$24.00 |
$24.00 |
$122.40
|
|
Target gsa panel hmtlmph neop
|
$832.20 |
$832.20 |
$832.20 |
$2,246.30
|
|
Target gsa panel organ/hmtlmph neop
|
$3,746.70 |
$3,746.70 |
$3,746.70 |
$3,746.70
|
|
Target gsa panel organ neop
|
$373.65 |
$373.65 |
$373.65 |
$1,655.52
|
|
Tbp gene detc abnor alleles
|
$107.70 |
$107.70 |
$107.70 |
$225.42
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$108.45 |
$108.45 |
$108.45 |
$177.65
|
|
Tc-99m exame autol wbc diag per dose
|
$902.70 |
$902.70 |
$902.70 |
$2,435.36
|
|
Tc-99m exametazime diag
|
$512.70 |
$512.70 |
$512.70 |
$2,033.20
|
|
Tc-99m labeled rbc
|
$209.85 |
$209.85 |
$209.85 |
$302.40
|
|
Tc-99m maa
|
$34.50 |
$34.50 |
$34.50 |
$292.80
|
|
Tc-99m mebrofenin
|
$37.05 |
$37.05 |
$37.05 |
$157.65
|
|
Tc-99m medronate
|
$19.05 |
$19.05 |
$19.05 |
$111.01
|
|
Tc-99m mertiatide
|
$256.05 |
$256.05 |
$256.05 |
$756.00
|
|
Tc-99m oxidronate
|
$19.05 |
$19.05 |
$19.05 |
$105.60
|
|
Tc-99m pentetate dtpa
|
$46.05 |
$46.05 |
$46.05 |
$222.60
|
|
Tc-99m pertechnetate per mci
|
$3.75 |
$3.75 |
$3.75 |
$22.10
|
|
Tc-99m pyroph diag per dose up to 25 mci
|
$121.65 |
$121.65 |
$121.65 |
$136.40
|
|
Tc-99m sestamibi p study dose
|
$46.95 |
$46.95 |
$46.95 |
$274.45
|
|
Tc-99m succimer (dmsa)
|
$157.35 |
$157.35 |
$157.35 |
$1,128.40
|
|
Tc-99m sulfur colloid
|
$45.75 |
$45.75 |
$45.75 |
$240.50
|
|
Tc-99m tetrofosmin p study dose
|
$154.35 |
$154.35 |
$154.35 |
$190.80
|
|
Tc-99m tilmanocept diag
|
$168.30 |
$168.30 |
$168.30 |
$955.60
|
|
T cells absolute cd4/cd8 including ratio
|
$82.20 |
$82.20 |
$82.20 |
$176.40
|
|
T cells absolute cd 4 count
|
$46.80 |
$46.80 |
$46.80 |
$111.20
|
|
T cells total count
|
$66.00 |
$66.00 |
$66.00 |
$126.90
|
|
Telehealth original site facility fee
|
$22.95 |
$22.95 |
$22.95 |
$51.00
|
|
Telethx isodose plan cplx
|
$174.30 |
$174.30 |
$174.30 |
$1,526.85
|
|
Telethx isodose plan simple
|
$107.70 |
$107.70 |
$107.70 |
$873.62
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$7,446.87 |
$7,446.87 |
$7,446.87 |
$15,245.38
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$9.78 |
$9.78 |
$9.78 |
$39.33
|
