|
Sp bone algrft morsel add-on
|
$139.65 |
$139.65 |
$139.65 |
$498.55
|
|
Special radiation dosimetry
|
$35.15 |
$35.15 |
$35.15 |
$392.50
|
|
Special radiation treatment
|
$81.89 |
$81.89 |
$81.89 |
$1,986.00
|
|
Special supplies phys/qhp
|
$640.49 |
$640.49 |
$640.49 |
$60.00
|
|
Special teletx port plan
|
$38.19 |
$38.19 |
$38.19 |
$1,086.99
|
|
Specific gravity body fluid
|
$14.82 |
$14.82 |
$14.82 |
$22.00
|
|
Specimen fat stain
|
$14.44 |
$14.44 |
$14.44 |
$35.10
|
|
Speech evaluation complex
|
$214.70 |
$214.70 |
$214.70 |
$527.06
|
|
Sperm antibody test
|
$9.17 |
$9.17 |
$9.17 |
$57.85
|
|
Sphenoid sinus surgery
|
$696.54 |
$696.54 |
$696.54 |
$6,547.81
|
|
Sphincteroplasty inc/prolapse adult 46750
|
$486.78 |
$486.78 |
$486.78 |
$3,245.23
|
|
Spinal bone allograftstructural 20931
|
$68.40 |
$68.40 |
$68.40 |
$266.40
|
|
Spinal bone autograftlocal 20936
|
$153.33 |
$153.33 |
$153.33 |
$424.20
|
|
Spinal puncture lumbar diagnostic w/fluoroscopic or CT guidance
|
$583.49 |
$583.49 |
$583.49 |
$1,439.40
|
|
Spirometry bronchodilation responsiveness pre/post bronchodilator administration
|
$189.24 |
$189.24 |
$189.24 |
$543.26
|
|
Spleen imaging
|
$445.55 |
$445.55 |
$445.55 |
$679.00
|
|
Splenectomy total open 38100
|
$727.70 |
$727.70 |
$727.70 |
$2,166.00
|
|
Splint dorsal bloc wh med perf 3.2mm lf polyflex ii
|
$559.17 |
$559.17 |
$559.17 |
$392.09
|
|
Splint finger 4 prong foam sm
|
$32.30 |
$32.30 |
$32.30 |
$34.00
|
|
Splint func pos polyflex ii med
|
$13.68 |
$13.68 |
$13.68 |
$58.65
|
|
Splint rstrc wrst/cmc right med
|
$24.32 |
$24.32 |
$24.32 |
$99.04
|
|
Split atogrft f/s/n/h/f/g/m/d gt 1st 100sqcm/</1 %
|
$454.86 |
$454.86 |
$454.86 |
$4,619.65
|
|
Splt agrft f/s/n/h/f/g/m ea
|
$84.17 |
$84.17 |
$84.17 |
$1,612.78
|
|
Sr-89 stront chlor ther / mci
|
$560.69 |
$560.69 |
$560.69 |
$2,667.94
|
|
St analysis behavior qualitative voice/resonance
|
$136.42 |
$136.42 |
$136.42 |
$297.60
|
|
Staph a dna amp probe
|
$69.35 |
$69.35 |
$69.35 |
$125.00
|
|
St cognitve performance testing healthcare professional each hour
|
$158.65 |
$158.65 |
$158.65 |
$286.00
|
|
Stent axios caut enh 15x10mm electrocaut
|
$5,730.21 |
$5,730.21 |
$5,730.21 |
$32,403.15
|
|
Stent bili dbl pgtl 10fx5cm
|
$4,763.87 |
$4,763.87 |
$4,763.87 |
$2,520.08
|
|
Stent bili rx wallflx 10x80 uncvr
|
$3,592.90 |
$3,592.90 |
$3,592.90 |
$20,962.50
|
|
Stereotactic radiation trmt
|
$322.43 |
$322.43 |
$322.43 |
$845.60
|
|
Sterile water/saline, 10 ml
|
$8.38 |
$8.38 |
$8.38 |
$13.32
|
|
Sterile water/saline, 500 ml
|
$15.20 |
$15.20 |
$15.20 |
$28.11
|
|
Sternal debridement
|
$360.24 |
$360.24 |
$360.24 |
$1,318.40
|
|
St evaluate speech sound production
|
$127.49 |
$127.49 |
$127.49 |
$292.95
|
|
St evaluate speech sound production comprehensive/expressive
|
$155.04 |
$155.04 |
$155.04 |
$377.00
|
|
St evaluation motion fluoroscopic swallow function cine/video
|
$185.06 |
$185.06 |
$185.06 |
$399.60
|
|
St evaluation swallow function
|
$168.34 |
$168.34 |
$168.34 |
$314.40
|
|
Stimulants synthetic
|
$28.50 |
$28.50 |
$28.50 |
$80.08
|
|
Stot/tot hysterectomy after cesaren delivery 59525
|
$294.69 |
$294.69 |
$294.69 |
$2,607.60
|
|
Strapping of ankle and/or ft 29540
|
$111.34 |
$111.34 |
$111.34 |
$223.45
|
|
Strapping of chest
|
$11.59 |
$11.59 |
$11.59 |
$195.33
|
|
Strapping of elbow or wrist 29260
|
$86.45 |
$86.45 |
$86.45 |
$154.70
|
|
Strapping of hand or finger
|
$146.68 |
$146.68 |
$146.68 |
$174.82
|
|
Strapping of hip
|
$11.97 |
$11.97 |
$11.97 |
$164.70
|
|
Strapping of knee
|
$92.91 |
$92.91 |
$92.91 |
$205.20
|
|
Strapping of toes 29550
|
$45.98 |
$45.98 |
$45.98 |
$164.70
|
|
Strep b assay w/optic
|
$16.34 |
$16.34 |
$16.34 |
$80.16
|
|
Strep b dna amp probe
|
$59.09 |
$59.09 |
$59.09 |
$120.90
|
|
Stress test pulmonary
|
$97.47 |
$97.47 |
$97.47 |
$322.85
|
|
Stress tte complete
|
$60.99 |
$60.99 |
$60.99 |
$1,870.50
|
|
Str markers specimen anal
|
$47.98 |
$47.98 |
$47.98 |
$751.50
|
|
St treatment speech individual
|
$96.71 |
$96.71 |
$96.71 |
$248.84
|
|
St treatment swallow dysfunction/oral
|
$95.00 |
$95.00 |
$95.00 |
$240.31
|
|
Subq i/p critical care pr day age 28 days/less than 99469
|
$177.46 |
$177.46 |
$177.46 |
$717.60
|
|
Subsequent intensive care infant 1500-2500 grams 99479
|
$55.48 |
$55.48 |
$55.48 |
$224.80
|
|
Subsequent intensive care infant 2501-5000 grams 99480
|
$53.39 |
$53.39 |
$53.39 |
$216.00
|
|
Subtalar arthro w/fb rmvl
|
$428.07 |
$428.07 |
$428.07 |
$3,839.54
|
|
Subtalar arthro w/fusion
|
$581.78 |
$581.78 |
$581.78 |
$14,241.77
|
|
Sugars single quant
|
$1.95 |
$1.95 |
$1.95 |
$64.28
|
|
Sulfonylurea screen qn-sendout
|
$24.32 |
$24.32 |
$24.32 |
$156.16
|
|
Sumatriptan 6 mg/0.5 ml subcutaneous solution
|
$19.57 |
$19.57 |
$19.57 |
$114.88
|
|
Support clav 29.6-40.5in med
|
$18.05 |
$18.05 |
$18.05 |
$94.19
|
|
Suprv interfacilty transport
|
$27.17 |
$27.17 |
$27.17 |
$139.20
|
|
Suprv interfac trnsport addl
|
$23.75 |
$23.75 |
$23.75 |
$120.80
|
|
Surg dx exam anorectal
|
$68.40 |
$68.40 |
$68.40 |
$3,245.23
|
|
Surg ect salp-oophorectomy 59120
|
$514.71 |
$514.71 |
$514.71 |
$1,632.60
|
|
Surg ect without salp-oophorectomy 59121
|
$514.52 |
$514.52 |
$514.52 |
$1,634.40
|
|
Surgical opening of stomach 43500
|
$503.12 |
$503.12 |
$503.12 |
$1,477.80
|
|
Surgical pathology level 1 gross examination only
|
$1.50 |
$1.50 |
$1.50 |
$79.50
|
|
Surgical pathology level 2 gross & microscopic examination
|
$3.79 |
$3.79 |
$3.79 |
$141.94
|
|
Surgical pathology level 3 gross & microscopic examination
|
$5.08 |
$5.08 |
$5.08 |
$181.00
|
|
Surgical pathology level 4 gross & microscopic examination
|
$6.63 |
$6.63 |
$6.63 |
$239.85
|
|
Surgical pathology level 5 gross & microscopic examination
|
$9.35 |
$9.35 |
$9.35 |
$480.00
|
|
Surgical pathology level 6 gross & microscopic examination
|
$13.89 |
$13.89 |
$13.89 |
$718.00
|
|
Surgical repair stomach bleedin ulcer 43501
|
$852.53 |
$852.53 |
$852.53 |
$2,536.20
|
|
Surgical repair stomach gastric lac 43502
|
$962.92 |
$962.92 |
$962.92 |
$2,864.40
|
|
Surgical revision intestine
|
$681.34 |
$681.34 |
$681.34 |
$2,607.20
|
|
Surg tx anal fistula 2nd stage 46285
|
$284.81 |
$284.81 |
$284.81 |
$3,245.23
|
|
Susceptibility agar dilution per agent
|
$18.62 |
$18.62 |
$18.62 |
$45.45
|
|
Susceptibility enzyme detection per enzyme
|
$19.38 |
$19.38 |
$19.38 |
$35.70
|
|
Susceptibility mic per plate
|
$95.76 |
$95.76 |
$95.76 |
$106.00
|
|
Suscept studies macrobroth dilution ea
|
$1.12 |
$1.12 |
$1.12 |
$59.28
|
|
Suspension of testis
|
$195.32 |
$195.32 |
$195.32 |
$4,061.71
|
|
Suspension of uterus 58400
|
$41.23 |
$41.23 |
$41.23 |
$1,136.00
|
|
Sutr lg intestine 1/mult perf without colostomy 44604
|
$665.95 |
$665.95 |
$665.95 |
$1,995.00
|
|
Suture bile duct injury 47900
|
$874.19 |
$874.19 |
$874.19 |
$3,036.66
|
|
Svc venogram s&i
|
$1,064.57 |
$1,064.57 |
$1,064.57 |
$1,934.62
|
|
Sympathectomy digital artery
|
$509.01 |
$509.01 |
$509.01 |
$2,310.83
|
|
Sympathectomy supfc palmar
|
$525.54 |
$525.54 |
$525.54 |
$3,880.00
|
|
Syphilis test non-treponemal antibody quantitative rpr
|
$17.86 |
$17.86 |
$17.86 |
$41.60
|
|
System pacing micra av
|
$13,775.00 |
$13,775.00 |
$13,775.00 |
$24,577.07
|
|
System pcmkr dual chamber leadless micra av2 intrdcr cath
|
$8,836.14 |
$8,836.14 |
$8,836.14 |
$12,003.00
|
|
T3 (triiodothyronine) free
|
$57.00 |
$57.00 |
$57.00 |
$99.20
|
|
T3 (triiodothyronine) total
|
$56.81 |
$56.81 |
$56.81 |
$93.52
|
|
T4 (thyroxine) free
|
$76.38 |
$76.38 |
$76.38 |
$85.20
|
|
T4 (thyroxine) total
|
$52.25 |
$52.25 |
$52.25 |
$69.00
|
|
Tacrolimus 1 mg capsule, immediate-release
|
$3.63 |
$3.63 |
$3.63 |
$9.84
|
|
Tacrolimus therapeutic drug level
|
$2.32 |
$2.32 |
$2.32 |
$122.40
|
|
Tah w/mmk 58152
|
$795.34 |
$795.34 |
$795.34 |
$2,428.80
|
