|
Shoulder MRI (without contrast)
|
$1,355.25 |
$1,355.25 |
$1,355.25 |
$2,088.20
|
|
Shoulder prosthesis removal
|
$4,940.00 |
$4,940.00 |
$4,940.00 |
$4,832.80
|
|
Shoulder X-ray
|
$507.65 |
$507.65 |
$507.65 |
$341.40
|
|
Shoulder X-ray (single view, both shoulders)
|
$494.00 |
$494.00 |
$494.00 |
$264.00
|
|
Shuntogram nonvascular supervision & interpretation
|
$134.55 |
$134.55 |
$134.55 |
$355.80
|
|
Sialography s&i
|
$98.80 |
$98.80 |
$98.80 |
$499.20
|
|
Sialolithotomy 42330
|
$12,121.20 |
$12,121.20 |
$12,121.20 |
$3,837.72
|
|
Sickling rbc
|
$70.85 |
$70.85 |
$70.85 |
$59.40
|
|
Sigmoidoscopy and biopsy
|
$326.30 |
$326.30 |
$326.30 |
$1,446.90
|
|
Sigmoidoscopy flex decompression 45337
|
$3,407.95 |
$3,407.95 |
$3,407.95 |
$1,078.88
|
|
Sigmoidoscopy for bleeding
|
$4,407.00 |
$4,407.00 |
$4,407.00 |
$1,993.08
|
|
Sigmoidoscopy/submucosal injection 45335
|
$3,407.95 |
$3,407.95 |
$3,407.95 |
$1,650.75
|
|
Sigmoidoscopy w/ablation
|
$803.40 |
$803.40 |
$803.40 |
$2,604.00
|
|
Sigmoidoscopy w/fb removal 45332
|
$503.10 |
$503.10 |
$503.10 |
$1,395.28
|
|
Sigmoidoscopy w/plcmt stent
|
$778.05 |
$778.05 |
$778.05 |
$3,692.00
|
|
Sigmoidoscopy w/resection
|
$10,249.85 |
$10,249.85 |
$10,249.85 |
$2,997.10
|
|
Sigmoidoscopy w/tumr remove
|
$4,407.00 |
$4,407.00 |
$4,407.00 |
$1,645.43
|
|
Sigmoidoscopy w/ultrasound
|
$3,407.95 |
$3,407.95 |
$3,407.95 |
$1,740.57
|
|
Sigmoidoscopy w/us guide bx
|
$852.15 |
$852.15 |
$852.15 |
$2,288.00
|
|
Signal avg ecg w or without ecg 93278
|
$278.20 |
$278.20 |
$278.20 |
$280.00
|
|
Sig w/tndsc balloon dilation
|
$4,407.00 |
$4,407.00 |
$4,407.00 |
$2,288.00
|
|
Simple cystometrogram 51725
|
$909.35 |
$909.35 |
$909.35 |
$589.45
|
|
Sincalide 5 mcg solution for injection
|
$305.29 |
$305.29 |
$305.29 |
$309.14
|
|
Single energy x-ray study
|
$63.05 |
$63.05 |
$63.05 |
$125.84
|
|
Sinus CT scan (with and without contrast)
|
$997.75 |
$997.75 |
$997.75 |
$1,796.50
|
|
Sinus CT scan (with contrast)
|
$997.75 |
$997.75 |
$997.75 |
$1,527.60
|
|
Sinus CT scan (without contrast)
|
$596.70 |
$596.70 |
$596.70 |
$1,289.00
|
|
Sinus/juglr venogram s&i
|
$17,646.20 |
$17,646.20 |
$17,646.20 |
$2,517.48
|
|
Sinusotomy sinus remove polyps 31032
|
$1,739.40 |
$1,739.40 |
$1,739.40 |
$6,465.11
|
|
Sinus X-ray (complete)
|
$494.00 |
$494.00 |
$494.00 |
$347.10
|
|
Sinus X-ray (limited)
|
$494.00 |
$494.00 |
$494.00 |
$215.75
|
|
Sipuleucel-t - su
|
$585.96 |
$585.96 |
$585.96 |
$100,990.51
|
|
Sirolimus, oral
|
$56.88 |
$56.88 |
$56.88 |
$41.70
|
|
Skin and muscle repair face
|
$3,723.20 |
$3,723.20 |
$3,723.20 |
$4,332.25
|
|
Skin Biopsy
|
$484.25 |
$484.25 |
$484.25 |
$361.20
|
|
Skin full graft 20sq cm less 15200
|
$2,379.00 |
$2,379.00 |
$2,379.00 |
$2,379.00
|
|
Skin full graft add-on 15241
|
$531.70 |
$531.70 |
$531.70 |
$560.01
|
|
Skin split graft addl 100sq cm 15101
|
$447.20 |
$447.20 |
$447.20 |
$1,793.40
|
|
Skull X-ray (1 to 3 views)
|
$596.70 |
$596.70 |
$596.70 |
$294.66
|
|
Skull X-ray (complete)
|
$596.70 |
$596.70 |
$596.70 |
$423.15
|
|
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)
|
$5,703.75 |
$5,703.75 |
$5,703.75 |
$3,734.50
|
|
Sleep study unattended
|
$877.50 |
$877.50 |
$877.50 |
$594.00
|
|
Sleeve fing rolyan med
|
$16.25 |
$16.25 |
$16.25 |
$203.58
|
|
Slitting of prepuce
|
$7,656.35 |
$7,656.35 |
$7,656.35 |
$3,376.23
|
|
Slp pure tone screening
|
$52.00 |
$52.00 |
$52.00 |
$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 |
$557.70
|
|
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
|
$7,090.20 |
$7,090.20 |
$7,090.20 |
$2,518.10
|
|
Small bowel endoscopy
|
$7,090.20 |
$7,090.20 |
$7,090.20 |
$2,638.57
|
|
Small bowel endoscopy
|
$7,090.20 |
$7,090.20 |
$7,090.20 |
$3,265.60
|
|
Small bowel endoscopy
|
$3,504.15 |
$3,504.15 |
$3,504.15 |
$2,088.00
|
|
Small bowel endoscopy/biopsy
|
$720.20 |
$720.20 |
$720.20 |
$2,490.15
|
|
Small bowel endoscopy br/wa
|
$226.20 |
$226.20 |
$226.20 |
$1,924.00
|
|
Small bowel endoscopy br/wa
|
$7,090.20 |
$7,090.20 |
$7,090.20 |
$2,406.40
|
|
Smear fluorescent and/or acid fast stain
|
$20.80 |
$20.80 |
$20.80 |
$64.20
|
|
Smear gram stain
|
$48.10 |
$48.10 |
$48.10 |
$55.42
|
|
Smear nasal eosinophil
|
$23.40 |
$23.40 |
$23.40 |
$46.20
|
|
Smear special stain inclusion bodies/parasites
|
$70.85 |
$70.85 |
$70.85 |
$73.15
|
|
Smear wet mount
|
$48.10 |
$48.10 |
$48.10 |
$67.49
|
|
Sodium 24 hour urine
|
$70.85 |
$70.85 |
$70.85 |
$48.75
|
|
Sodium chloride 0.9 % intravenous solution
|
$81.25 |
$81.25 |
$81.25 |
$48.58
|
|
Sodium chloride 0.9 % IV bolus
|
$65.00 |
$65.00 |
$65.00 |
$45.56
|
|
Sodium chloride 0.9 % IV bolus
|
$45.50 |
$45.50 |
$45.50 |
$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
|
$14.88 |
$14.88 |
$14.88 |
$80.73
|
|
Sodium hyaluronate 20 mg/2 ml syringe
|
$222.30 |
$222.30 |
$222.30 |
$410.40
|
|
Sodium serum/plasma/whole blood
|
$47.45 |
$47.45 |
$47.45 |
$46.26
|
|
Sodium thiosulfate 12.5 gram/50 ml (250 mg/ml) intravenous solution
|
$4.68 |
$4.68 |
$4.68 |
$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
|
|
Sp bone algrft morsel add-on
|
$498.55 |
$498.55 |
$498.55 |
$498.55
|
|
Special physics consult
|
$744.25 |
$744.25 |
$744.25 |
$725.00
|
|
Special radiation dosimetry
|
$744.25 |
$744.25 |
$744.25 |
$392.50
|
|
Special radiation treatment
|
$3,242.85 |
$3,242.85 |
$3,242.85 |
$2,052.00
|
|
Special supplies phys/qhp
|
$31.85 |
$31.85 |
$31.85 |
$60.00
|
|
Special teletx port plan
|
$2,052.70 |
$2,052.70 |
$2,052.70 |
$1,095.05
|
|
Specific gravity body fluid
|
$12.35 |
$12.35 |
$12.35 |
$22.00
|
|
Speech and Language Evaluation (comprehensive)
|
$998.40 |
$998.40 |
$998.40 |
$385.00
|
|
Speech Therapy Session (one-on-one)
|
$384.15 |
$384.15 |
$384.15 |
$248.30
|
|
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 |
$1,457.50
|
|
Spine X-ray (single view, one level)
|
$494.00 |
$494.00 |
$494.00 |
$251.00
|
|
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 |
$114.40 |
$679.00
|
|
Splenectomy total open 38100
|
$5,083.00 |
$5,083.00 |
$5,083.00 |
$2,166.00
|
|
Splint dorsal bloc wh med perf 3.2mm lf polyflex ii
|
$47.45 |
$47.45 |
$47.45 |
$388.80
|
|
Splint extn xsm w sof-stretch rolyan
|
$16.25 |
$16.25 |
$16.25 |
$71.44
|
|
Splint finger frog med
|
$17.55 |
$17.55 |
$17.55 |
$38.08
|
|
Split atogrft f/s/n/h/f/g/m/d gt 1st 100sqcm/</1 %
|
$8,923.85 |
$8,923.85 |
$8,923.85 |
$4,689.60
|
|
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
|
