|
Sodium chloride 0.9 % IV bolus
|
$30.00 |
$30.00 |
$30.00 |
$37.50
|
|
Sodium ferric gluconate complex in sucrose 62.5 mg/5 ml intravenous
|
$160.28 |
$160.28 |
$160.28 |
$77.77
|
|
Sodium hyaluronate 20 mg/2 ml syringe
|
$410.40 |
$410.40 |
$410.40 |
$410.40
|
|
Sodium serum/plasma/whole blood
|
$135.45 |
$135.45 |
$135.45 |
$45.60
|
|
Soft interface below knee se
|
$170.43 |
$170.43 |
$170.43 |
$179.08
|
|
Solid skin barrier
|
$2.84 |
$2.84 |
$2.84 |
$2.84
|
|
Solid skin barrier 6x6
|
$6.51 |
$6.51 |
$6.51 |
$6.51
|
|
Somatropin injection
|
$1,204.34 |
$1,204.34 |
$1,204.34 |
$2,381.48
|
|
Special supplies phys/qhp
|
$60.00 |
$60.00 |
$60.00 |
$60.00
|
|
Spinal puncture lumbar diagnostic w/fluoroscopic or CT guidance
|
$2,776.65 |
$2,776.65 |
$2,776.65 |
$1,439.40
|
|
Spirometry bronchodilation responsiveness pre/post bronchodilator administration
|
$454.65 |
$454.65 |
$454.65 |
$543.26
|
|
Splint extn xsm w sof-stretch rolyan
|
$87.92 |
$87.92 |
$87.92 |
$68.25
|
|
Splint finger frog med
|
$21.47 |
$21.47 |
$21.47 |
$38.08
|
|
Splint func pos polyflex ii med
|
$307.50 |
$307.50 |
$307.50 |
$58.65
|
|
Splint rstrc wrst/cmc right med
|
$88.81 |
$88.81 |
$88.81 |
$99.04
|
|
Split atogrft f/s/n/h/f/g/m/d gt 1st 100sqcm/</1 %
|
$3,692.85 |
$3,692.85 |
$3,692.85 |
$4,619.65
|
|
Split blood or products
|
$102.90 |
$102.90 |
$102.90 |
$127.48
|
|
Sputum specimen collection
|
$102.90 |
$102.90 |
$102.90 |
$180.00
|
|
St analysis behavior qualitative voice/resonance
|
$356.85 |
$356.85 |
$356.85 |
$297.60
|
|
Static or dynami afo pre ots
|
$416.73 |
$416.73 |
$416.73 |
$284.60
|
|
Stent/athrectomy/fem/pop/unilat 37227
|
$22,970.40 |
$22,970.40 |
$22,970.40 |
$21,626.50
|
|
Stent axios caut enh 15x10mm electrocaut
|
$42,000.00 |
$42,000.00 |
$42,000.00 |
$32,403.15
|
|
Stent bili dbl pgtl 10fx5cm
|
$12,150.00 |
$12,150.00 |
$12,150.00 |
$2,520.08
|
|
Stent bili rx wallflx 10x80 uncvr
|
$26,820.30 |
$26,820.30 |
$26,820.30 |
$20,962.50
|
|
Stent bronch dumon sil 10x40mm
|
$1,599.00 |
$1,599.00 |
$1,599.00 |
$4,939.20
|
|
Stent iliac/open or perc/uni/init 37221
|
$10,413.45 |
$10,413.45 |
$10,413.45 |
$14,356.50
|
|
Stent iliac/open/perc/ea ad/ipsila 37223
|
$10,413.45 |
$10,413.45 |
$10,413.45 |
$9,008.54
|
|
Stent/tib/peroneal/unilat/initial 37230
|
$13,263.60 |
$13,263.60 |
$13,263.60 |
$17,271.50
|
|
St evaluate speech sound production
|
$356.85 |
$356.85 |
$356.85 |
$292.95
|
|
St evaluate speech sound production comprehensive/expressive
|
$356.85 |
$356.85 |
$356.85 |
$377.00
|
|
St evaluation motion fluoroscopic swallow function cine/video
|
$731.70 |
$731.70 |
$731.70 |
$399.60
|
|
St evaluation swallow function
|
$1,672.05 |
$1,672.05 |
$1,672.05 |
$314.40
|
|
Stot/tot hysterectomy after cesaren delivery 59525
|
$5,454.00 |
$5,454.00 |
$5,454.00 |
$2,607.60
|
|
Strapping of ankle and/or ft 29540
|
$205.20 |
$205.20 |
$205.20 |
$223.45
|
|
Strapping of elbow or wrist 29260
|
$225.15 |
$225.15 |
$225.15 |
$154.70
|
|
Strapping of hand or finger
|
$225.15 |
$225.15 |
$225.15 |
$174.82
|
|
Strapping of knee
|
$205.20 |
$205.20 |
$205.20 |
$205.20
|
|
Strapping of toes 29550
|
$142.05 |
$142.05 |
$142.05 |
$164.70
|
|
Strep a ag ia
|
$141.00 |
$141.00 |
$141.00 |
$75.40
|
|
Streptomycin injection
|
$87.75 |
$87.75 |
$87.75 |
$138.30
|
|
St treatment speech individual
|
$524.40 |
$524.40 |
$524.40 |
$248.84
|
|
St treatment swallow dysfunction/oral
|
$125.85 |
$125.85 |
$125.85 |
$240.31
|
|
Succinylcholine chloride 20 mg/ml injection solution (wrapper)
|
$63.42 |
$63.42 |
$63.42 |
$52.31
|
|
Sulbactam 1 gram-durlobactam 1 gram (0.5 gram x2) intravenous solution
|
$295.20 |
$295.20 |
$295.20 |
$7,345.98
|
|
Sulfonylurea screen qn-sendout
|
$331.20 |
$331.20 |
$331.20 |
$156.16
|
|
Sumatriptan 6 mg/0.5 ml subcutaneous solution
|
$32.84 |
$32.84 |
$32.84 |
$114.88
|
|
Support clav 29.6-40.5in med
|
$124.85 |
$124.85 |
$124.85 |
$94.19
|
|
Supprelin la implant
|
$93,838.08 |
$93,838.08 |
$93,838.08 |
$80,935.72
|
|
Surgical pathology level 1 gross examination only
|
$207.45 |
$207.45 |
$207.45 |
$79.50
|
|
Surgical pathology level 2 gross & microscopic examination
|
$107.85 |
$107.85 |
$107.85 |
$141.94
|
|
Surgical pathology level 3 gross & microscopic examination
|
$97.05 |
$97.05 |
$97.05 |
$181.00
|
|
Surgical pathology level 4 gross & microscopic examination
|
$576.00 |
$576.00 |
$576.00 |
$239.85
|
|
Surgical pathology level 5 gross & microscopic examination
|
$387.00 |
$387.00 |
$387.00 |
$480.00
|
|
Surgical pathology level 6 gross & microscopic examination
|
$490.20 |
$490.20 |
$490.20 |
$718.00
|
|
Susceptibility agar dilution per agent
|
$177.75 |
$177.75 |
$177.75 |
$45.45
|
|
Susceptibility enzyme detection per enzyme
|
$46.05 |
$46.05 |
$46.05 |
$35.70
|
|
Susceptibility mic per plate
|
$258.30 |
$258.30 |
$258.30 |
$106.00
|
|
Synvisc or synvisc-one
|
$2,711.85 |
$2,711.85 |
$2,711.85 |
$1,274.94
|
|
Syphilis test non-treponemal antibody quantitative rpr
|
$136.35 |
$136.35 |
$136.35 |
$41.60
|
|
System cardiomems hosp electronics
|
$30,006.00 |
$30,006.00 |
$30,006.00 |
$39,037.95
|
|
System pacing micra av
|
$34,155.00 |
$34,155.00 |
$34,155.00 |
$24,577.07
|
|
System pcmkr dual chamber leadless micra av2 intrdcr cath
|
$12,003.00 |
$12,003.00 |
$12,003.00 |
$12,003.00
|
|
System sealant biosentry tract
|
$904.05 |
$904.05 |
$904.05 |
$889.35
|
|
T3 (triiodothyronine) free
|
$324.00 |
$324.00 |
$324.00 |
$99.20
|
|
T3 (triiodothyronine) total
|
$188.70 |
$188.70 |
$188.70 |
$93.52
|
|
T4 (thyroxine) free
|
$284.70 |
$284.70 |
$284.70 |
$85.20
|
|
T4 (thyroxine) total
|
$110.40 |
$110.40 |
$110.40 |
$69.00
|
|
Tacrol envarsus ex rel oral
|
$10.86 |
$10.86 |
$10.86 |
$15.60
|
|
Tacrolimus 1 mg capsule, immediate-release
|
$9.78 |
$9.78 |
$9.78 |
$9.84
|
|
Tacrolimus 5 mg/ml intravenous solution
|
$534.82 |
$534.82 |
$534.82 |
$601.95
|
|
Tacrolimus therapeutic drug level
|
$181.50 |
$181.50 |
$181.50 |
$122.40
|
|
Tbo-filgrastim 300 mcg/0.5 ml subcutaneous syringe
|
$863.75 |
$863.75 |
$863.75 |
$937.50
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$244.65 |
$244.65 |
$244.65 |
$177.65
|
|
Tc-99m exame autol wbc diag per dose
|
$2,431.95 |
$2,431.95 |
$2,431.95 |
$2,435.36
|
|
Tc-99m labeled rbc
|
$306.00 |
$306.00 |
$306.00 |
$302.40
|
|
Tc-99m maa
|
$74.55 |
$74.55 |
$74.55 |
$292.80
|
|
Tc-99m mebrofenin
|
$202.80 |
$202.80 |
$202.80 |
$157.65
|
|
Tc-99m medronate
|
$41.70 |
$41.70 |
$41.70 |
$111.01
|
|
Tc-99m oxidronate
|
$74.55 |
$74.55 |
$74.55 |
$105.60
|
|
Tc-99m pentetate dtpa aerosol
|
$139.65 |
$139.65 |
$139.65 |
$190.80
|
|
Tc-99m sestamibi p study dose
|
$408.45 |
$408.45 |
$408.45 |
$274.45
|
|
Tc-99m sulfur colloid
|
$347.10 |
$347.10 |
$347.10 |
$240.50
|
|
Tc-99m tetrofosmin p study dose
|
$366.60 |
$366.60 |
$366.60 |
$190.80
|
|
Tc-99m tilmanocept diag
|
$1,121.70 |
$1,121.70 |
$1,121.70 |
$955.60
|
|
T cells absolute cd4/cd8 including ratio
|
$246.00 |
$246.00 |
$246.00 |
$176.40
|
|
T cells absolute cd 4 count
|
$107.10 |
$107.10 |
$107.10 |
$111.20
|
|
T cells total count
|
$123.00 |
$123.00 |
$123.00 |
$126.90
|
|
Tebentafusp-tebn 100 mcg/0.5 ml intravenous solution
|
$40,114.80 |
$40,114.80 |
$40,114.80 |
$40,114.80
|
|
Telavancin injection
|
$1,191.80 |
$1,191.80 |
$1,191.80 |
$1,191.80
|
|
Temozolomide
|
$647.64 |
$647.64 |
$647.64 |
$588.46
|
|
Temsirolimus 30 mg/3 ml (10 mg/ml) (first dilution) intravenous soln
|
$4,950.80 |
$4,950.80 |
$4,950.80 |
$3,723.60
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$9,028.34 |
$9,028.34 |
$9,028.34 |
$15,245.38
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$10.95 |
$10.95 |
$10.95 |
$39.33
|
|
Test stress cardiovascular tracing only
|
$818.10 |
$818.10 |
$818.10 |
$949.70
|
|
Tetanus immune globulin inj
|
$1,285.36 |
$1,285.36 |
$1,285.36 |
$1,285.36
|
|
Theophylline therapeutic drug level
|
$276.75 |
$276.75 |
$276.75 |
$108.00
|
|
Therapy nutrition individual initial f2f w/patient each 15 minutes
|
$86.40 |
$86.40 |
$86.40 |
$57.31
|
|
Therapy nutrition individual reassessment/intervention f2f w/patient each 15 minutes
|
$90.00 |
$90.00 |
$90.00 |
$50.00
|
|
Ther/proph/diag inj ia
|
$186.15 |
$186.15 |
$186.15 |
$240.35
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$13.62 |
$13.62 |
$13.62 |
$25.54
|
