|
Special radiation treatment
|
$1,976.00 |
$1,976.00 |
$1,976.00 |
$1,986.00
|
|
Special teletx port plan
|
$648.00 |
$648.00 |
$648.00 |
$1,086.99
|
|
Specific gravity body fluid
|
$11.60 |
$11.60 |
$11.60 |
$22.00
|
|
Specimen fat stain
|
$21.20 |
$21.20 |
$21.20 |
$35.10
|
|
Spinal puncture lumbar diagnostic w/fluoroscopic or CT guidance
|
$982.80 |
$982.80 |
$982.80 |
$1,439.40
|
|
Spirometry bronchodilation responsiveness pre/post bronchodilator administration
|
$534.80 |
$534.80 |
$534.80 |
$543.26
|
|
Splint arm vnyl coated padded lft med
|
$225.20 |
$225.20 |
$225.20 |
$45.60
|
|
Splint dorsal bloc wh med perf 3.2mm lf polyflex ii
|
$237.60 |
$237.60 |
$237.60 |
$392.09
|
|
Splint extn xsm w sof-stretch rolyan
|
$549.20 |
$549.20 |
$549.20 |
$68.25
|
|
Splint finger 4 prong foam sm
|
$18.40 |
$18.40 |
$18.40 |
$34.00
|
|
Splint finger frog med
|
$35.20 |
$35.20 |
$35.20 |
$38.08
|
|
Splint fing stax assort 1-7in
|
$3.60 |
$3.60 |
$3.60 |
$5.60
|
|
Splint func pos polyflex ii med
|
$160.00 |
$160.00 |
$160.00 |
$58.65
|
|
Splint rstrc wrst/cmc right med
|
$253.60 |
$253.60 |
$253.60 |
$99.04
|
|
Split blood or products
|
$218.00 |
$218.00 |
$218.00 |
$127.48
|
|
Split flat caliper stirr & p
|
$54.00 |
$54.00 |
$54.00 |
$109.20
|
|
Srs linear based
|
$16,382.80 |
$16,382.80 |
$16,382.80 |
$13,585.00
|
|
Srs multisource
|
$50,198.40 |
$50,198.40 |
$50,198.40 |
$34,165.20
|
|
Static or dynami afo pre ots
|
$420.80 |
$420.80 |
$420.80 |
$284.60
|
|
St cognitve performance testing healthcare professional each hour
|
$177.60 |
$177.60 |
$177.60 |
$286.00
|
|
Stem cells total count
|
$144.80 |
$144.80 |
$144.80 |
$179.64
|
|
Stent axios caut enh 15x10mm electrocaut
|
$35,611.60 |
$35,611.60 |
$35,611.60 |
$32,403.15
|
|
Stent bili dbl pgtl 10fx5cm
|
$3,760.00 |
$3,760.00 |
$3,760.00 |
$2,520.08
|
|
Stent bili rx wallflx 10x80 uncvr
|
$50,120.00 |
$50,120.00 |
$50,120.00 |
$20,962.50
|
|
Stent placemt retro carotid
|
$7,157.60 |
$7,157.60 |
$7,157.60 |
$5,328.00
|
|
Sterile needle
|
$648.00 |
$648.00 |
$648.00 |
$190.13
|
|
St evaluate speech sound production
|
$215.20 |
$215.20 |
$215.20 |
$292.95
|
|
St evaluate speech sound production comprehensive/expressive
|
$268.00 |
$268.00 |
$268.00 |
$377.00
|
|
St evaluation motion fluoroscopic swallow function cine/video
|
$382.00 |
$382.00 |
$382.00 |
$399.60
|
|
St evaluation swallow function
|
$352.00 |
$352.00 |
$352.00 |
$314.40
|
|
Stimulants synthetic
|
$40.80 |
$40.80 |
$40.80 |
$80.08
|
|
Strapping of hand or finger
|
$60.40 |
$60.40 |
$60.40 |
$174.82
|
|
Strapping of toes 29550
|
$106.80 |
$106.80 |
$106.80 |
$164.70
|
|
Strep a ag ia
|
$60.00 |
$60.00 |
$60.00 |
$75.40
|
|
Stress test pulmonary
|
$241.60 |
$241.60 |
$241.60 |
$322.85
|
|
Stress tte complete
|
$932.80 |
$932.80 |
$932.80 |
$1,870.50
|
|
Str markers specimen anal
|
$950.40 |
$950.40 |
$950.40 |
$751.50
|
|
St treatment speech individual
|
$154.80 |
$154.80 |
$154.80 |
$248.84
|
|
St treatment swallow dysfunction/oral
|
$127.60 |
$127.60 |
$127.60 |
$240.31
|
|
Succinylcholine chloride 20 mg/ml injection solution (wrapper)
|
$115.20 |
$115.20 |
$115.20 |
$52.31
|
|
Sugars single quant
|
$50.80 |
$50.80 |
$50.80 |
$64.28
|
|
Sulbactam 1 gram-durlobactam 1 gram (0.5 gram x2) intravenous solution
|
$92.68 |
$92.68 |
$92.68 |
$7,345.98
|
|
Sulfonylurea screen qn-sendout
|
$106.80 |
$106.80 |
$106.80 |
$156.16
|
|
Sumatriptan 6 mg/0.5 ml subcutaneous solution
|
$55.38 |
$55.38 |
$55.38 |
$114.88
|
|
Support clav 29.6-40.5in med
|
$36.40 |
$36.40 |
$36.40 |
$94.19
|
|
Surg dx exam anorectal
|
$3,818.40 |
$3,818.40 |
$3,818.40 |
$3,245.23
|
|
Surgical pathology level 1 gross examination only
|
$39.20 |
$39.20 |
$39.20 |
$79.50
|
|
Surgical pathology level 2 gross & microscopic examination
|
$60.80 |
$60.80 |
$60.80 |
$141.94
|
|
Surgical pathology level 3 gross & microscopic examination
|
$90.00 |
$90.00 |
$90.00 |
$181.00
|
|
Surgical pathology level 4 gross & microscopic examination
|
$90.00 |
$90.00 |
$90.00 |
$239.85
|
|
Surgical pathology level 5 gross & microscopic examination
|
$481.60 |
$481.60 |
$481.60 |
$480.00
|
|
Surgical pathology level 6 gross & microscopic examination
|
$1,202.00 |
$1,202.00 |
$1,202.00 |
$718.00
|
|
Susceptibility agar dilution per agent
|
$21.20 |
$21.20 |
$21.20 |
$45.45
|
|
Susceptibility enzyme detection per enzyme
|
$21.20 |
$21.20 |
$21.20 |
$35.70
|
|
Susceptibility mic per plate
|
$38.00 |
$38.00 |
$38.00 |
$106.00
|
|
Suscept studies macrobroth dilution ea
|
$29.20 |
$29.20 |
$29.20 |
$59.28
|
|
Suspension sleeve lower ext
|
$75.60 |
$75.60 |
$75.60 |
$251.38
|
|
Svc venogram s&i
|
$2,348.40 |
$2,348.40 |
$2,348.40 |
$1,934.62
|
|
Synvisc or synvisc-one
|
$12.40 |
$12.40 |
$12.40 |
$1,274.94
|
|
Syphilis test non-treponemal antibody quantitative rpr
|
$19.20 |
$19.20 |
$19.20 |
$41.60
|
|
System cardiomems hosp electronics
|
$165,516.80 |
$165,516.80 |
$165,516.80 |
$39,037.95
|
|
System pacing micra av
|
$21,574.40 |
$21,574.40 |
$21,574.40 |
$24,577.07
|
|
System pcmkr dual chamber leadless micra av2 intrdcr cath
|
$8,168.00 |
$8,168.00 |
$8,168.00 |
$12,003.00
|
|
System sealant biosentry tract
|
$991.60 |
$991.60 |
$991.60 |
$889.35
|
|
T3 (triiodothyronine) free
|
$74.80 |
$74.80 |
$74.80 |
$99.20
|
|
T3 (triiodothyronine) total
|
$62.80 |
$62.80 |
$62.80 |
$93.52
|
|
T4 (thyroxine) free
|
$39.60 |
$39.60 |
$39.60 |
$85.20
|
|
T4 (thyroxine) total
|
$30.00 |
$30.00 |
$30.00 |
$69.00
|
|
Tacrolimus therapeutic drug level
|
$60.80 |
$60.80 |
$60.80 |
$122.40
|
|
Target gsa panel hmtlmph neop
|
$2,718.00 |
$2,718.00 |
$2,718.00 |
$2,246.30
|
|
Target gsa panel organ/hmtlmph neop
|
$10,447.20 |
$10,447.20 |
$10,447.20 |
$3,746.70
|
|
Target gsa panel organ neop
|
$2,139.60 |
$2,139.60 |
$2,139.60 |
$1,655.52
|
|
Tavr perq femoral
|
$5,214.40 |
$5,214.40 |
$5,214.40 |
$15,454.40
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$77.20 |
$77.20 |
$77.20 |
$177.65
|
|
Tc-99m bicisate
|
$3,027.60 |
$3,027.60 |
$3,027.60 |
$1,969.45
|
|
Tc-99m disofenin
|
$168.80 |
$168.80 |
$168.80 |
$124.32
|
|
Tc-99m exame autol wbc diag per dose
|
$4,083.20 |
$4,083.20 |
$4,083.20 |
$2,435.36
|
|
Tc-99m exametazime diag
|
$2,952.40 |
$2,952.40 |
$2,952.40 |
$2,033.20
|
|
Tc-99m labeled rbc
|
$446.00 |
$446.00 |
$446.00 |
$302.40
|
|
Tc-99m maa
|
$440.40 |
$440.40 |
$440.40 |
$292.80
|
|
Tc-99m mebrofenin
|
$85.20 |
$85.20 |
$85.20 |
$157.65
|
|
Tc-99m medronate
|
$121.60 |
$121.60 |
$121.60 |
$111.01
|
|
Tc-99m mertiatide
|
$828.40 |
$828.40 |
$828.40 |
$756.00
|
|
Tc-99m pentetate dtpa
|
$430.40 |
$430.40 |
$430.40 |
$222.60
|
|
Tc-99m pentetate dtpa aerosol
|
$489.60 |
$489.60 |
$489.60 |
$190.80
|
|
Tc-99m pertechnetate per mci
|
$2.00 |
$2.00 |
$2.00 |
$22.10
|
|
Tc-99m pyroph diag per dose up to 25 mci
|
$192.80 |
$192.80 |
$192.80 |
$136.40
|
|
Tc-99m sestamibi p study dose
|
$99.60 |
$99.60 |
$99.60 |
$274.45
|
|
Tc-99m sulfur colloid
|
$641.60 |
$641.60 |
$641.60 |
$240.50
|
|
Tc-99m tetrofosmin p study dose
|
$121.20 |
$121.20 |
$121.20 |
$190.80
|
|
Tc-99m tilmanocept diag
|
$1,513.20 |
$1,513.20 |
$1,513.20 |
$955.60
|
|
Tcd emboli detect without inj
|
$424.80 |
$424.80 |
$424.80 |
$475.28
|
|
T cells absolute cd4/cd8 including ratio
|
$108.00 |
$108.00 |
$108.00 |
$176.40
|
|
T cells absolute cd 4 count
|
$118.80 |
$118.80 |
$118.80 |
$111.20
|
|
T cells total count
|
$166.80 |
$166.80 |
$166.80 |
$126.90
|
|
Telehealth original site facility fee
|
$58.00 |
$58.00 |
$58.00 |
$51.00
|
|
Telethx isodose plan cplx
|
$648.00 |
$648.00 |
$648.00 |
$1,526.85
|
|
Telethx isodose plan simple
|
$648.00 |
$648.00 |
$648.00 |
$873.62
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$306.38 |
$306.38 |
$306.38 |
$15,245.38
|
|
Tension based scoliosis orth
|
$1,957.20 |
$1,957.20 |
$1,957.20 |
$3,528.00
|
