|
Small bowel endoscopy
|
$103.36 |
$103.36 |
$103.36 |
$2,463.36
|
|
Small bowel endoscopy
|
$186.24 |
$186.24 |
$186.24 |
$2,638.57
|
|
Small bowel endoscopy/biopsy
|
$124.16 |
$124.16 |
$124.16 |
$2,413.20
|
|
Smear fluorescent and/or acid fast stain
|
$158.72 |
$158.72 |
$158.72 |
$64.20
|
|
Smear gram stain
|
$158.72 |
$158.72 |
$158.72 |
$55.25
|
|
Smear nasal eosinophil
|
$6.08 |
$6.08 |
$6.08 |
$46.20
|
|
Smear special stain inclusion bodies/parasites
|
$13.44 |
$13.44 |
$13.44 |
$73.15
|
|
Smear wet mount
|
$32.32 |
$32.32 |
$32.32 |
$67.49
|
|
Sodium 24 hour urine
|
$43.20 |
$43.20 |
$43.20 |
$48.60
|
|
Sodium chloride 0.9 % intravenous solution
|
$13.76 |
$13.76 |
$13.76 |
$48.11
|
|
Sodium chloride 0.9 % IV bolus
|
$13.76 |
$13.76 |
$13.76 |
$46.00
|
|
Sodium chloride 0.9 % IV bolus
|
$13.69 |
$13.69 |
$13.69 |
$37.50
|
|
Sodium chloride 3 % ivpb
|
$14.39 |
$14.39 |
$14.39 |
$40.61
|
|
Sodium ferric gluconate complex in sucrose 62.5 mg/5 ml intravenous
|
$45.18 |
$45.18 |
$45.18 |
$77.77
|
|
Sodium serum/plasma/whole blood
|
$44.80 |
$44.80 |
$44.80 |
$45.60
|
|
Sodium thiosulfate 12.5 gram/50 ml (250 mg/ml) intravenous solution
|
$107.74 |
$107.74 |
$107.74 |
$177.52
|
|
Sp bone algrft morsel add-on
|
$429.76 |
$429.76 |
$429.76 |
$498.55
|
|
Special physics consult
|
$131.84 |
$131.84 |
$131.84 |
$725.00
|
|
Special radiation treatment
|
$504.64 |
$504.64 |
$504.64 |
$1,986.00
|
|
Special supplies phys/qhp
|
$19.84 |
$19.84 |
$19.84 |
$60.00
|
|
Special teletx port plan
|
$464.96 |
$464.96 |
$464.96 |
$1,086.99
|
|
Specific gravity body fluid
|
$4.48 |
$4.48 |
$4.48 |
$22.00
|
|
Specimen fat stain
|
$105.60 |
$105.60 |
$105.60 |
$35.10
|
|
Speech recep thresh
|
$27.20 |
$27.20 |
$27.20 |
$82.88
|
|
Spinal puncture lumbar diagnostic w/fluoroscopic or CT guidance
|
$761.92 |
$761.92 |
$761.92 |
$1,439.40
|
|
Spirometry bronchodilation responsiveness pre/post bronchodilator administration
|
$364.80 |
$364.80 |
$364.80 |
$543.26
|
|
Splint finger 4 prong foam sm
|
$64.64 |
$64.64 |
$64.64 |
$34.00
|
|
Split atogrft f/s/n/h/f/g/m/d gt 1st 100sqcm/</1 %
|
$442.56 |
$442.56 |
$442.56 |
$4,619.65
|
|
Sr-89 stront chlor ther / mci
|
$2,181.12 |
$2,181.12 |
$2,181.12 |
$2,667.94
|
|
St analysis behavior qualitative voice/resonance
|
$130.56 |
$130.56 |
$130.56 |
$297.60
|
|
Staph a dna amp probe
|
$33.28 |
$33.28 |
$33.28 |
$125.00
|
|
St cognitve performance testing healthcare professional each hour
|
$156.16 |
$156.16 |
$156.16 |
$286.00
|
|
Stent axios caut enh 15x10mm electrocaut
|
$40,000.00 |
$40,000.00 |
$40,000.00 |
$32,403.15
|
|
Stent bili dbl pgtl 10fx5cm
|
$6,593.92 |
$6,593.92 |
$6,593.92 |
$2,520.08
|
|
Stent bili rx wallflx 10x80 uncvr
|
$18,867.20 |
$18,867.20 |
$18,867.20 |
$20,962.50
|
|
Stent bronch dumon sil 10x40mm
|
$4,512.00 |
$4,512.00 |
$4,512.00 |
$4,939.20
|
|
Sterile water/saline, 10 ml
|
$12.16 |
$12.16 |
$12.16 |
$13.32
|
|
Sterile water/saline, 500 ml
|
$16.00 |
$16.00 |
$16.00 |
$28.11
|
|
St evaluate speech sound production
|
$120.32 |
$120.32 |
$120.32 |
$292.95
|
|
St evaluate speech sound production comprehensive/expressive
|
$145.92 |
$145.92 |
$145.92 |
$377.00
|
|
St evaluation motion fluoroscopic swallow function cine/video
|
$182.40 |
$182.40 |
$182.40 |
$399.60
|
|
St evaluation swallow function
|
$178.88 |
$178.88 |
$178.88 |
$314.40
|
|
Stimulants synthetic
|
$40.32 |
$40.32 |
$40.32 |
$80.08
|
|
Strapping of ankle and/or ft 29540
|
$86.40 |
$86.40 |
$86.40 |
$223.45
|
|
Strapping of elbow or wrist 29260
|
$86.40 |
$86.40 |
$86.40 |
$154.70
|
|
Strapping of hand or finger
|
$86.40 |
$86.40 |
$86.40 |
$174.82
|
|
Strapping of knee
|
$86.40 |
$86.40 |
$86.40 |
$205.20
|
|
Strapping of toes 29550
|
$23.68 |
$23.68 |
$23.68 |
$164.70
|
|
Strep a dna dir probe
|
$25.92 |
$25.92 |
$25.92 |
$96.72
|
|
Strep b dna amp probe
|
$67.84 |
$67.84 |
$67.84 |
$120.90
|
|
Stress test pulmonary
|
$170.24 |
$170.24 |
$170.24 |
$322.85
|
|
Stress tte complete
|
$635.52 |
$635.52 |
$635.52 |
$1,870.50
|
|
St treatment speech individual
|
$80.96 |
$80.96 |
$80.96 |
$248.84
|
|
St treatment swallow dysfunction/oral
|
$117.12 |
$117.12 |
$117.12 |
$240.31
|
|
Subq i/p critical care pr day age 28 days/less than 99469
|
$235.84 |
$235.84 |
$235.84 |
$717.60
|
|
Subsequent intensive care infant 1500-2500 grams 99479
|
$93.76 |
$93.76 |
$93.76 |
$224.80
|
|
Subsequent intensive care infant 2501-5000 grams 99480
|
$91.84 |
$91.84 |
$91.84 |
$216.00
|
|
Succinylcholine chloride 20 mg/ml injection solution (wrapper)
|
$6.08 |
$6.08 |
$6.08 |
$52.31
|
|
Sugars single quant
|
$10.24 |
$10.24 |
$10.24 |
$64.28
|
|
Sulfonylurea screen qn-sendout
|
$59.84 |
$59.84 |
$59.84 |
$156.16
|
|
Surg dx exam anorectal
|
$83.20 |
$83.20 |
$83.20 |
$3,245.23
|
|
Surg ect salp-oophorectomy 59120
|
$636.16 |
$636.16 |
$636.16 |
$1,632.60
|
|
Surg ect without salp-oophorectomy 59121
|
$635.84 |
$635.84 |
$635.84 |
$1,634.40
|
|
Surgical pathology level 1 gross examination only
|
$30.08 |
$30.08 |
$30.08 |
$79.50
|
|
Surgical pathology level 2 gross & microscopic examination
|
$63.04 |
$63.04 |
$63.04 |
$141.94
|
|
Surgical pathology level 3 gross & microscopic examination
|
$88.96 |
$88.96 |
$88.96 |
$181.00
|
|
Surgical pathology level 4 gross & microscopic examination
|
$129.28 |
$129.28 |
$129.28 |
$239.85
|
|
Surgical pathology level 5 gross & microscopic examination
|
$220.16 |
$220.16 |
$220.16 |
$480.00
|
|
Surgical pathology level 6 gross & microscopic examination
|
$440.96 |
$440.96 |
$440.96 |
$718.00
|
|
Susceptibility agar dilution per agent
|
$19.52 |
$19.52 |
$19.52 |
$45.45
|
|
Susceptibility enzyme detection per enzyme
|
$7.67 |
$7.67 |
$7.67 |
$35.70
|
|
Susceptibility mic per plate
|
$47.36 |
$47.36 |
$47.36 |
$106.00
|
|
Suscept studies macrobroth dilution ea
|
$24.00 |
$24.00 |
$24.00 |
$59.28
|
|
Sutr lg intestine 1/mult perf without colostomy 44604
|
$813.44 |
$813.44 |
$813.44 |
$1,995.00
|
|
Svc venogram s&i
|
$616.96 |
$616.96 |
$616.96 |
$1,934.62
|
|
Syphilis test non-treponemal antibody quantitative rpr
|
$35.20 |
$35.20 |
$35.20 |
$41.60
|
|
System pacing micra av
|
$23,200.00 |
$23,200.00 |
$23,200.00 |
$24,577.07
|
|
System pcmkr dual chamber leadless micra av2 intrdcr cath
|
$10,400.00 |
$10,400.00 |
$10,400.00 |
$12,003.00
|
|
T3 (triiodothyronine) free
|
$91.84 |
$91.84 |
$91.84 |
$99.20
|
|
T3 (triiodothyronine) total
|
$88.00 |
$88.00 |
$88.00 |
$93.52
|
|
T4 (thyroxine) free
|
$39.36 |
$39.36 |
$39.36 |
$85.20
|
|
T4 (thyroxine) total
|
$57.60 |
$57.60 |
$57.60 |
$69.00
|
|
Tacrolimus 1 mg capsule, immediate-release
|
$6.28 |
$6.28 |
$6.28 |
$9.84
|
|
Tacrolimus therapeutic drug level
|
$142.40 |
$142.40 |
$142.40 |
$122.40
|
|
Tamoxifen 10 mg tabs 60 each bottle
|
$7.30 |
$7.30 |
$7.30 |
$14.62
|
|
Target gsa panel hmtlmph neop
|
$96.00 |
$96.00 |
$96.00 |
$2,246.30
|
|
Target gsa panel organ/hmtlmph neop
|
$1,868.16 |
$1,868.16 |
$1,868.16 |
$3,746.70
|
|
Target gsa panel organ neop
|
$384.00 |
$384.00 |
$384.00 |
$1,655.52
|
|
Tbp gene detc abnor alleles
|
$72.25 |
$72.25 |
$72.25 |
$225.42
|
|
Tb test cell mediated immunity antigen response enumeration gamma interferon t-cells
|
$85.76 |
$85.76 |
$85.76 |
$194.35
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$128.96 |
$128.96 |
$128.96 |
$177.65
|
|
Tc-99m diag per dose
|
$47.36 |
$47.36 |
$47.36 |
$470.40
|
|
Tc-99m disofenin
|
$29.76 |
$29.76 |
$29.76 |
$124.32
|
|
Tc-99m exametazime diag
|
$384.64 |
$384.64 |
$384.64 |
$2,033.20
|
|
Tc-99m gluceptate
|
$32.64 |
$32.64 |
$32.64 |
$31.35
|
|
Tc-99m labeled rbc
|
$57.60 |
$57.60 |
$57.60 |
$302.40
|
|
Tc-99m maa
|
$989.12 |
$989.12 |
$989.12 |
$292.80
|
|
Tc-99m mebrofenin
|
$49.60 |
$49.60 |
$49.60 |
$157.65
|
|
Tc-99m medronate
|
$54.72 |
$54.72 |
$54.72 |
$111.01
|
|
Tc-99m mertiatide
|
$162.88 |
$162.88 |
$162.88 |
$756.00
|
