|
Skeletal muscle relaxant 1/2
|
$15.00 |
$15.00 |
$15.00 |
$83.85
|
|
Skin Biopsy
|
$484.25 |
$484.25 |
$484.25 |
$362.40
|
|
Skin full graft 20sq cm less 15200
|
$2,379.00 |
$2,379.00 |
$2,379.00 |
$2,379.00
|
|
Skin split graft addl 100sq cm 15101
|
$447.20 |
$447.20 |
$447.20 |
$1,793.40
|
|
Skull X-ray (1 to 3 views)
|
$648.05 |
$648.05 |
$648.05 |
$295.10
|
|
Skull X-ray (complete)
|
$669.50 |
$669.50 |
$669.50 |
$424.80
|
|
Skyla, 13.5 mg
|
$1,577.76 |
$1,577.76 |
$1,577.76 |
$1,643.47
|
|
Sleep study attended
|
$2,974.40 |
$2,974.40 |
$2,974.40 |
$1,329.00
|
|
Sleep Study (Polysomnography)
|
$6,418.75 |
$6,418.75 |
$6,418.75 |
$3,734.50
|
|
Sleep study unattended
|
$1,143.35 |
$1,143.35 |
$1,143.35 |
$594.00
|
|
Sleeve fing rolyan med
|
$381.55 |
$381.55 |
$381.55 |
$206.00
|
|
Sling arm deluxe w/pad xs
|
$37.70 |
$37.70 |
$37.70 |
$30.35
|
|
Slitting of prepuce
|
$7,656.35 |
$7,656.35 |
$7,656.35 |
$3,376.23
|
|
Slp pure tone screening
|
$40.30 |
$40.30 |
$40.30 |
$64.50
|
|
Slp stdy unatnd w/anal
|
$221.00 |
$221.00 |
$221.00 |
$285.00
|
|
Small Bowel Barium X-ray (Follow-Through)
|
$997.75 |
$997.75 |
$997.75 |
$561.60
|
|
Small bowel endoscopy
|
$647.40 |
$647.40 |
$647.40 |
$2,596.41
|
|
Small bowel endoscopy
|
$943.80 |
$943.80 |
$943.80 |
$2,244.82
|
|
Small bowel endoscopy
|
$7,090.20 |
$7,090.20 |
$7,090.20 |
$2,638.57
|
|
Small bowel endoscopy
|
$1,146.60 |
$1,146.60 |
$1,146.60 |
$2,518.10
|
|
Small bowel endoscopy
|
$1,339.00 |
$1,339.00 |
$1,339.00 |
$2,638.57
|
|
Small bowel endoscopy
|
$1,825.20 |
$1,825.20 |
$1,825.20 |
$3,265.60
|
|
Small bowel endoscopy
|
$3,504.15 |
$3,504.15 |
$3,504.15 |
$2,088.00
|
|
Small bowel endoscopy >2nd w/remove 44363
|
$881.40 |
$881.40 |
$881.40 |
$2,590.33
|
|
Small bowel endoscopy 44365
|
$834.60 |
$834.60 |
$834.60 |
$2,244.82
|
|
Small bowel endoscopy/biopsy
|
$720.20 |
$720.20 |
$720.20 |
$2,490.15
|
|
Small bowel endoscopy/biopsy
|
$1,409.20 |
$1,409.20 |
$1,409.20 |
$2,244.82
|
|
Small bowel endoscopy br/wa
|
$3,504.15 |
$3,504.15 |
$3,504.15 |
$1,924.00
|
|
Small bowel endoscopy br/wa
|
$7,090.20 |
$7,090.20 |
$7,090.20 |
$2,406.40
|
|
Small bowel endoscopy/stent 44370
|
$1,219.40 |
$1,219.40 |
$1,219.40 |
$4,992.00
|
|
Smear fluorescent and/or acid fast stain
|
$20.80 |
$20.80 |
$20.80 |
$64.00
|
|
Smear gram stain
|
$52.65 |
$52.65 |
$52.65 |
$55.35
|
|
Smear nasal eosinophil
|
$27.95 |
$27.95 |
$378.00 |
$45.83
|
|
Smear special stain inclusion bodies/parasites
|
$114.40 |
$114.40 |
$114.40 |
$73.15
|
|
Smear wet mount
|
$55.90 |
$55.90 |
$55.90 |
$67.55
|
|
Smpd1 gene common variants
|
$84.50 |
$84.50 |
$84.50 |
$133.84
|
|
Snrpn/ube3a gene
|
$588.90 |
$588.90 |
$588.90 |
$230.63
|
|
Sodium 24 hour urine
|
$70.85 |
$70.85 |
$70.85 |
$48.68
|
|
Sodium chloride 0.9 % intravenous solution
|
$81.25 |
$81.25 |
$382.00 |
$48.58
|
|
Sodium chloride 0.9 % IV bolus
|
$65.00 |
$65.00 |
$382.00 |
$45.56
|
|
Sodium chloride 0.9 % IV bolus
|
$54.60 |
$54.60 |
$54.60 |
$37.64
|
|
Sodium chloride 3 % ivpb
|
$0.60 |
$0.60 |
$0.60 |
$39.60
|
|
Sodium ferric gluconate complex in sucrose 62.5 mg/5 ml intravenous
|
$22.10 |
$22.10 |
$934.00 |
$80.73
|
|
Sodium hyaluronate 20 mg/2 ml syringe
|
$242.45 |
$242.45 |
$242.45 |
$410.40
|
|
Sodium serum/plasma/whole blood
|
$70.85 |
$70.85 |
$70.85 |
$46.00
|
|
Sodium thiosulfate 12.5 gram/50 ml (250 mg/ml) intravenous solution
|
$4.68 |
$4.68 |
$841.02 |
$177.52
|
|
Somatosensory testing
|
$1,745.90 |
$1,745.90 |
$1,745.90 |
$816.00
|
|
Somatropin injection
|
$2,770.40 |
$2,770.40 |
$2,770.40 |
$2,111.40
|
|
Sotalol hydrochloride IV
|
$771.26 |
$771.26 |
$771.26 |
$5,761.57
|
|
Spacer bag/reservoir
|
$22.75 |
$22.75 |
$22.75 |
$26.00
|
|
Sp bone agrft morsel add-on
|
$725.40 |
$725.40 |
$725.40 |
$406.40
|
|
Sp bone agrft struct add-on
|
$785.20 |
$785.20 |
$785.20 |
$442.40
|
|
Sp bone algrft morsel add-on
|
$498.55 |
$498.55 |
$498.55 |
$498.55
|
|
Special casting material
|
$83.20 |
$83.20 |
$83.20 |
$47.45
|
|
Special physics consult
|
$1,479.40 |
$1,479.40 |
$5,481.00 |
$725.00
|
|
Special radiation dosimetry
|
$993.20 |
$993.20 |
$1,659.00 |
$392.73
|
|
Special radiation treatment
|
$3,823.30 |
$3,823.30 |
$3,823.30 |
$2,052.00
|
|
Special supplies phys/qhp
|
$31.85 |
$31.85 |
$31.85 |
$60.00
|
|
Special teletx port plan
|
$2,324.40 |
$2,324.40 |
$2,324.40 |
$1,100.00
|
|
Specific gravity body fluid
|
$12.35 |
$12.35 |
$12.35 |
$22.00
|
|
Specimen fat stain
|
$7.15 |
$7.15 |
$650.00 |
$35.10
|
|
Speech and Language Evaluation (comprehensive)
|
$998.40 |
$998.40 |
$2,307.00 |
$385.00
|
|
Speech audiometry complete
|
$193.70 |
$193.70 |
$193.70 |
$109.20
|
|
Speech recep thresh
|
$193.70 |
$193.70 |
$193.70 |
$82.88
|
|
Speech Therapy Session (one-on-one)
|
$384.15 |
$384.15 |
$1,740.00 |
$248.84
|
|
Sperm antibody test
|
$182.65 |
$182.65 |
$182.65 |
$57.85
|
|
Sperm identification
|
$757.90 |
$757.90 |
$757.90 |
$101.55
|
|
Sperm isolation complex
|
$375.70 |
$375.70 |
$375.70 |
$176.28
|
|
Sperm isolation simple
|
$201.50 |
$201.50 |
$201.50 |
$126.05
|
|
Sphenoid sinus surgery
|
$1,885.00 |
$1,885.00 |
$1,885.00 |
$6,547.81
|
|
Spinal bone allograftstructural 20931
|
$470.60 |
$470.60 |
$470.60 |
$266.40
|
|
Spinal bone autograftlocal 20936
|
$707.85 |
$707.85 |
$707.85 |
$424.20
|
|
Spinal puncture lumbar diagnostic w/fluoroscopic or CT guidance
|
$3,882.45 |
$3,882.45 |
$3,882.45 |
$1,474.00
|
|
Spine X-ray (single view, one level)
|
$535.60 |
$535.60 |
$535.60 |
$251.40
|
|
Spirmtry w/brnchdil inf-2 yr
|
$741.00 |
$741.00 |
$741.00 |
$368.50
|
|
Spirometry up to 2 yrs old
|
$455.00 |
$455.00 |
$455.00 |
$242.25
|
|
Spleen imaging
|
$114.40 |
$114.40 |
$3,553.00 |
$679.00
|
|
Splenectomy total open 38100
|
$5,083.00 |
$5,083.00 |
$5,083.00 |
$2,166.00
|
|
Splint arm vnyl coated padded lft med
|
$37.05 |
$37.05 |
$37.05 |
$48.00
|
|
Splint dorsal bloc wh med perf 3.2mm lf polyflex ii
|
$754.00 |
$754.00 |
$754.00 |
$392.09
|
|
Splint extn xsm w sof-stretch rolyan
|
$94.25 |
$94.25 |
$94.25 |
$68.25
|
|
Splint finger 4 prong foam sm
|
$37.70 |
$37.70 |
$37.70 |
$34.00
|
|
Splint finger fold over sm
|
$105.30 |
$105.30 |
$105.30 |
$151.34
|
|
Splint finger frog med
|
$62.40 |
$62.40 |
$62.40 |
$38.08
|
|
Splint fing stax assort 1-7in
|
$6.50 |
$6.50 |
$6.50 |
$5.60
|
|
Splint func pos polyflex ii med
|
$37.05 |
$37.05 |
$37.05 |
$61.64
|
|
Splint rstrc wrst/cmc right med
|
$155.35 |
$155.35 |
$155.35 |
$100.00
|
|
Split atogrft f/s/n/h/f/g/m/d gt 1st 100sqcm/</1 %
|
$8,923.85 |
$8,923.85 |
$8,923.85 |
$4,687.20
|
|
Split blood or products
|
$122.85 |
$122.85 |
$122.85 |
$129.50
|
|
Splt agrft f/s/n/h/f/g/m ea
|
$520.00 |
$520.00 |
$520.00 |
$1,612.78
|
|
Sprchoroidal spc njx rx agt
|
$1,240.20 |
$1,240.20 |
$1,240.20 |
$454.19
|
|
Sputum specimen collection
|
$117.00 |
$117.00 |
$117.00 |
$180.00
|
|
Srs cranial lesion complex
|
$5,161.00 |
$5,161.00 |
$5,161.00 |
$3,244.00
|
|
Srs cranial lesion simple
|
$3,621.80 |
$3,621.80 |
$3,621.80 |
$3,145.05
|
|
Srs cran les complex addl
|
$1,250.60 |
$1,250.60 |
$1,250.60 |
$711.20
|
|
Srs cran les simple addl
|
$904.80 |
$904.80 |
$904.80 |
$719.20
|
|
Srs linear based
|
$42,857.10 |
$42,857.10 |
$42,857.10 |
$14,124.25
|
|
Srs spinal lesion
|
$4,461.60 |
$4,461.60 |
$4,461.60 |
$2,631.20
|
|
Srs spinal lesion addl
|
$1,144.00 |
$1,144.00 |
$1,144.00 |
$591.20
|
|
Staggered spondaic word test
|
$224.25 |
$224.25 |
$224.25 |
$253.00
|
