|
Sinus CT scan (with and without contrast)
|
$786.50 |
$786.50 |
$786.50 |
$1,790.00
|
|
Sinus CT scan (with contrast)
|
$559.50 |
$559.50 |
$559.50 |
$1,527.60
|
|
Sinus CT scan (without contrast)
|
$526.50 |
$526.50 |
$526.50 |
$1,292.04
|
|
Skin Biopsy
|
$389.50 |
$389.50 |
$389.50 |
$360.34
|
|
Skin full graft 20sq cm less 15200
|
$679.00 |
$679.00 |
$679.00 |
$2,371.50
|
|
Skin split graft addl 100sq cm 15101
|
$116.50 |
$116.50 |
$116.50 |
$1,793.40
|
|
Skyla, 13.5 mg
|
$1,517.50 |
$1,517.50 |
$1,517.50 |
$1,643.47
|
|
Sleep study unattended
|
$493.50 |
$493.50 |
$493.50 |
$580.87
|
|
Sleeve fing rolyan med
|
$44.00 |
$44.00 |
$44.00 |
$203.58
|
|
Slitting of prepuce
|
$145.50 |
$145.50 |
$145.50 |
$3,365.50
|
|
Slp pure tone screening
|
$30.00 |
$30.00 |
$30.00 |
$60.48
|
|
Small bowel endoscopy/biopsy
|
$159.50 |
$159.50 |
$159.50 |
$2,413.20
|
|
Small bowel endoscopy/biopsy
|
$298.50 |
$298.50 |
$298.50 |
$2,244.82
|
|
Smear fluorescent and/or acid fast stain
|
$12.50 |
$12.50 |
$12.50 |
$64.20
|
|
Smear gram stain
|
$15.00 |
$15.00 |
$15.00 |
$55.25
|
|
Smear special stain inclusion bodies/parasites
|
$19.50 |
$19.50 |
$19.50 |
$73.15
|
|
Smear wet mount
|
$23.50 |
$23.50 |
$23.50 |
$67.49
|
|
Sodium 24 hour urine
|
$15.00 |
$15.00 |
$15.00 |
$48.60
|
|
Sodium chloride 0.9 % intravenous solution
|
$7.00 |
$7.00 |
$7.00 |
$48.11
|
|
Sodium chloride 0.9 % IV bolus
|
$6.00 |
$6.00 |
$6.00 |
$46.00
|
|
Sodium ferric gluconate complex in sucrose 62.5 mg/5 ml intravenous
|
$2.50 |
$2.50 |
$2.50 |
$77.77
|
|
Sodium hyaluronate 20 mg/2 ml syringe
|
$356.00 |
$356.00 |
$356.00 |
$410.40
|
|
Sodium serum/plasma/whole blood
|
$15.00 |
$15.00 |
$15.00 |
$45.60
|
|
Sp bone agrft morsel add-on
|
$177.00 |
$177.00 |
$177.00 |
$406.40
|
|
Speech audiometry complete
|
$57.00 |
$57.00 |
$57.00 |
$109.20
|
|
Speech recep thresh
|
$30.00 |
$30.00 |
$30.00 |
$82.88
|
|
Spinal puncture lumbar diagnostic w/fluoroscopic or CT guidance
|
$1,115.00 |
$1,115.00 |
$1,115.00 |
$1,439.40
|
|
Spirometry bronchodilation responsiveness pre/post bronchodilator administration
|
$407.00 |
$407.00 |
$407.00 |
$543.26
|
|
Splenectomy total open 38100
|
$1,267.00 |
$1,267.00 |
$1,267.00 |
$2,166.00
|
|
Splice spleen/kidney veins
|
$2,547.00 |
$2,547.00 |
$2,547.00 |
$3,256.92
|
|
Split atogrft f/s/n/h/f/g/m/d gt 1st 100sqcm/</1 %
|
$696.00 |
$696.00 |
$696.00 |
$4,619.65
|
|
Sprchoroidal spc njx rx agt
|
$424.00 |
$424.00 |
$424.00 |
$454.19
|
|
Sputum specimen collection
|
$50.50 |
$50.50 |
$50.50 |
$180.00
|
|
St evaluate speech sound production
|
$182.00 |
$182.00 |
$182.00 |
$292.95
|
|
St evaluate speech sound production comprehensive/expressive
|
$373.50 |
$373.50 |
$373.50 |
$377.00
|
|
St evaluation swallow function
|
$149.50 |
$149.50 |
$149.50 |
$314.40
|
|
Strapping of ankle and/or ft 29540
|
$18.00 |
$18.00 |
$18.00 |
$223.45
|
|
Strapping of knee
|
$17.50 |
$17.50 |
$17.50 |
$205.20
|
|
Strapping of toes 29550
|
$11.50 |
$11.50 |
$11.50 |
$164.70
|
|
Strep a ag ia
|
$8.50 |
$8.50 |
$8.50 |
$75.40
|
|
Stress test pulmonary
|
$228.00 |
$228.00 |
$228.00 |
$322.85
|
|
Stress tte complete
|
$90.50 |
$90.50 |
$90.50 |
$1,870.50
|
|
Str markers specimen anal
|
$751.50 |
$751.50 |
$751.50 |
$751.50
|
|
St treatment speech individual
|
$154.00 |
$154.00 |
$154.00 |
$248.84
|
|
St treatment swallow dysfunction/oral
|
$109.00 |
$109.00 |
$109.00 |
$240.31
|
|
Subq njx filling matrl 1cc/<
|
$51.50 |
$51.50 |
$51.50 |
$235.13
|
|
Sugars single quant
|
$520.00 |
$520.00 |
$520.00 |
$64.28
|
|
Sulbactam 1 gram-durlobactam 1 gram (0.5 gram x2) intravenous solution
|
$236.50 |
$236.50 |
$236.50 |
$7,345.98
|
|
Sulfonylurea screen qn-sendout
|
$110.00 |
$110.00 |
$110.00 |
$156.16
|
|
Sumatriptan 6 mg/0.5 ml subcutaneous solution
|
$8.50 |
$8.50 |
$8.50 |
$114.88
|
|
Supprelin la implant
|
$75,271.50 |
$75,271.50 |
$75,271.50 |
$80,935.72
|
|
Surg dx exam anorectal
|
$115.50 |
$115.50 |
$115.50 |
$3,245.23
|
|
Surgical pathology level 1 gross examination only
|
$24.00 |
$24.00 |
$24.00 |
$79.50
|
|
Surgical pathology level 2 gross & microscopic examination
|
$58.50 |
$58.50 |
$58.50 |
$141.94
|
|
Surgical pathology level 3 gross & microscopic examination
|
$145.50 |
$145.50 |
$145.50 |
$181.00
|
|
Surgical pathology level 4 gross & microscopic examination
|
$79.50 |
$79.50 |
$79.50 |
$239.85
|
|
Surgical pathology level 5 gross & microscopic examination
|
$261.50 |
$261.50 |
$261.50 |
$480.00
|
|
Surgical pathology level 6 gross & microscopic examination
|
$261.50 |
$261.50 |
$261.50 |
$718.00
|
|
Surgical repair stomach bleedin ulcer 43501
|
$1,498.50 |
$1,498.50 |
$1,498.50 |
$2,536.20
|
|
Surg tx anal fistula 2nd stage 46285
|
$472.50 |
$472.50 |
$472.50 |
$3,245.23
|
|
Susceptibility agar dilution per agent
|
$107.50 |
$107.50 |
$107.50 |
$45.45
|
|
Susceptibility mic per plate
|
$462.00 |
$462.00 |
$462.00 |
$106.00
|
|
Suscept studies macrobroth dilution ea
|
$29.00 |
$29.00 |
$29.00 |
$59.28
|
|
Sutr lg intestine 1/mult perf without colostomy 44604
|
$1,150.50 |
$1,150.50 |
$1,150.50 |
$1,995.00
|
|
Synch audio-only est high 40
|
$127.00 |
$127.00 |
$127.00 |
$189.40
|
|
Synch audio-only est low 20
|
$59.50 |
$59.50 |
$59.50 |
$90.60
|
|
Synch audio-only est mod 30
|
$85.50 |
$85.50 |
$85.50 |
$136.64
|
|
Synch audio-only est sf 10
|
$33.00 |
$33.00 |
$33.00 |
$53.20
|
|
Synch audio-only new high 60
|
$156.50 |
$156.50 |
$156.50 |
$200.30
|
|
Synch audio-only new low 30
|
$75.50 |
$75.50 |
$75.50 |
$117.00
|
|
Synch audio-only new mod 45
|
$118.50 |
$118.50 |
$118.50 |
$163.38
|
|
Synch audio-only new sf 15
|
$44.50 |
$44.50 |
$44.50 |
$67.80
|
|
Synvisc or synvisc-one
|
$20.00 |
$20.00 |
$20.00 |
$1,274.94
|
|
Syphilis test non-treponemal antibody quantitative rpr
|
$37.00 |
$37.00 |
$37.00 |
$41.60
|
|
T3 (triiodothyronine) free
|
$84.00 |
$84.00 |
$84.00 |
$99.20
|
|
T3 (triiodothyronine) total
|
$49.00 |
$49.00 |
$49.00 |
$93.52
|
|
T4 (thyroxine) free
|
$31.50 |
$31.50 |
$31.50 |
$85.20
|
|
T4 (thyroxine) total
|
$31.50 |
$31.50 |
$31.50 |
$69.00
|
|
Tacrol envarsus ex rel oral
|
$2.50 |
$2.50 |
$2.50 |
$15.60
|
|
Tacrolimus therapeutic drug level
|
$193.50 |
$193.50 |
$193.50 |
$122.40
|
|
Tap block bilat cont infusion 64489
|
$2,913.00 |
$2,913.00 |
$2,913.00 |
$1,407.60
|
|
Tap block uni by cont infusion 64487
|
$1,062.50 |
$1,062.50 |
$1,062.50 |
$869.40
|
|
Target gsa panel hmtlmph neop
|
$2,600.00 |
$2,600.00 |
$2,600.00 |
$2,246.30
|
|
Target gsa panel organ neop
|
$1,100.00 |
$1,100.00 |
$1,100.00 |
$1,655.52
|
|
Tb test cell mediated immunity antigen response enumeration gamma interferon t-cells
|
$139.00 |
$139.00 |
$139.00 |
$194.35
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$118.50 |
$118.50 |
$118.50 |
$177.65
|
|
Tc-99m labeled rbc
|
$354.50 |
$354.50 |
$354.50 |
$302.40
|
|
Tc-99m maa
|
$861.50 |
$861.50 |
$861.50 |
$292.80
|
|
Tc-99m mebrofenin
|
$83.50 |
$83.50 |
$83.50 |
$157.65
|
|
Tc-99m medronate
|
$52.00 |
$52.00 |
$52.00 |
$111.01
|
|
Tc-99m pentetate dtpa
|
$214.50 |
$214.50 |
$214.50 |
$222.60
|
|
Tc-99m pentetate dtpa aerosol
|
$565.50 |
$565.50 |
$565.50 |
$190.80
|
|
Tc-99m sestamibi p study dose
|
$330.50 |
$330.50 |
$330.50 |
$274.45
|
|
Tc-99m sulfur colloid
|
$145.00 |
$145.00 |
$145.00 |
$240.50
|
|
T cells absolute cd 4 count
|
$32.00 |
$32.00 |
$32.00 |
$111.20
|
|
Teaec w/wo patch graft iliofemoral
|
$1,131.00 |
$1,131.00 |
$1,131.00 |
$5,163.60
|
|
Telehealth original site facility fee
|
$57.00 |
$57.00 |
$57.00 |
$51.00
|
|
Tenodesis biceps tdn at elbw
|
$655.00 |
$655.00 |
$655.00 |
$5,886.74
|
|
Tenolysis extensor tendon hand/finger each
|
$642.00 |
$642.00 |
$642.00 |
$2,811.20
|
|
Tenosynovectomy radic 26145
|
$546.50 |
$546.50 |
$546.50 |
$1,893.86
|
