|
Sinus CT scan (with contrast)
|
$880.90 |
$880.90 |
$880.90 |
$1,519.50
|
|
Sinus CT scan (without contrast)
|
$667.19 |
$667.19 |
$667.19 |
$1,279.50
|
|
Sinus/juglr venogram s&i
|
$612.72 |
$612.72 |
$612.72 |
$2,489.25
|
|
Sirolimus, oral
|
$2,170.16 |
$2,170.16 |
$2,170.16 |
$42.11
|
|
Skin Biopsy
|
$258.41 |
$258.41 |
$258.41 |
$382.80
|
|
Sleep Study (Polysomnography)
|
$2,195.14 |
$2,195.14 |
$2,195.14 |
$3,936.80
|
|
Sleep study unattended
|
$254.56 |
$254.56 |
$254.56 |
$595.50
|
|
Slp stdy unatnd w/anal
|
$63.64 |
$63.64 |
$63.64 |
$307.50
|
|
Small bowel endoscopy
|
$1,788.14 |
$1,788.14 |
$1,788.14 |
$2,244.82
|
|
Smallpox&monkeypox vac 0.5ml
|
$0.08 |
$0.08 |
$0.08 |
$318.64
|
|
Smear fluorescent and/or acid fast stain
|
$93.54 |
$93.54 |
$93.54 |
$64.20
|
|
Smear gram stain
|
$55.65 |
$55.65 |
$55.65 |
$57.85
|
|
Smear nasal eosinophil
|
$30.49 |
$30.49 |
$30.49 |
$49.50
|
|
Smear special stain inclusion bodies/parasites
|
$8.00 |
$8.00 |
$8.00 |
$64.35
|
|
Smear wet mount
|
$67.49 |
$67.49 |
$67.49 |
$68.63
|
|
Sodium 24 hour urine
|
$13.03 |
$13.03 |
$13.03 |
$48.50
|
|
Sodium chloride 0.9 % intravenous solution
|
$6.22 |
$6.22 |
$6.22 |
$46.43
|
|
Sodium chloride 0.9 % IV bolus
|
$6.16 |
$6.16 |
$6.16 |
$47.27
|
|
Sodium chloride 0.9 % IV bolus
|
$5.45 |
$5.45 |
$5.45 |
$43.78
|
|
Sodium chloride 3 % ivpb
|
$7.77 |
$7.77 |
$7.77 |
$48.11
|
|
Sodium ferric gluconate complex in sucrose 62.5 mg/5 ml intravenous
|
$52.95 |
$52.95 |
$52.95 |
$84.80
|
|
Sodium serum/plasma/whole blood
|
$8.29 |
$8.29 |
$8.29 |
$42.70
|
|
Sodium thiosulfate 12.5 gram/50 ml (250 mg/ml) intravenous solution
|
$127.08 |
$127.08 |
$127.08 |
$195.48
|
|
Special physics consult
|
$228.52 |
$228.52 |
$228.52 |
$700.74
|
|
Special radiation dosimetry
|
$249.83 |
$249.83 |
$249.83 |
$445.50
|
|
Special radiation treatment
|
$358.76 |
$358.76 |
$358.76 |
$1,934.03
|
|
Special teletx port plan
|
$759.54 |
$759.54 |
$759.54 |
$1,046.65
|
|
Specific gravity body fluid
|
$16.28 |
$16.28 |
$16.28 |
$23.63
|
|
Specimen fat stain
|
$58.91 |
$58.91 |
$58.91 |
$32.76
|
|
Sperm antibody test
|
$53.88 |
$53.88 |
$53.88 |
$56.44
|
|
Spinal puncture lumbar diagnostic w/fluoroscopic or CT guidance
|
$742.08 |
$742.08 |
$742.08 |
$1,502.08
|
|
Spirometry bronchodilation responsiveness pre/post bronchodilator administration
|
$293.64 |
$293.64 |
$293.64 |
$559.96
|
|
Srs linear based
|
$4,013.47 |
$4,013.47 |
$4,013.47 |
$14,124.25
|
|
St analysis behavior qualitative voice/resonance
|
$84.36 |
$84.36 |
$84.36 |
$300.00
|
|
Staph a dna amp probe
|
$41.44 |
$41.44 |
$41.44 |
$116.39
|
|
Stent/athrectomy/fem/pop/unilat 37227
|
$15,942.86 |
$15,942.86 |
$15,942.86 |
$23,387.00
|
|
Stent axios caut enh 15x10mm electrocaut
|
$2,399.97 |
$2,399.97 |
$2,399.97 |
$32,403.15
|
|
Stent bili dbl pgtl 10fx5cm
|
$238.28 |
$238.28 |
$238.28 |
$1,322.36
|
|
Stent bili rx wallflx 10x80 uncvr
|
$1,112.96 |
$1,112.96 |
$1,112.96 |
$18,714.49
|
|
Stent iliac/open or perc/uni/init 37221
|
$17,114.13 |
$17,114.13 |
$17,114.13 |
$17,281.80
|
|
Stent iliac/open/perc/ea ad/ipsila 37223
|
$4,563.73 |
$4,563.73 |
$4,563.73 |
$9,276.80
|
|
Stent placemt retro carotid
|
$1,452.77 |
$1,452.77 |
$1,452.77 |
$9,313.36
|
|
Stent/tib/peroneal/unilat/initial 37230
|
$5,484.29 |
$5,484.29 |
$5,484.29 |
$19,765.20
|
|
St evaluate speech sound production
|
$76.37 |
$76.37 |
$76.37 |
$300.00
|
|
St evaluate speech sound production comprehensive/expressive
|
$144.16 |
$144.16 |
$144.16 |
$393.00
|
|
St evaluation motion fluoroscopic swallow function cine/video
|
$263.44 |
$263.44 |
$263.44 |
$406.40
|
|
St evaluation swallow function
|
$156.29 |
$156.29 |
$156.29 |
$336.60
|
|
Strep b assay w/optic
|
$26.35 |
$26.35 |
$26.35 |
$32.00
|
|
Strep b dna amp probe
|
$30.79 |
$30.79 |
$30.79 |
$139.20
|
|
Stress test pulmonary
|
$141.20 |
$141.20 |
$141.20 |
$327.20
|
|
St treatment speech individual
|
$184.12 |
$184.12 |
$184.12 |
$254.15
|
|
St treatment swallow dysfunction/oral
|
$149.19 |
$149.19 |
$149.19 |
$261.60
|
|
Succinylcholine chloride 20 mg/ml injection solution (wrapper)
|
$20.83 |
$20.83 |
$20.83 |
$49.13
|
|
Sugars single quant
|
$50.92 |
$50.92 |
$50.92 |
$52.47
|
|
Sulbactam 1 gram-durlobactam 1 gram (0.5 gram x2) intravenous solution
|
$3,557.98 |
$3,557.98 |
$3,557.98 |
$5,446.00
|
|
Sumatriptan 6 mg/0.5 ml subcutaneous solution
|
$21.88 |
$21.88 |
$21.88 |
$151.29
|
|
Surgical pathology level 1 gross examination only
|
$44.70 |
$44.70 |
$44.70 |
$92.59
|
|
Surgical pathology level 2 gross & microscopic examination
|
$95.61 |
$95.61 |
$95.61 |
$149.76
|
|
Surgical pathology level 3 gross & microscopic examination
|
$173.76 |
$173.76 |
$173.76 |
$192.00
|
|
Surgical pathology level 4 gross & microscopic examination
|
$78.15 |
$78.15 |
$78.15 |
$253.75
|
|
Surgical pathology level 5 gross & microscopic examination
|
$294.82 |
$294.82 |
$294.82 |
$494.00
|
|
Surgical pathology level 6 gross & microscopic examination
|
$412.04 |
$412.04 |
$412.04 |
$790.00
|
|
Susceptibility enzyme detection per enzyme
|
$5.92 |
$5.92 |
$5.92 |
$34.48
|
|
Susceptibility mic per plate
|
$21.91 |
$21.91 |
$21.91 |
$94.38
|
|
Suscept studies macrobroth dilution ea
|
$8.00 |
$8.00 |
$8.00 |
$48.30
|
|
Svc venogram s&i
|
$1,287.31 |
$1,287.31 |
$1,287.31 |
$1,908.00
|
|
Syphilis test non-treponemal antibody quantitative rpr
|
$35.82 |
$35.82 |
$35.82 |
$44.85
|
|
System pcmkr dual chamber leadless micra av2 intrdcr cath
|
$0.30 |
$0.30 |
$0.30 |
$10,980.00
|
|
T3 (triiodothyronine) free
|
$33.75 |
$33.75 |
$33.75 |
$89.82
|
|
T3 (triiodothyronine) total
|
$23.39 |
$23.39 |
$23.39 |
$94.90
|
|
T4 (thyroxine) free
|
$52.10 |
$52.10 |
$52.10 |
$81.60
|
|
T4 (thyroxine) total
|
$15.40 |
$15.40 |
$15.40 |
$73.64
|
|
Tacrolimus 1 mg capsule, immediate-release
|
$138.72 |
$138.72 |
$138.72 |
$12.25
|
|
Tacrolimus 5 mg/ml intravenous solution
|
$315.46 |
$315.46 |
$315.46 |
$612.11
|
|
Tacrolimus therapeutic drug level
|
$206.32 |
$206.32 |
$206.32 |
$122.40
|
|
Tavr perq femoral
|
$3,217.52 |
$3,217.52 |
$3,217.52 |
$16,357.00
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$24.87 |
$24.87 |
$24.87 |
$166.46
|
|
Tc-99m exame autol wbc diag per dose
|
$2,210.83 |
$2,210.83 |
$2,210.83 |
$2,393.40
|
|
Tc-99m exametazime diag
|
$1,096.68 |
$1,096.68 |
$1,096.68 |
$2,166.26
|
|
Tc-99m labeled rbc
|
$122.55 |
$122.55 |
$122.55 |
$323.01
|
|
Tc-99m maa
|
$96.80 |
$96.80 |
$96.80 |
$312.06
|
|
Tc-99m mebrofenin
|
$23.39 |
$23.39 |
$23.39 |
$169.53
|
|
Tc-99m mertiatide
|
$218.16 |
$218.16 |
$218.16 |
$757.25
|
|
Tc-99m oxidronate
|
$30.79 |
$30.79 |
$30.79 |
$124.23
|
|
Tc-99m pentetate dtpa aerosol
|
$65.42 |
$65.42 |
$65.42 |
$244.02
|
|
Tc-99m pertechnetate per mci
|
$15.99 |
$15.99 |
$15.99 |
$28.08
|
|
Tc-99m sestamibi p study dose
|
$39.37 |
$39.37 |
$39.37 |
$221.60
|
|
Tc-99m succimer (dmsa)
|
$1,038.96 |
$1,038.96 |
$1,038.96 |
$1,578.33
|
|
Tc-99m sulfur colloid
|
$166.36 |
$166.36 |
$166.36 |
$245.70
|
|
Tc-99m tetrofosmin p study dose
|
$70.45 |
$70.45 |
$70.45 |
$198.05
|
|
Tc-99m tilmanocept diag
|
$502.32 |
$502.32 |
$502.32 |
$930.54
|
|
Tcd emboli detect w/inj
|
$182.64 |
$182.64 |
$182.64 |
$404.68
|
|
Tcd emboli detect without inj
|
$182.64 |
$182.64 |
$182.64 |
$397.15
|
|
T cells absolute cd4/cd8 including ratio
|
$69.86 |
$69.86 |
$69.86 |
$186.00
|
|
T cells absolute cd 4 count
|
$38.19 |
$38.19 |
$38.19 |
$120.25
|
|
T cells total count
|
$44.40 |
$44.40 |
$44.40 |
$124.11
|
|
Telethx isodose plan cplx
|
$894.52 |
$894.52 |
$894.52 |
$1,617.00
|
|
Telethx isodose plan simple
|
$456.44 |
$456.44 |
$456.44 |
$848.72
|
|
Temozolomide
|
$108.99 |
$108.99 |
$108.99 |
$374.66
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$14,929.17 |
$14,929.17 |
$14,929.17 |
$16,531.64
|
