|
Sock wool above knee
|
$21.22 |
$21.22 |
$21.22 |
$51.18
|
|
Sodium 24 hour urine
|
$23.00 |
$23.00 |
$23.00 |
$48.60
|
|
Sodium serum/plasma/whole blood
|
$23.00 |
$23.00 |
$23.00 |
$45.60
|
|
Soft interface below knee se
|
$69.86 |
$69.86 |
$69.86 |
$179.08
|
|
So vest canvas/web pre ots
|
$94.70 |
$94.70 |
$94.70 |
$256.54
|
|
Spacer bag/reservoir
|
$20.18 |
$20.18 |
$20.18 |
$26.00
|
|
Special physics consult
|
$673.50 |
$673.50 |
$673.50 |
$725.00
|
|
Special radiation dosimetry
|
$222.00 |
$222.00 |
$222.00 |
$392.50
|
|
Special radiation treatment
|
$1,894.50 |
$1,894.50 |
$1,894.50 |
$1,986.00
|
|
Special supplies phys/qhp
|
$18.63 |
$18.63 |
$18.63 |
$60.00
|
|
Special teletx port plan
|
$713.50 |
$713.50 |
$713.50 |
$1,086.99
|
|
Specific gravity body fluid
|
$12.50 |
$12.50 |
$12.50 |
$22.00
|
|
Spinal puncture lumbar diagnostic w/fluoroscopic or CT guidance
|
$1,811.00 |
$1,811.00 |
$1,811.00 |
$1,439.40
|
|
Spirometry bronchodilation responsiveness pre/post bronchodilator administration
|
$321.50 |
$321.50 |
$321.50 |
$543.26
|
|
Spleen imaging
|
$381.50 |
$381.50 |
$381.50 |
$679.00
|
|
Splint arm vnyl coated padded lft med
|
$28.98 |
$28.98 |
$28.98 |
$45.60
|
|
Splint dorsal bloc wh med perf 3.2mm lf polyflex ii
|
$269.62 |
$269.62 |
$269.62 |
$392.09
|
|
Splint extn xsm w sof-stretch rolyan
|
$26.40 |
$26.40 |
$26.40 |
$68.25
|
|
Splint finger 4 prong foam sm
|
$15.52 |
$15.52 |
$15.52 |
$34.00
|
|
Splint finger fold over sm
|
$83.00 |
$83.00 |
$83.00 |
$146.88
|
|
Splint finger frog med
|
$18.63 |
$18.63 |
$18.63 |
$38.08
|
|
Splint fing stax assort 1-7in
|
$8.28 |
$8.28 |
$8.28 |
$5.60
|
|
Splint func pos polyflex ii med
|
$32.60 |
$32.60 |
$32.60 |
$58.65
|
|
Splint rstrc wrst/cmc right med
|
$63.66 |
$63.66 |
$63.66 |
$99.04
|
|
Split atogrft f/s/n/h/f/g/m/d gt 1st 100sqcm/</1 %
|
$5,132.50 |
$5,132.50 |
$5,132.50 |
$4,619.65
|
|
Split blood or products
|
$254.50 |
$254.50 |
$254.50 |
$127.48
|
|
Srs linear based
|
$10,508.50 |
$10,508.50 |
$10,508.50 |
$13,585.00
|
|
Srs multisource
|
$17,099.50 |
$17,099.50 |
$17,099.50 |
$34,165.20
|
|
St analysis behavior qualitative voice/resonance
|
$302.50 |
$302.50 |
$302.50 |
$297.60
|
|
St cognitve performance testing healthcare professional each hour
|
$373.00 |
$373.00 |
$373.00 |
$286.00
|
|
Stem cells total count
|
$168.00 |
$168.00 |
$168.00 |
$179.64
|
|
Stent/athrectomy/fem/pop/unilat 37227
|
$28,718.00 |
$28,718.00 |
$28,718.00 |
$21,626.50
|
|
Stent axios caut enh 15x10mm electrocaut
|
$8,528.62 |
$8,528.62 |
$8,528.62 |
$32,403.15
|
|
Stent bili dbl pgtl 10fx5cm
|
$577.72 |
$577.72 |
$577.72 |
$2,520.08
|
|
Stent bili rx wallflx 10x80 uncvr
|
$7,326.76 |
$7,326.76 |
$7,326.76 |
$20,962.50
|
|
Stent iliac/open or perc/uni/init 37221
|
$8,134.50 |
$8,134.50 |
$8,134.50 |
$14,356.50
|
|
Stent iliac/open/perc/ea ad/ipsila 37223
|
$1,829.00 |
$1,829.00 |
$1,829.00 |
$9,008.54
|
|
Stent/tib/peroneal/unilat/initial 37230
|
$17,271.50 |
$17,271.50 |
$17,271.50 |
$17,271.50
|
|
St evaluate speech sound production
|
$202.00 |
$202.00 |
$202.00 |
$292.95
|
|
St evaluate speech sound production comprehensive/expressive
|
$601.50 |
$601.50 |
$601.50 |
$377.00
|
|
St evaluation motion fluoroscopic swallow function cine/video
|
$212.00 |
$212.00 |
$212.00 |
$399.60
|
|
St evaluation swallow function
|
$212.00 |
$212.00 |
$212.00 |
$314.40
|
|
Strapping of ankle and/or ft 29540
|
$194.50 |
$194.50 |
$194.50 |
$223.45
|
|
Strapping of chest
|
$74.50 |
$74.50 |
$74.50 |
$195.33
|
|
Strapping of elbow or wrist 29260
|
$56.00 |
$56.00 |
$56.00 |
$154.70
|
|
Strapping of hand or finger
|
$99.50 |
$99.50 |
$99.50 |
$174.82
|
|
Strapping of hip
|
$156.50 |
$156.50 |
$156.50 |
$164.70
|
|
Strapping of knee
|
$248.50 |
$248.50 |
$248.50 |
$205.20
|
|
Strapping of toes 29550
|
$62.50 |
$62.50 |
$62.50 |
$164.70
|
|
Stress test pulmonary
|
$247.00 |
$247.00 |
$247.00 |
$322.85
|
|
Stress tte complete
|
$994.00 |
$994.00 |
$994.00 |
$1,870.50
|
|
Str markers specimen anal
|
$998.50 |
$998.50 |
$998.50 |
$751.50
|
|
St treatment speech individual
|
$144.50 |
$144.50 |
$144.50 |
$248.84
|
|
St treatment swallow dysfunction/oral
|
$144.50 |
$144.50 |
$144.50 |
$240.31
|
|
Suction lipectomy lwr extrem
|
$5,291.00 |
$5,291.00 |
$5,291.00 |
$5,339.00
|
|
Support clav 29.6-40.5in med
|
$44.50 |
$44.50 |
$44.50 |
$94.19
|
|
Surgical pathology level 1 gross examination only
|
$38.00 |
$38.00 |
$38.00 |
$79.50
|
|
Surgical pathology level 2 gross & microscopic examination
|
$116.00 |
$116.00 |
$116.00 |
$141.94
|
|
Surgical pathology level 3 gross & microscopic examination
|
$72.00 |
$72.00 |
$72.00 |
$181.00
|
|
Surgical pathology level 4 gross & microscopic examination
|
$168.50 |
$168.50 |
$168.50 |
$239.85
|
|
Surgical pathology level 5 gross & microscopic examination
|
$233.50 |
$233.50 |
$233.50 |
$480.00
|
|
Surgical pathology level 6 gross & microscopic examination
|
$373.50 |
$373.50 |
$373.50 |
$718.00
|
|
Susceptibility enzyme detection per enzyme
|
$24.50 |
$24.50 |
$24.50 |
$35.70
|
|
Susceptibility mic per plate
|
$238.50 |
$238.50 |
$238.50 |
$106.00
|
|
Svc venogram s&i
|
$1,622.50 |
$1,622.50 |
$1,622.50 |
$1,934.62
|
|
Syphilis test non-treponemal antibody quantitative rpr
|
$20.00 |
$20.00 |
$20.00 |
$41.60
|
|
System cardiomems hosp electronics
|
$12,675.00 |
$12,675.00 |
$12,675.00 |
$39,037.95
|
|
System pacing micra av
|
$7,044.00 |
$7,044.00 |
$7,044.00 |
$24,577.07
|
|
System pcmkr dual chamber leadless micra av2 intrdcr cath
|
$7,262.60 |
$7,262.60 |
$7,262.60 |
$12,003.00
|
|
System sealant biosentry tract
|
$358.63 |
$358.63 |
$358.63 |
$889.35
|
|
T3 (triiodothyronine) free
|
$74.50 |
$74.50 |
$74.50 |
$99.20
|
|
T3 (triiodothyronine) total
|
$63.50 |
$63.50 |
$63.50 |
$93.52
|
|
T4 (thyroxine) free
|
$42.00 |
$42.00 |
$42.00 |
$85.20
|
|
T4 (thyroxine) total
|
$33.00 |
$33.00 |
$33.00 |
$69.00
|
|
Tacrolimus therapeutic drug level
|
$82.00 |
$82.00 |
$82.00 |
$122.40
|
|
Target gsa panel hmtlmph neop
|
$2,342.00 |
$2,342.00 |
$2,342.00 |
$2,246.30
|
|
Target gsa panel organ neop
|
$1,119.00 |
$1,119.00 |
$1,119.00 |
$1,655.52
|
|
Tas congenital car anomal
|
$2,554.50 |
$2,554.50 |
$2,554.50 |
$6,003.27
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$261.50 |
$261.50 |
$261.50 |
$177.65
|
|
Tc-99m bicisate
|
$1,695.50 |
$1,695.50 |
$1,695.50 |
$1,969.45
|
|
Tc-99m exame autol wbc diag per dose
|
$1,132.00 |
$1,132.00 |
$1,132.00 |
$2,435.36
|
|
Tc-99m exametazime diag
|
$1,132.00 |
$1,132.00 |
$1,132.00 |
$2,033.20
|
|
Tc-99m labeled rbc
|
$219.00 |
$219.00 |
$219.00 |
$302.40
|
|
Tc-99m maa
|
$197.00 |
$197.00 |
$197.00 |
$292.80
|
|
Tc-99m mebrofenin
|
$96.50 |
$96.50 |
$96.50 |
$157.65
|
|
Tc-99m medronate
|
$58.50 |
$58.50 |
$58.50 |
$111.01
|
|
Tc-99m mertiatide
|
$341.50 |
$341.50 |
$341.50 |
$756.00
|
|
Tc-99m non-heu per study dose
|
$6.00 |
$6.00 |
$6.00 |
$6.60
|
|
Tc-99m oxidronate
|
$35.00 |
$35.00 |
$35.00 |
$105.60
|
|
Tc-99m pentetate dtpa
|
$166.00 |
$166.00 |
$166.00 |
$222.60
|
|
Tc-99m pentetate dtpa aerosol
|
$191.50 |
$191.50 |
$191.50 |
$190.80
|
|
Tc-99m pertechnetate per mci
|
$43.00 |
$43.00 |
$43.00 |
$22.10
|
|
Tc-99m pyroph diag per dose up to 25 mci
|
$73.50 |
$73.50 |
$73.50 |
$136.40
|
|
Tc-99m sestamibi p study dose
|
$183.50 |
$183.50 |
$183.50 |
$274.45
|
|
Tc-99m succimer (dmsa)
|
$358.00 |
$358.00 |
$358.00 |
$1,128.40
|
|
Tc-99m sulfur colloid
|
$78.00 |
$78.00 |
$78.00 |
$240.50
|
|
Tc-99m tetrofosmin p study dose
|
$159.00 |
$159.00 |
$159.00 |
$190.80
|
|
Tc-99m tilmanocept diag
|
$657.00 |
$657.00 |
$657.00 |
$955.60
|
|
T cells absolute cd4/cd8 including ratio
|
$206.50 |
$206.50 |
$206.50 |
$176.40
|
|
T cells absolute cd 4 count
|
$112.50 |
$112.50 |
$112.50 |
$111.20
|
