|
Small bowel endoscopy
|
$387.00 |
$387.00 |
$387.00 |
$2,842.50
|
|
Small bowel endoscopy
|
$76.20 |
$76.20 |
$76.20 |
$1,620.78
|
|
Small bowel endoscopy
|
$154.50 |
$154.50 |
$154.50 |
$2,956.20
|
|
Small bowel endoscopy >2nd w/remove 44363
|
$193.80 |
$193.80 |
$193.80 |
$2,389.40
|
|
Small bowel endoscopy/biopsy
|
$161.10 |
$161.10 |
$161.10 |
$2,413.20
|
|
Small bowel endoscopy/biopsy
|
$300.60 |
$300.60 |
$300.60 |
$2,244.82
|
|
Small bowel endoscopy br/wa
|
$59.70 |
$59.70 |
$59.70 |
$1,924.00
|
|
Small bowel endoscopy br/wa
|
$86.40 |
$86.40 |
$86.40 |
$2,381.60
|
|
Smear fluorescent and/or acid fast stain
|
$5.40 |
$5.40 |
$5.40 |
$64.20
|
|
Smear gram stain
|
$61.20 |
$61.20 |
$61.20 |
$55.25
|
|
Smear nasal eosinophil
|
$31.80 |
$31.80 |
$31.80 |
$46.20
|
|
Smear special stain inclusion bodies/parasites
|
$1.60 |
$1.60 |
$1.60 |
$73.15
|
|
Smear wet mount
|
$53.70 |
$53.70 |
$53.70 |
$67.49
|
|
Snrpn/ube3a gene
|
$100.50 |
$100.50 |
$100.50 |
$231.85
|
|
Sodium 24 hour urine
|
$59.70 |
$59.70 |
$59.70 |
$48.60
|
|
Sodium chloride 0.9 % intravenous solution
|
$20.40 |
$20.40 |
$20.40 |
$48.11
|
|
Sodium chloride 0.9 % IV bolus
|
$14.46 |
$14.46 |
$14.46 |
$46.00
|
|
Sodium chloride 0.9 % IV bolus
|
$14.62 |
$14.62 |
$14.62 |
$37.50
|
|
Sodium chloride 3 % ivpb
|
$14.70 |
$14.70 |
$14.70 |
$40.61
|
|
Sodium ferric gluconate complex in sucrose 62.5 mg/5 ml intravenous
|
$80.14 |
$80.14 |
$80.14 |
$77.77
|
|
Sodium hyaluronate 20 mg/2 ml syringe
|
$69.90 |
$69.90 |
$69.90 |
$410.40
|
|
Sodium serum/plasma/whole blood
|
$69.30 |
$69.30 |
$69.30 |
$45.60
|
|
Sp bone agrft morsel add-on
|
$164.40 |
$164.40 |
$164.40 |
$406.40
|
|
Sp bone agrft struct add-on
|
$178.80 |
$178.80 |
$178.80 |
$442.40
|
|
Sp bone algrft morsel add-on
|
$220.50 |
$220.50 |
$220.50 |
$498.55
|
|
Special radiation dosimetry
|
$55.50 |
$55.50 |
$55.50 |
$392.50
|
|
Special radiation treatment
|
$129.30 |
$129.30 |
$129.30 |
$1,986.00
|
|
Special supplies phys/qhp
|
$1,235.40 |
$1,235.40 |
$1,235.40 |
$60.00
|
|
Special teletx port plan
|
$60.30 |
$60.30 |
$60.30 |
$1,086.99
|
|
Specific gravity body fluid
|
$17.10 |
$17.10 |
$17.10 |
$22.00
|
|
Speech evaluation complex
|
$301.80 |
$301.80 |
$301.80 |
$527.06
|
|
Speech recep thresh
|
$24.00 |
$24.00 |
$24.00 |
$82.88
|
|
Sphenoid sinus surgery
|
$1,099.80 |
$1,099.80 |
$1,099.80 |
$6,547.81
|
|
Sphincteroplasty inc/prolapse adult 46750
|
$768.60 |
$768.60 |
$768.60 |
$3,245.23
|
|
Spinal bone allograftstructural 20931
|
$108.00 |
$108.00 |
$108.00 |
$266.40
|
|
Spinal bone autograftlocal 20936
|
$242.10 |
$242.10 |
$242.10 |
$424.20
|
|
Spinal puncture lumbar diagnostic w/fluoroscopic or CT guidance
|
$785.70 |
$785.70 |
$785.70 |
$1,439.40
|
|
Spirometry bronchodilation responsiveness pre/post bronchodilator administration
|
$338.40 |
$338.40 |
$338.40 |
$543.26
|
|
Splenectomy total open 38100
|
$1,149.00 |
$1,149.00 |
$1,149.00 |
$2,166.00
|
|
Splint dorsal bloc wh med perf 3.2mm lf polyflex ii
|
$435.60 |
$435.60 |
$435.60 |
$392.09
|
|
Splint extn xsm w sof-stretch rolyan
|
$52.80 |
$52.80 |
$52.80 |
$68.25
|
|
Splint finger 4 prong foam sm
|
$86.10 |
$86.10 |
$86.10 |
$34.00
|
|
Splint finger frog med
|
$28.20 |
$28.20 |
$28.20 |
$38.08
|
|
Splint func pos polyflex ii med
|
$12.60 |
$12.60 |
$12.60 |
$58.65
|
|
Splint rstrc wrst/cmc right med
|
$72.00 |
$72.00 |
$72.00 |
$99.04
|
|
Split atogrft f/s/n/h/f/g/m/d gt 1st 100sqcm/</1 %
|
$718.20 |
$718.20 |
$718.20 |
$4,619.65
|
|
Splt agrft f/s/n/h/f/g/m ea
|
$132.90 |
$132.90 |
$132.90 |
$1,612.78
|
|
St analysis behavior qualitative voice/resonance
|
$186.90 |
$186.90 |
$186.90 |
$297.60
|
|
Staph a dna amp probe
|
$189.30 |
$189.30 |
$189.30 |
$125.00
|
|
St cognitve performance testing healthcare professional each hour
|
$145.20 |
$145.20 |
$145.20 |
$286.00
|
|
Stenger test speech
|
$23.40 |
$23.40 |
$23.40 |
$404.25
|
|
Stent axios caut enh 15x10mm electrocaut
|
$9,047.70 |
$9,047.70 |
$9,047.70 |
$32,403.15
|
|
Stereotactic radiation trmt
|
$509.10 |
$509.10 |
$509.10 |
$845.60
|
|
Sterile water/saline, 10 ml
|
$15.00 |
$15.00 |
$15.00 |
$13.32
|
|
Sternal debridement
|
$568.80 |
$568.80 |
$568.80 |
$1,318.40
|
|
St evaluate speech sound production
|
$142.80 |
$142.80 |
$142.80 |
$292.95
|
|
St evaluate speech sound production comprehensive/expressive
|
$233.10 |
$233.10 |
$233.10 |
$377.00
|
|
St evaluation motion fluoroscopic swallow function cine/video
|
$358.50 |
$358.50 |
$358.50 |
$399.60
|
|
St evaluation swallow function
|
$171.00 |
$171.00 |
$171.00 |
$314.40
|
|
Stimulants synthetic
|
$2.10 |
$2.10 |
$2.10 |
$80.08
|
|
Stot/tot hysterectomy after cesaren delivery 59525
|
$465.30 |
$465.30 |
$465.30 |
$2,607.60
|
|
Strapping of ankle and/or ft 29540
|
$30.00 |
$30.00 |
$30.00 |
$223.45
|
|
Strapping of chest
|
$33.60 |
$33.60 |
$33.60 |
$195.33
|
|
Strapping of elbow or wrist 29260
|
$86.70 |
$86.70 |
$86.70 |
$154.70
|
|
Strapping of hand or finger
|
$52.80 |
$52.80 |
$52.80 |
$174.82
|
|
Strapping of hip
|
$36.90 |
$36.90 |
$36.90 |
$164.70
|
|
Strapping of knee
|
$31.20 |
$31.20 |
$31.20 |
$205.20
|
|
Strapping of toes 29550
|
$21.00 |
$21.00 |
$21.00 |
$164.70
|
|
Strep b dna amp probe
|
$174.60 |
$174.60 |
$174.60 |
$120.90
|
|
Stress test pulmonary
|
$208.42 |
$208.42 |
$208.42 |
$322.85
|
|
Stress tte complete
|
$96.30 |
$96.30 |
$96.30 |
$1,870.50
|
|
St treatment speech individual
|
$108.90 |
$108.90 |
$108.90 |
$248.84
|
|
St treatment swallow dysfunction/oral
|
$111.30 |
$111.30 |
$111.30 |
$240.31
|
|
Subq i/p critical care pr day age 28 days/less than 99469
|
$280.20 |
$280.20 |
$280.20 |
$717.60
|
|
Subsequent intensive care infant 1500-2500 grams 99479
|
$87.60 |
$87.60 |
$87.60 |
$224.80
|
|
Subsequent intensive care infant 2501-5000 grams 99480
|
$84.30 |
$84.30 |
$84.30 |
$216.00
|
|
Subtalar arthro w/fb rmvl
|
$675.90 |
$675.90 |
$675.90 |
$3,839.54
|
|
Subtalar arthro w/fusion
|
$918.60 |
$918.60 |
$918.60 |
$14,241.77
|
|
Succinylcholine chloride 20 mg/ml injection solution (wrapper)
|
$5.94 |
$5.94 |
$5.94 |
$52.31
|
|
Sugars single quant
|
$3.07 |
$3.07 |
$3.07 |
$64.28
|
|
Sulfonylurea screen qn-sendout
|
$28.13 |
$28.13 |
$28.13 |
$156.16
|
|
Sumatriptan 6 mg/0.5 ml subcutaneous solution
|
$64.50 |
$64.50 |
$64.50 |
$114.88
|
|
Sup of prep of antigen # of vials 95144
|
$12.90 |
$12.90 |
$12.90 |
$54.60
|
|
Support clav 29.6-40.5in med
|
$65.40 |
$65.40 |
$65.40 |
$94.19
|
|
Suprv interfacilty transport
|
$42.90 |
$42.90 |
$42.90 |
$139.20
|
|
Suprv interfac trnsport addl
|
$37.50 |
$37.50 |
$37.50 |
$120.80
|
|
Surg dx exam anorectal
|
$108.00 |
$108.00 |
$108.00 |
$3,245.23
|
|
Surg ect salp-oophorectomy 59120
|
$812.70 |
$812.70 |
$812.70 |
$1,632.60
|
|
Surg ect without salp-oophorectomy 59121
|
$812.40 |
$812.40 |
$812.40 |
$1,634.40
|
|
Surgical opening of stomach 43500
|
$794.40 |
$794.40 |
$794.40 |
$1,477.80
|
|
Surgical pathology level 1 gross examination only
|
$33.90 |
$33.90 |
$33.90 |
$79.50
|
|
Surgical pathology level 2 gross & microscopic examination
|
$83.40 |
$83.40 |
$83.40 |
$141.94
|
|
Surgical pathology level 3 gross & microscopic examination
|
$90.00 |
$90.00 |
$90.00 |
$181.00
|
|
Surgical pathology level 4 gross & microscopic examination
|
$177.30 |
$177.30 |
$177.30 |
$239.85
|
|
Surgical pathology level 5 gross & microscopic examination
|
$343.80 |
$343.80 |
$343.80 |
$480.00
|
|
Surgical pathology level 6 gross & microscopic examination
|
$713.10 |
$713.10 |
$713.10 |
$718.00
|
|
Surgical repair stomach bleedin ulcer 43501
|
$1,346.10 |
$1,346.10 |
$1,346.10 |
$2,536.20
|
|
Surgical repair stomach gastric lac 43502
|
$1,520.40 |
$1,520.40 |
$1,520.40 |
$2,864.40
|
|
Surgical revision intestine
|
$1,075.80 |
$1,075.80 |
$1,075.80 |
$2,607.20
|
|
Surg tx anal fistula 2nd stage 46285
|
$449.70 |
$449.70 |
$449.70 |
$3,245.23
|
