|
Skin Biopsy
|
$235.62 |
$235.62 |
$235.62 |
$360.34
|
|
Skin full graft 20sq cm less 15200
|
$1,547.70 |
$1,547.70 |
$1,547.70 |
$2,371.50
|
|
Skin full graft add-on 15241
|
$238.26 |
$238.26 |
$238.26 |
$675.58
|
|
Skin pedicle flap trunk
|
$1,661.88 |
$1,661.88 |
$1,661.88 |
$2,501.86
|
|
Skin split graft addl 100sq cm 15101
|
$244.86 |
$244.86 |
$244.86 |
$1,793.40
|
|
Skyla, 13.5 mg
|
$1,205.82 |
$1,205.82 |
$1,205.82 |
$1,643.47
|
|
Slco1b1 gene com variants
|
$108.08 |
$108.08 |
$108.08 |
$241.24
|
|
Sleep study attended
|
$94.38 |
$94.38 |
$94.38 |
$1,329.00
|
|
Sleep Study (Polysomnography)
|
$1,079.76 |
$1,079.76 |
$1,079.76 |
$3,607.50
|
|
Sleep study unattended
|
$70.62 |
$70.62 |
$70.62 |
$580.87
|
|
Sling arm deluxe w/pad xs
|
$34.98 |
$34.98 |
$34.98 |
$30.35
|
|
Slitting of prepuce
|
$324.06 |
$324.06 |
$324.06 |
$3,365.50
|
|
Slp eval non-spch gen comm dev
|
$337.92 |
$337.92 |
$337.92 |
$285.09
|
|
Slp pure tone screening
|
$51.48 |
$51.48 |
$51.48 |
$60.48
|
|
Slp stdy unatnd w/anal
|
$165.66 |
$165.66 |
$165.66 |
$296.34
|
|
Small bowel endoscopy
|
$320.76 |
$320.76 |
$320.76 |
$2,463.36
|
|
Small bowel endoscopy
|
$454.74 |
$454.74 |
$454.74 |
$2,244.82
|
|
Small bowel endoscopy
|
$532.62 |
$532.62 |
$532.62 |
$2,638.57
|
|
Small bowel endoscopy
|
$545.82 |
$545.82 |
$545.82 |
$2,389.40
|
|
Small bowel endoscopy
|
$630.96 |
$630.96 |
$630.96 |
$2,638.57
|
|
Small bowel endoscopy
|
$851.40 |
$851.40 |
$851.40 |
$2,842.50
|
|
Small bowel endoscopy
|
$167.64 |
$167.64 |
$167.64 |
$1,620.78
|
|
Small bowel endoscopy
|
$339.90 |
$339.90 |
$339.90 |
$2,956.20
|
|
Small bowel endoscopy >2nd w/remove 44363
|
$426.36 |
$426.36 |
$426.36 |
$2,389.40
|
|
Small bowel endoscopy/biopsy
|
$354.42 |
$354.42 |
$354.42 |
$2,413.20
|
|
Small bowel endoscopy/biopsy
|
$661.32 |
$661.32 |
$661.32 |
$2,244.82
|
|
Small bowel endoscopy br/wa
|
$131.34 |
$131.34 |
$131.34 |
$1,924.00
|
|
Small bowel endoscopy br/wa
|
$190.08 |
$190.08 |
$190.08 |
$2,381.60
|
|
Smear fluorescent and/or acid fast stain
|
$6.63 |
$6.63 |
$6.63 |
$64.20
|
|
Smear gram stain
|
$44.22 |
$44.22 |
$44.22 |
$55.25
|
|
Smear nasal eosinophil
|
$25.08 |
$25.08 |
$25.08 |
$46.20
|
|
Smear special stain inclusion bodies/parasites
|
$50.16 |
$50.16 |
$50.16 |
$73.15
|
|
Smear wet mount
|
$25.74 |
$25.74 |
$25.74 |
$67.49
|
|
Snrpn/ube3a gene
|
$23.10 |
$23.10 |
$23.10 |
$231.85
|
|
Sodium 24 hour urine
|
$56.10 |
$56.10 |
$56.10 |
$48.60
|
|
Sodium chloride 0.9 % intravenous solution
|
$44.88 |
$44.88 |
$44.88 |
$48.11
|
|
Sodium chloride 0.9 % IV bolus
|
$33.04 |
$33.04 |
$33.04 |
$46.00
|
|
Sodium chloride 0.9 % IV bolus
|
$32.81 |
$32.81 |
$32.81 |
$37.50
|
|
Sodium chloride 3 % ivpb
|
$33.00 |
$33.00 |
$33.00 |
$40.61
|
|
Sodium hyaluronate 20 mg/2 ml syringe
|
$144.54 |
$144.54 |
$144.54 |
$410.40
|
|
Sodium serum/plasma/whole blood
|
$56.10 |
$56.10 |
$56.10 |
$45.60
|
|
Sp bone agrft morsel add-on
|
$361.68 |
$361.68 |
$361.68 |
$406.40
|
|
Sp bone agrft struct add-on
|
$393.36 |
$393.36 |
$393.36 |
$442.40
|
|
Sp bone algrft morsel add-on
|
$485.10 |
$485.10 |
$485.10 |
$498.55
|
|
Special radiation dosimetry
|
$122.10 |
$122.10 |
$122.10 |
$392.50
|
|
Special radiation treatment
|
$284.46 |
$284.46 |
$284.46 |
$1,986.00
|
|
Special supplies phys/qhp
|
$793.98 |
$793.98 |
$793.98 |
$60.00
|
|
Special teletx port plan
|
$132.66 |
$132.66 |
$132.66 |
$1,086.99
|
|
Speech recep thresh
|
$52.80 |
$52.80 |
$52.80 |
$82.88
|
|
Sphenoid sinus surgery
|
$2,419.56 |
$2,419.56 |
$2,419.56 |
$6,547.81
|
|
Sphincteroplasty inc/prolapse adult 46750
|
$1,690.92 |
$1,690.92 |
$1,690.92 |
$3,245.23
|
|
Spinal bone allograftstructural 20931
|
$237.60 |
$237.60 |
$237.60 |
$266.40
|
|
Spinal bone autograftlocal 20936
|
$532.62 |
$532.62 |
$532.62 |
$424.20
|
|
Spinal puncture lumbar diagnostic w/fluoroscopic or CT guidance
|
$1,801.80 |
$1,801.80 |
$1,801.80 |
$1,439.40
|
|
Spirometry bronchodilation responsiveness pre/post bronchodilator administration
|
$382.14 |
$382.14 |
$382.14 |
$543.26
|
|
Splenectomy total open 38100
|
$2,527.80 |
$2,527.80 |
$2,527.80 |
$2,166.00
|
|
Splint dorsal bloc wh med perf 3.2mm lf polyflex ii
|
$958.32 |
$958.32 |
$958.32 |
$392.09
|
|
Splint extn xsm w sof-stretch rolyan
|
$116.16 |
$116.16 |
$116.16 |
$68.25
|
|
Splint finger 4 prong foam sm
|
$133.32 |
$133.32 |
$133.32 |
$34.00
|
|
Splint finger frog med
|
$62.04 |
$62.04 |
$62.04 |
$38.08
|
|
Splint func pos polyflex ii med
|
$27.72 |
$27.72 |
$27.72 |
$58.65
|
|
Splint rstrc wrst/cmc right med
|
$158.40 |
$158.40 |
$158.40 |
$99.04
|
|
Split atogrft f/s/n/h/f/g/m/d gt 1st 100sqcm/</1 %
|
$1,580.04 |
$1,580.04 |
$1,580.04 |
$4,619.65
|
|
Splt agrft f/s/n/h/f/g/m ea
|
$292.38 |
$292.38 |
$292.38 |
$1,612.78
|
|
St analysis behavior qualitative voice/resonance
|
$425.70 |
$425.70 |
$425.70 |
$297.60
|
|
Staph a dna amp probe
|
$73.92 |
$73.92 |
$73.92 |
$125.00
|
|
St cognitve performance testing healthcare professional each hour
|
$239.58 |
$239.58 |
$239.58 |
$286.00
|
|
Stenger test speech
|
$51.48 |
$51.48 |
$51.48 |
$404.25
|
|
Stereotactic radiation trmt
|
$1,120.02 |
$1,120.02 |
$1,120.02 |
$845.60
|
|
Sterile water/saline, 10 ml
|
$13.93 |
$13.93 |
$13.93 |
$13.32
|
|
Sternal debridement
|
$1,251.36 |
$1,251.36 |
$1,251.36 |
$1,318.40
|
|
St evaluate speech sound production
|
$405.90 |
$405.90 |
$405.90 |
$292.95
|
|
St evaluate speech sound production comprehensive/expressive
|
$506.88 |
$506.88 |
$506.88 |
$377.00
|
|
St evaluation motion fluoroscopic swallow function cine/video
|
$702.24 |
$702.24 |
$702.24 |
$399.60
|
|
St evaluation swallow function
|
$460.02 |
$460.02 |
$460.02 |
$314.40
|
|
Stimulants synthetic
|
$4.62 |
$4.62 |
$4.62 |
$80.08
|
|
Stot/tot hysterectomy after cesaren delivery 59525
|
$1,023.66 |
$1,023.66 |
$1,023.66 |
$2,607.60
|
|
Strapping of ankle and/or ft 29540
|
$66.00 |
$66.00 |
$66.00 |
$223.45
|
|
Strapping of chest
|
$73.92 |
$73.92 |
$73.92 |
$195.33
|
|
Strapping of elbow or wrist 29260
|
$67.32 |
$67.32 |
$67.32 |
$154.70
|
|
Strapping of hand or finger
|
$68.64 |
$68.64 |
$68.64 |
$174.82
|
|
Strapping of hip
|
$81.18 |
$81.18 |
$81.18 |
$164.70
|
|
Strapping of knee
|
$68.64 |
$68.64 |
$68.64 |
$205.20
|
|
Strapping of toes 29550
|
$46.20 |
$46.20 |
$46.20 |
$164.70
|
|
Stress test pulmonary
|
$353.10 |
$353.10 |
$353.10 |
$322.85
|
|
Stress tte complete
|
$211.86 |
$211.86 |
$211.86 |
$1,870.50
|
|
St treatment speech individual
|
$361.02 |
$361.02 |
$361.02 |
$248.84
|
|
St treatment swallow dysfunction/oral
|
$119.46 |
$119.46 |
$119.46 |
$240.31
|
|
Subq i/p critical care pr day age 28 days/less than 99469
|
$616.44 |
$616.44 |
$616.44 |
$717.60
|
|
Subsequent intensive care infant 1500-2500 grams 99479
|
$192.72 |
$192.72 |
$192.72 |
$224.80
|
|
Subsequent intensive care infant 2501-5000 grams 99480
|
$185.46 |
$185.46 |
$185.46 |
$216.00
|
|
Subtalar arthro w/fb rmvl
|
$1,486.98 |
$1,486.98 |
$1,486.98 |
$3,839.54
|
|
Subtalar arthro w/fusion
|
$2,020.92 |
$2,020.92 |
$2,020.92 |
$14,241.77
|
|
Succinylcholine chloride 20 mg/ml injection solution (wrapper)
|
$3.54 |
$3.54 |
$3.54 |
$52.31
|
|
Sulfonylurea screen qn-sendout
|
$84.48 |
$84.48 |
$84.48 |
$156.16
|
|
Sumatriptan 6 mg/0.5 ml subcutaneous solution
|
$141.90 |
$141.90 |
$141.90 |
$114.88
|
|
Sup of prep of antigen # of vials 95144
|
$28.38 |
$28.38 |
$28.38 |
$54.60
|
|
Support clav 29.6-40.5in med
|
$143.88 |
$143.88 |
$143.88 |
$94.19
|
|
Suprv interfacilty transport
|
$94.38 |
$94.38 |
$94.38 |
$139.20
|
|
Suprv interfac trnsport addl
|
$82.50 |
$82.50 |
$82.50 |
$120.80
|