|
Scrotal (Testicle) Ultrasound
|
$382.20 |
$409.00 |
$942.66 |
|
|
Sec art mech thrmbc non-intracranial add-on
|
$2,068.50 |
$3,968.40 |
$3,968.40 |
|
|
Sedation moderate same physician performing a gastrointestinal endoscopic service >= 5 years initial 15 minutes intra-service time
|
$286.80 |
$306.00 |
$578.40 |
|
|
Sedimentation rate erythrocyte automated
|
$26.40 |
$64.20 |
$138.60 |
|
|
Select picture audiometry
|
$73.20 |
$170.00 |
$178.50 |
|
|
Self-Care and Home Skills Training (each 15 minutes)
|
$60.00 |
$78.50 |
$192.13 |
|
|
Semen analysis presence/motility
|
$80.40 |
$130.50 |
$150.38 |
|
|
Semen analysis w/count
|
$46.61 |
$145.80 |
$151.80 |
|
|
Sept9 promoter methylation analysis
|
$1,237.60 |
$1,237.60 |
$1,237.60 |
|
|
Serial casting application 97139app
|
$18.00 |
$39.17 |
$76.80 |
|
|
Serpina1 gene
|
$148.20 |
$359.40 |
$1,271.34 |
|
|
Set radiation therapy field
|
$498.12 |
$1,293.00 |
$2,630.26 |
|
|
Set radiation therapy field
|
$572.50 |
$1,914.60 |
$4,083.66 |
|
|
Set radiation therapy field
|
$1,173.25 |
$2,328.00 |
$4,779.22 |
|
|
Sewho cap design without jnts cf
|
$1,351.20 |
$1,351.20 |
$1,351.20 |
|
|
Sex chromatin identification
|
$119.40 |
$144.00 |
$144.00 |
|
|
Sheath gldlight lasr 12fx50cm
|
$29,251.69 |
$29,251.69 |
$29,251.69 |
|
|
Shoe post-op mens m
|
$22.20 |
$36.00 |
$58.20 |
|
|
Shot (Injection into Muscle or Under the Skin)
|
$117.38 |
$148.20 |
$326.80 |
|
|
Shoulder AC Joint X-ray (both sides)
|
$186.12 |
$234.60 |
$972.74 |
|
|
Shoulder Blade (Scapula) X-ray (both sides)
|
$247.50 |
$444.00 |
$2,127.42 |
|
|
Shoulder MRI (with and without contrast)
|
$582.60 |
$1,349.00 |
$8,876.26 |
|
|
Shoulder MRI (with contrast)
|
$582.60 |
$1,169.50 |
$6,516.07 |
|
|
Shoulder MRI (without contrast)
|
$582.60 |
$1,165.20 |
$6,450.03 |
|
|
Shoulder X-ray
|
$275.50 |
$391.20 |
$1,957.50 |
|
|
Shoulder X-ray (single view, both shoulders)
|
$183.94 |
$325.20 |
$1,301.88 |
|
|
Shunt glaucoma baerveldt 350mm
|
$5,545.60 |
$5,545.60 |
$5,545.60 |
|
|
Shuntogram nonvascular supervision & interpretation
|
$285.00 |
$285.00 |
$2,463.65 |
|
|
Sialidase enzyme assay
|
$57.60 |
$88.80 |
$418.34 |
|
|
Sialography s&i
|
$258.00 |
$258.00 |
$1,226.47 |
|
|
Sickling rbc
|
$13.50 |
$80.40 |
$138.60 |
|
|
Signal avg ecg w or without ecg 93278
|
$742.43 |
$742.43 |
$742.43 |
|
|
Simple cystometrogram 51725
|
$1,217.10 |
$1,217.10 |
$1,217.10 |
|
|
Sincalide 5 mcg solution for injection
|
$199.80 |
$364.46 |
$1,337.85 |
|
|
Sinus CT scan (with and without contrast)
|
$501.75 |
$751.50 |
$3,588.64 |
|
|
Sinus CT scan (with contrast)
|
$473.25 |
$634.50 |
$3,046.99 |
|
|
Sinus CT scan (without contrast)
|
$436.25 |
$542.40 |
$2,842.00 |
|
|
Sinus/juglr venogram s&i
|
$1,212.00 |
$1,294.80 |
$14,670.66 |
|
|
Sinus X-ray (complete)
|
$246.50 |
$283.80 |
$994.27 |
|
|
Sinus X-ray (limited)
|
$129.88 |
$192.00 |
$917.77 |
|
|
Sipuleucel-t - su
|
$103,303.45 |
$103,303.45 |
$103,303.45 |
|
|
Sirolimus, oral
|
$11.61 |
$3,675.46 |
$3,675.46 |
|
|
Sirolimus-protein bound 100 mg intravenous suspension
|
$704.28 |
$19,113.40 |
$19,113.40 |
|
|
Skeletal muscle relaxant 1/2
|
$191.15 |
$191.15 |
$191.15 |
|
|
Skin Biopsy
|
$48.82 |
$456.60 |
$489.00 |
|
|
Skin test unlisted antigen ea
|
$62.89 |
$62.89 |
$120.60 |
|
|
Skull X-ray (1 to 3 views)
|
$117.00 |
$232.80 |
$1,259.91 |
|
|
Skull X-ray (complete)
|
$259.75 |
$306.60 |
$1,817.52 |
|
|
Skyla, 13.5 mg
|
$1,205.40 |
$1,205.40 |
$1,205.40 |
|
|
Sleep study attended
|
$790.80 |
$1,147.20 |
$2,722.80 |
|
|
Sleep Study (Polysomnography)
|
$2,001.38 |
$3,991.80 |
$9,473.05 |
|
|
Sleep study unattended
|
$585.00 |
$781.20 |
$1,535.60 |
|
|
Sleeve fing rolyan med
|
$74.00 |
$75.50 |
$204.60 |
|
|
Sling arm deluxe w/pad xs
|
$64.86 |
$64.86 |
$64.86 |
|
|
Sling pelv split sam med
|
$287.01 |
$287.01 |
$287.01 |
|
|
Sling suprapubic suburetheral
|
$5,222.40 |
$5,222.40 |
$74,664.38 |
|
|
Slp eval for nonspeech dev ea addl 30 mins
|
$106.80 |
$106.80 |
$194.58 |
|
|
Slp eval non-spch gen comm dev
|
$211.80 |
$281.00 |
$431.97 |
|
|
Slp pure tone screening
|
$34.80 |
$124.00 |
$130.00 |
|
|
Slp stdy unatnd w/anal
|
$585.00 |
$771.60 |
$832.80 |
|
|
Slp ther svc non-spch gen
|
$185.00 |
$191.00 |
$270.00 |
|
|
Sm-153 lexidron ther
|
$43,032.62 |
$43,032.62 |
$43,032.62 |
|
|
Small Bowel Barium X-ray (Follow-Through)
|
$258.00 |
$530.50 |
$1,677.54 |
|
|
Smallpox&monkeypox vac 0.5ml
|
$0.01 |
$0.01 |
$0.01 |
|
|
Smear fluorescent and/or acid fast stain
|
$32.00 |
$97.20 |
$157.80 |
|
|
Smear gram stain
|
$31.50 |
$73.80 |
$117.00 |
|
|
Smear nasal eosinophil
|
$36.50 |
$81.60 |
$122.40 |
|
|
Smear special stain inclusion bodies/parasites
|
$8.00 |
$119.40 |
$182.40 |
|
|
Smear wet mount
|
$37.75 |
$83.40 |
$127.20 |
|
|
Smn1 gene full gene sequence
|
$961.43 |
$961.43 |
$961.43 |
|
|
Smn1 gen nown famil seq vrnt
|
$961.43 |
$961.43 |
$961.43 |
|
|
Smpd1 gene common variants
|
$1,664.14 |
$1,664.14 |
$1,664.14 |
|
|
Snrpn/ube3a gene
|
$1,718.84 |
$1,718.84 |
$1,718.84 |
|
|
Sock fracture or equal each
|
$74.51 |
$74.51 |
$74.51 |
|
|
Sodium 24 hour urine
|
$24.00 |
$62.40 |
$109.80 |
|
|
Sodium chloride 0.9 % intravenous solution
|
$49.07 |
$49.32 |
$103.80 |
|
|
Sodium chloride 0.9 % IV bolus
|
$39.81 |
$66.00 |
$79.09 |
|
|
Sodium chloride 0.9 % IV bolus
|
$49.00 |
$79.66 |
$80.48 |
|
|
Sodium chloride 3 % ivpb
|
$62.00 |
$79.30 |
$79.30 |
|
|
Sodium ferric gluconate complex in sucrose 62.5 mg/5 ml intravenous
|
$45.14 |
$104.98 |
$330.08 |
|
|
Sodium hyaluronate 20 mg/2 ml syringe
|
$328.05 |
$1,063.10 |
$3,003.98 |
|
|
Sodium serum/plasma/whole blood
|
$28.62 |
$57.60 |
$90.60 |
|
|
Sodium thiosulfate 12.5 gram/50 ml (250 mg/ml) intravenous solution
|
$8.34 |
$537.10 |
$537.10 |
|
|
So neo gsap dna/dna&rna
|
$9,855.00 |
$9,855.00 |
$9,855.00 |
|
|
Special casting material
|
$0.60 |
$0.60 |
$0.60 |
|
|
Special physics consult
|
$868.20 |
$1,111.00 |
$3,125.87 |
|
|
Special radiation dosimetry
|
$188.00 |
$676.80 |
$1,682.12 |
|
|
Special radiation treatment
|
$1,523.75 |
$2,726.50 |
$6,807.38 |
|
|
Special teletx port plan
|
$539.88 |
$1,456.80 |
$4,807.98 |
|
|
Specific gravity body fluid
|
$3.00 |
$11.40 |
$115.36 |
|
|
Specimen fat stain
|
$53.64 |
$126.00 |
$126.60 |
|
|
Speech and Language Evaluation (comprehensive)
|
$204.00 |
$264.00 |
$824.80 |
|
|
Speech audiometry complete
|
$90.00 |
$198.00 |
$204.50 |
|
|
Speech evaluation complex
|
$315.00 |
$485.40 |
$786.00 |
|
|
Speech recep thresh
|
$44.40 |
$90.60 |
$139.00 |
|
|
Speech Therapy Session (one-on-one)
|
$148.80 |
$220.50 |
$643.69 |
|
|
Sperm antibody test
|
$124.73 |
$124.73 |
$459.60 |
|
|
Spinal puncture lumbar diagnostic w/fluoroscopic or CT guidance
|
$867.50 |
$1,654.20 |
$1,974.00 |
|
|
Spine X-ray (single view, one level)
|
$128.00 |
$171.60 |
$599.46 |
|
|
Spleen imaging
|
$2,472.19 |
$2,472.19 |
$2,472.19 |
|
