|
Special radiation treatment
|
$1,850.00 |
$1,850.00 |
$2,596.80 |
$1,986.00
|
|
Special supplies phys/qhp
|
$18.63 |
$18.63 |
$18.63 |
$60.00
|
|
Special teletx port plan
|
$732.60 |
$732.60 |
$919.00 |
$1,086.99
|
|
Specific gravity body fluid
|
$59.00 |
$59.00 |
$59.00 |
$22.00
|
|
Spinal puncture lumbar diagnostic w/fluoroscopic or CT guidance
|
$1,938.00 |
$1,938.00 |
$2,424.60 |
$1,439.40
|
|
Spirometry bronchodilation responsiveness pre/post bronchodilator administration
|
$410.40 |
$410.40 |
$475.00 |
$543.26
|
|
Spleen imaging
|
$679.00 |
$679.00 |
$679.00 |
$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
|
$211.14 |
$211.14 |
$1,795.18 |
$392.09
|
|
Splint extn xsm w sof-stretch rolyan
|
$25.88 |
$25.88 |
$232.69 |
$68.25
|
|
Splint finger 4 prong foam sm
|
$34.16 |
$34.16 |
$34.16 |
$34.00
|
|
Splint finger fold over sm
|
$77.62 |
$77.62 |
$342.17 |
$146.88
|
|
Splint finger frog med
|
$18.63 |
$18.63 |
$348.21 |
$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 |
$342.17 |
$99.04
|
|
Split atogrft f/s/n/h/f/g/m/d gt 1st 100sqcm/</1 %
|
$4,958.50 |
$4,958.50 |
$4,958.50 |
$4,619.65
|
|
Split blood or products
|
$92.00 |
$92.00 |
$92.00 |
$127.48
|
|
Sputum specimen collection
|
$152.40 |
$152.40 |
$152.40 |
$180.00
|
|
Srs linear based
|
$8,245.80 |
$8,245.80 |
$10,508.50 |
$13,585.00
|
|
Srs multisource
|
$14,869.00 |
$14,869.00 |
$14,869.00 |
$34,165.20
|
|
St analysis behavior qualitative voice/resonance
|
$328.50 |
$328.50 |
$328.50 |
$297.60
|
|
Static or dynami afo pre ots
|
$1,079.25 |
$1,079.25 |
$1,079.25 |
$284.60
|
|
St cognitve performance testing healthcare professional each hour
|
$267.60 |
$267.60 |
$281.00 |
$286.00
|
|
Stem cells total count
|
$106.50 |
$106.50 |
$106.50 |
$179.64
|
|
Stent/athrectomy/fem/pop/unilat 37227
|
$21,626.50 |
$21,626.50 |
$21,626.50 |
$21,626.50
|
|
Stent axios caut enh 15x10mm electrocaut
|
$16,570.85 |
$16,570.85 |
$77,873.07 |
$32,403.15
|
|
Stent bili dbl pgtl 10fx5cm
|
$713.00 |
$713.00 |
$62,596.50 |
$2,520.08
|
|
Stent bili rx wallflx 10x80 uncvr
|
$7,885.15 |
$7,885.15 |
$67,992.75 |
$20,962.50
|
|
Stent bronch dumon sil 10x40mm
|
$1,510.95 |
$1,510.95 |
$1,510.95 |
$4,939.20
|
|
Stent iliac/open or perc/uni/init 37221
|
$14,356.50 |
$14,356.50 |
$14,356.50 |
$14,356.50
|
|
Stent iliac/open/perc/ea ad/ipsila 37223
|
$14,356.50 |
$14,356.50 |
$14,356.50 |
$9,008.54
|
|
Stent/tib/peroneal/unilat/initial 37230
|
$14,018.00 |
$14,018.00 |
$14,018.00 |
$17,271.50
|
|
Sterile water/saline, 10 ml
|
$78.00 |
$78.00 |
$78.00 |
$13.32
|
|
Sternal pad
|
$390.56 |
$390.56 |
$390.56 |
$216.89
|
|
St evaluate speech sound production
|
$287.40 |
$287.40 |
$328.50 |
$292.95
|
|
St evaluate speech sound production comprehensive/expressive
|
$287.40 |
$287.40 |
$328.50 |
$377.00
|
|
St evaluation motion fluoroscopic swallow function cine/video
|
$153.00 |
$153.00 |
$303.00 |
$399.60
|
|
St evaluation swallow function
|
$287.40 |
$287.40 |
$299.50 |
$314.40
|
|
Stocking sup grips 4 pre ots
|
$60.87 |
$60.87 |
$60.87 |
$31.58
|
|
Straight knee joint heavy du
|
$571.96 |
$571.96 |
$571.96 |
$317.69
|
|
Strapping of ankle and/or ft 29540
|
$202.80 |
$202.80 |
$367.00 |
$223.45
|
|
Strapping of chest
|
$167.50 |
$167.50 |
$167.50 |
$195.33
|
|
Strapping of elbow or wrist 29260
|
$79.80 |
$79.80 |
$380.50 |
$154.70
|
|
Strapping of hand or finger
|
$79.80 |
$79.80 |
$475.50 |
$174.82
|
|
Strapping of hip
|
$167.50 |
$167.50 |
$167.50 |
$164.70
|
|
Strapping of knee
|
$162.00 |
$162.00 |
$385.00 |
$205.20
|
|
Strapping of toes 29550
|
$375.50 |
$375.50 |
$375.50 |
$164.70
|
|
Strep a ag ia
|
$9.50 |
$9.50 |
$9.50 |
$75.40
|
|
Stress test pulmonary
|
$348.00 |
$348.00 |
$348.00 |
$322.85
|
|
Stress tte complete
|
$910.00 |
$910.00 |
$910.00 |
$1,870.50
|
|
Str markers specimen anal
|
$173.50 |
$173.50 |
$733.80 |
$751.50
|
|
St treatment speech individual
|
$129.00 |
$129.00 |
$260.50 |
$248.84
|
|
St treatment swallow dysfunction/oral
|
$217.20 |
$217.20 |
$259.50 |
$240.31
|
|
Subq njx fil matrl 5.1-10cc
|
$988.00 |
$988.00 |
$988.00 |
$988.00
|
|
Succinylcholine chloride 20 mg/ml injection solution (wrapper)
|
$24.00 |
$24.00 |
$24.00 |
$52.31
|
|
Suction lipectomy lwr extrem
|
$5,661.00 |
$5,661.00 |
$5,661.00 |
$5,339.00
|
|
Sugars single quant
|
$63.60 |
$63.60 |
$63.60 |
$64.28
|
|
Sulfamethoxazole 400 mg-trimethoprim 80 mg/5 ml intravenous solution
|
$241.52 |
$241.52 |
$241.52 |
$82.43
|
|
Support clav 29.6-40.5in med
|
$44.50 |
$44.50 |
$985.53 |
$94.19
|
|
Surgical pathology level 1 gross examination only
|
$87.50 |
$87.50 |
$111.00 |
$79.50
|
|
Surgical pathology level 2 gross & microscopic examination
|
$168.00 |
$168.00 |
$219.00 |
$141.94
|
|
Surgical pathology level 3 gross & microscopic examination
|
$105.00 |
$105.00 |
$269.40 |
$181.00
|
|
Surgical pathology level 4 gross & microscopic examination
|
$219.00 |
$219.00 |
$252.00 |
$239.85
|
|
Surgical pathology level 5 gross & microscopic examination
|
$363.00 |
$363.00 |
$480.60 |
$480.00
|
|
Surgical pathology level 6 gross & microscopic examination
|
$547.50 |
$547.50 |
$599.40 |
$718.00
|
|
Susceptibility agar dilution per agent
|
$28.20 |
$28.20 |
$28.20 |
$45.45
|
|
Susceptibility enzyme detection per enzyme
|
$40.80 |
$40.80 |
$81.00 |
$35.70
|
|
Susceptibility mic per plate
|
$108.60 |
$108.60 |
$238.50 |
$106.00
|
|
Suspension sleeve lower ext
|
$413.53 |
$413.53 |
$413.53 |
$251.38
|
|
Svc venogram s&i
|
$1,736.00 |
$1,736.00 |
$1,736.00 |
$1,934.62
|
|
Syphilis test non-treponemal antibody quantitative rpr
|
$27.00 |
$27.00 |
$66.50 |
$41.60
|
|
System cardiomems hosp electronics
|
$13,118.62 |
$13,118.62 |
$82,023.00 |
$39,037.95
|
|
System pacing micra av
|
$8,453.36 |
$8,453.36 |
$72,093.90 |
$24,577.07
|
|
System pcmkr dual chamber leadless micra av2 intrdcr cath
|
$16,721.46 |
$16,721.46 |
$34,833.88 |
$12,003.00
|
|
System recell skin grafting/harvesting
|
$29,679.38 |
$29,679.38 |
$29,679.38 |
$11,183.00
|
|
System sealant biosentry tract
|
$244.50 |
$244.50 |
$244.50 |
$889.35
|
|
T3 (triiodothyronine) free
|
$103.00 |
$103.00 |
$181.20 |
$99.20
|
|
T3 (triiodothyronine) total
|
$84.60 |
$84.60 |
$187.00 |
$93.52
|
|
T4 (thyroxine) free
|
$77.50 |
$77.50 |
$104.40 |
$85.20
|
|
T4 (thyroxine) total
|
$102.00 |
$102.00 |
$128.00 |
$69.00
|
|
Tacrolimus 1 mg capsule, immediate-release
|
$11.41 |
$11.41 |
$11.41 |
$9.84
|
|
Tacrolimus 5 mg/ml intravenous solution
|
$1,637.28 |
$1,637.28 |
$1,637.28 |
$601.95
|
|
Tacrolimus therapeutic drug level
|
$134.00 |
$134.00 |
$163.20 |
$122.40
|
|
Talymed
|
$5,612.10 |
$5,612.10 |
$5,612.10 |
$3,411.49
|
|
Tap block bilat cont infusion 64489
|
$2,217.60 |
$2,217.60 |
$2,217.60 |
$1,407.60
|
|
Tap block uni by cont infusion 64487
|
$1,110.00 |
$1,110.00 |
$1,110.00 |
$869.40
|
|
Target gsa panel hmtlmph neop
|
$2,342.00 |
$2,342.00 |
$2,342.00 |
$2,246.30
|
|
Target gsa panel organ neop
|
$1,387.50 |
$1,387.50 |
$1,387.50 |
$1,655.52
|
|
Tas congenital car anomal
|
$2,802.00 |
$2,802.00 |
$2,802.00 |
$6,003.27
|
|
Tbo-filgrastim 300 mcg/0.5 ml subcutaneous syringe
|
$1,499.59 |
$1,499.59 |
$1,499.59 |
$937.50
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$49.50 |
$49.50 |
$378.60 |
$177.65
|
|
Tc-99m bicisate
|
$948.00 |
$948.00 |
$8,799.18 |
$1,969.45
|
|
Tc-99m exame autol wbc diag per dose
|
$998.00 |
$998.00 |
$5,141.90 |
$2,435.36
|
|
Tc-99m exametazime diag
|
$543.50 |
$543.50 |
$543.50 |
$2,033.20
|
|
Tc-99m labeled rbc
|
$120.50 |
$120.50 |
$120.50 |
$302.40
|
|
Tc-99m maa
|
$941.50 |
$941.50 |
$941.50 |
$292.80
|
|
Tc-99m mebrofenin
|
$103.50 |
$103.50 |
$128.82 |
$157.65
|
|
Tc-99m medronate
|
$63.00 |
$63.00 |
$63.00 |
$111.01
|
|
Tc-99m mertiatide
|
$378.00 |
$378.00 |
$378.00 |
$756.00
|
