|
Slitting of prepuce
|
$2,733.50 |
$2,733.50 |
$2,733.50 |
$3,365.50
|
|
Slp pure tone screening
|
$36.50 |
$36.50 |
$36.50 |
$60.48
|
|
Slp stdy unatnd w/anal
|
$212.50 |
$212.50 |
$212.50 |
$296.34
|
|
Slp ther svc non-spch gen
|
$111.50 |
$111.50 |
$111.50 |
$188.50
|
|
Smear fluorescent and/or acid fast stain
|
$36.00 |
$36.00 |
$36.00 |
$64.20
|
|
Smear gram stain
|
$33.00 |
$33.00 |
$33.00 |
$55.25
|
|
Smear nasal eosinophil
|
$25.00 |
$25.00 |
$25.00 |
$46.20
|
|
Smear special stain inclusion bodies/parasites
|
$184.00 |
$184.00 |
$184.00 |
$73.15
|
|
Smear wet mount
|
$56.50 |
$56.50 |
$56.50 |
$67.49
|
|
Snrpn/ube3a gene
|
$178.00 |
$178.00 |
$178.00 |
$231.85
|
|
Socket insert without lock mech
|
$1,319.00 |
$1,319.00 |
$1,319.00 |
$1,192.50
|
|
Socket insert w lock mech
|
$1,544.50 |
$1,544.50 |
$1,544.50 |
$1,544.50
|
|
Sodium 24 hour urine
|
$39.50 |
$39.50 |
$39.50 |
$48.60
|
|
Sodium chloride 0.9 % intravenous solution
|
$120.00 |
$120.00 |
$120.00 |
$48.11
|
|
Sodium chloride 0.9 % IV bolus
|
$85.00 |
$85.00 |
$85.00 |
$46.00
|
|
Sodium ferric gluconate complex in sucrose 62.5 mg/5 ml intravenous
|
$72.34 |
$72.34 |
$72.34 |
$77.77
|
|
Sodium hyaluronate 20 mg/2 ml syringe
|
$541.00 |
$541.00 |
$541.00 |
$410.40
|
|
Sodium serum/plasma/whole blood
|
$27.50 |
$27.50 |
$27.50 |
$45.60
|
|
Specific gravity body fluid
|
$14.50 |
$14.50 |
$14.50 |
$22.00
|
|
Spirmtry w/brnchdil inf-2 yr
|
$545.50 |
$545.50 |
$545.50 |
$368.50
|
|
Spirometry bronchodilation responsiveness pre/post bronchodilator administration
|
$562.50 |
$562.50 |
$562.50 |
$543.26
|
|
Spirometry up to 2 yrs old
|
$297.00 |
$297.00 |
$297.00 |
$326.04
|
|
Splint extn xsm w sof-stretch rolyan
|
$90.50 |
$90.50 |
$90.50 |
$68.25
|
|
Split flat caliper stirr & p
|
$164.50 |
$164.50 |
$164.50 |
$109.20
|
|
Sprchoroidal spc njx rx agt
|
$424.00 |
$424.00 |
$424.00 |
$454.19
|
|
Sputum specimen collection
|
$488.00 |
$488.00 |
$488.00 |
$180.00
|
|
St analysis behavior qualitative voice/resonance
|
$149.00 |
$149.00 |
$149.00 |
$297.60
|
|
St cognitve performance testing healthcare professional each hour
|
$148.50 |
$148.50 |
$148.50 |
$286.00
|
|
Sterile needle
|
$320.50 |
$320.50 |
$320.50 |
$190.13
|
|
St evaluate speech sound production
|
$142.50 |
$142.50 |
$142.50 |
$292.95
|
|
St evaluate speech sound production comprehensive/expressive
|
$295.50 |
$295.50 |
$295.50 |
$377.00
|
|
St evaluation motion fluoroscopic swallow function cine/video
|
$272.00 |
$272.00 |
$272.00 |
$399.60
|
|
St evaluation swallow function
|
$266.50 |
$266.50 |
$266.50 |
$314.40
|
|
Stimulants synthetic
|
$85.00 |
$85.00 |
$85.00 |
$80.08
|
|
Strapping of ankle and/or ft 29540
|
$127.00 |
$127.00 |
$127.00 |
$223.45
|
|
Strapping of elbow or wrist 29260
|
$225.00 |
$225.00 |
$225.00 |
$154.70
|
|
Strapping of hand or finger
|
$120.50 |
$120.50 |
$120.50 |
$174.82
|
|
Strapping of knee
|
$225.00 |
$225.00 |
$225.00 |
$205.20
|
|
Strapping of toes 29550
|
$129.00 |
$129.00 |
$129.00 |
$164.70
|
|
Strep a ag ia
|
$35.50 |
$35.50 |
$35.50 |
$75.40
|
|
Stress test pulmonary
|
$279.00 |
$279.00 |
$279.00 |
$322.85
|
|
Stress tte complete
|
$939.50 |
$939.50 |
$939.50 |
$1,870.50
|
|
Str markers specimen anal
|
$751.50 |
$751.50 |
$751.50 |
$751.50
|
|
St treatment speech individual
|
$167.00 |
$167.00 |
$167.00 |
$248.84
|
|
St treatment swallow dysfunction/oral
|
$219.00 |
$219.00 |
$219.00 |
$240.31
|
|
Subq njx filling matrl 1cc/<
|
$237.00 |
$237.00 |
$237.00 |
$235.13
|
|
Succinylcholine chloride 20 mg/ml injection solution (wrapper)
|
$4.71 |
$4.71 |
$4.71 |
$52.31
|
|
Sugars single quant
|
$520.00 |
$520.00 |
$520.00 |
$64.28
|
|
Sulbactam 1 gram-durlobactam 1 gram (0.5 gram x2) intravenous solution
|
$354.50 |
$354.50 |
$354.50 |
$7,345.98
|
|
Sulfonylurea screen qn-sendout
|
$110.00 |
$110.00 |
$110.00 |
$156.16
|
|
Sumatriptan 6 mg/0.5 ml subcutaneous solution
|
$12.50 |
$12.50 |
$12.50 |
$114.88
|
|
Supprelin la implant
|
$75,271.50 |
$75,271.50 |
$75,271.50 |
$80,935.72
|
|
Surgical pathology level 1 gross examination only
|
$48.50 |
$48.50 |
$48.50 |
$79.50
|
|
Surgical pathology level 2 gross & microscopic examination
|
$67.50 |
$67.50 |
$67.50 |
$141.94
|
|
Surgical pathology level 3 gross & microscopic examination
|
$218.00 |
$218.00 |
$218.00 |
$181.00
|
|
Surgical pathology level 4 gross & microscopic examination
|
$822.00 |
$822.00 |
$822.00 |
$239.85
|
|
Surgical pathology level 5 gross & microscopic examination
|
$529.50 |
$529.50 |
$529.50 |
$480.00
|
|
Surgical pathology level 6 gross & microscopic examination
|
$720.50 |
$720.50 |
$720.50 |
$718.00
|
|
Susceptibility agar dilution per agent
|
$51.00 |
$51.00 |
$51.00 |
$45.45
|
|
Susceptibility enzyme detection per enzyme
|
$12.50 |
$12.50 |
$12.50 |
$35.70
|
|
Susceptibility mic per plate
|
$462.00 |
$462.00 |
$462.00 |
$106.00
|
|
Suscept studies macrobroth dilution ea
|
$169.00 |
$169.00 |
$169.00 |
$59.28
|
|
Synch audio-only est low 20
|
$59.50 |
$59.50 |
$59.50 |
$90.60
|
|
Synch audio-only est mod 30
|
$88.50 |
$88.50 |
$88.50 |
$136.64
|
|
Synch audio-only est sf 10
|
$33.00 |
$33.00 |
$33.00 |
$53.20
|
|
Synch audio-only new high 60
|
$160.00 |
$160.00 |
$160.00 |
$200.30
|
|
Synch audio-only new mod 45
|
$122.00 |
$122.00 |
$122.00 |
$163.38
|
|
Synvisc or synvisc-one
|
$1,912.41 |
$1,912.41 |
$1,912.41 |
$1,274.94
|
|
Syphilis test non-treponemal antibody quantitative rpr
|
$25.00 |
$25.00 |
$25.00 |
$41.60
|
|
T3 (triiodothyronine) free
|
$202.00 |
$202.00 |
$202.00 |
$99.20
|
|
T3 (triiodothyronine) total
|
$92.50 |
$92.50 |
$92.50 |
$93.52
|
|
T4 (thyroxine) free
|
$79.50 |
$79.50 |
$79.50 |
$85.20
|
|
T4 (thyroxine) total
|
$49.50 |
$49.50 |
$49.50 |
$69.00
|
|
Tacrol envarsus ex rel oral
|
$3.50 |
$3.50 |
$3.50 |
$15.60
|
|
Tacrolimus therapeutic drug level
|
$322.50 |
$322.50 |
$322.50 |
$122.40
|
|
Tap block bilat cont infusion 64489
|
$3,494.50 |
$3,494.50 |
$3,494.50 |
$1,407.60
|
|
Tap block uni by cont infusion 64487
|
$1,274.50 |
$1,274.50 |
$1,274.50 |
$869.40
|
|
Target gsa panel hmtlmph neop
|
$2,600.00 |
$2,600.00 |
$2,600.00 |
$2,246.30
|
|
Target gsa panel organ neop
|
$1,550.00 |
$1,550.00 |
$1,550.00 |
$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
|
$106.50 |
$106.50 |
$106.50 |
$177.65
|
|
Tc-99m bicisate
|
$1,672.50 |
$1,672.50 |
$1,672.50 |
$1,969.45
|
|
Tc-99m disofenin
|
$114.50 |
$114.50 |
$114.50 |
$124.32
|
|
Tc-99m labeled rbc
|
$276.50 |
$276.50 |
$276.50 |
$302.40
|
|
Tc-99m maa
|
$37.00 |
$37.00 |
$37.00 |
$292.80
|
|
Tc-99m mebrofenin
|
$163.00 |
$163.00 |
$163.00 |
$157.65
|
|
Tc-99m medronate
|
$37.00 |
$37.00 |
$37.00 |
$111.01
|
|
Tc-99m mertiatide
|
$1,112.00 |
$1,112.00 |
$1,112.00 |
$756.00
|
|
Tc-99m oxidronate
|
$77.00 |
$77.00 |
$77.00 |
$105.60
|
|
Tc-99m pentetate dtpa
|
$76.50 |
$76.50 |
$76.50 |
$222.60
|
|
Tc-99m pentetate dtpa aerosol
|
$139.00 |
$139.00 |
$139.00 |
$190.80
|
|
Tc-99m pertechnetate per mci
|
$3.50 |
$3.50 |
$3.50 |
$22.10
|
|
Tc-99m pyroph diag per dose up to 25 mci
|
$84.00 |
$84.00 |
$84.00 |
$136.40
|
|
Tc-99m sestamibi p study dose
|
$644.00 |
$644.00 |
$644.00 |
$274.45
|
|
Tc-99m sulfur colloid
|
$214.00 |
$214.00 |
$214.00 |
$240.50
|
|
T cells absolute cd4/cd8 including ratio
|
$300.50 |
$300.50 |
$300.50 |
$176.40
|
|
T cells absolute cd 4 count
|
$246.50 |
$246.50 |
$246.50 |
$111.20
|
|
T cells total count
|
$72.00 |
$72.00 |
$72.00 |
$126.90
|
|
Telehealth original site facility fee
|
$104.00 |
$104.00 |
$104.00 |
$51.00
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$15,242.06 |
$15,242.06 |
$15,242.06 |
$15,245.38
|
