|
Sodium thiosulfate 12.5 gram/50 ml (250 mg/ml) intravenous solution
|
$170.35 |
$170.35 |
$170.35 |
$177.52
|
|
Spacer bag/reservoir
|
$6.00 |
$6.00 |
$6.60 |
$26.00
|
|
Special casting material
|
$34.80 |
$34.80 |
$36.60 |
$47.45
|
|
Special physics consult
|
$436.80 |
$436.80 |
$477.00 |
$725.00
|
|
Special radiation dosimetry
|
$249.00 |
$249.00 |
$272.40 |
$392.73
|
|
Special radiation treatment
|
$1,415.40 |
$1,415.40 |
$1,545.60 |
$2,052.00
|
|
Special supplies phys/qhp
|
$98.40 |
$98.40 |
$103.80 |
$60.00
|
|
Special teletx port plan
|
$490.80 |
$490.80 |
$536.40 |
$1,100.00
|
|
Specific gravity body fluid
|
$30.60 |
$30.60 |
$34.20 |
$22.00
|
|
Speech and Language Evaluation (comprehensive)
|
$342.60 |
$342.60 |
$381.60 |
$385.00
|
|
Speech audiometry complete
|
$20.40 |
$20.40 |
$22.80 |
$109.20
|
|
Speech recep thresh
|
$39.60 |
$39.60 |
$41.40 |
$82.88
|
|
Speech Therapy Session (one-on-one)
|
$265.20 |
$265.20 |
$295.80 |
$248.84
|
|
Sperm antibody test
|
$142.20 |
$142.20 |
$158.40 |
$57.85
|
|
Sperm washing 58323
|
$37.80 |
$37.80 |
$39.60 |
$238.06
|
|
Sphincteroplasty inc/prolapse adult 46750
|
$1,386.60 |
$1,386.60 |
$1,456.20 |
$3,245.23
|
|
Spinal bone allograftstructural 20931
|
$231.60 |
$231.60 |
$243.00 |
$266.40
|
|
Spinal bone autograftlocal 20936
|
$403.80 |
$403.80 |
$424.20 |
$424.20
|
|
Spinal puncture lumbar diagnostic w/fluoroscopic or CT guidance
|
$855.00 |
$855.00 |
$1,032.60 |
$1,474.00
|
|
Spine X-ray (single view, one level)
|
$135.60 |
$135.60 |
$148.20 |
$251.40
|
|
Splenectomy total open 38100
|
$2,062.80 |
$2,062.80 |
$2,166.00 |
$2,166.00
|
|
Splint arm vnyl coated padded lft med
|
$45.60 |
$45.60 |
$48.00 |
$48.00
|
|
Splint extn xsm w sof-stretch rolyan
|
$36.00 |
$36.00 |
$36.00 |
$68.25
|
|
Splint finger 4 prong foam sm
|
$16.20 |
$16.20 |
$16.80 |
$34.00
|
|
Splint finger frog med
|
$3.00 |
$3.00 |
$3.00 |
$38.08
|
|
Splint fing stax assort 1-7in
|
$3.60 |
$3.60 |
$3.60 |
$5.60
|
|
Splint func pos polyflex ii med
|
$4.80 |
$4.80 |
$4.80 |
$61.64
|
|
Splint rstrc wrst/cmc right med
|
$15.60 |
$15.60 |
$16.20 |
$100.00
|
|
Split atogrft f/s/n/h/f/g/m/d gt 1st 100sqcm/</1 %
|
$1,573.20 |
$1,573.20 |
$1,651.80 |
$4,687.20
|
|
Split blood or products
|
$28.80 |
$28.80 |
$32.40 |
$129.50
|
|
Spontaneous nystagmus study
|
$49.80 |
$49.80 |
$52.20 |
$130.65
|
|
Sr-89 stront chlor ther / mci
|
$767.40 |
$767.40 |
$805.80 |
$2,515.15
|
|
Srs linear based
|
$6,634.80 |
$6,634.80 |
$7,717.80 |
$14,124.25
|
|
Staging lapro hodgkins disease/lymphoma 49220
|
$1,739.40 |
$1,739.40 |
$1,826.40 |
$1,826.40
|
|
St analysis behavior qualitative voice/resonance
|
$202.80 |
$202.80 |
$225.60 |
$297.68
|
|
St cognitve performance testing healthcare professional each hour
|
$67.80 |
$67.80 |
$78.60 |
$286.00
|
|
Stenger test pure tone
|
$38.40 |
$38.40 |
$43.20 |
$77.84
|
|
Stent/athrectomy/fem/pop/unilat 37227
|
$21,216.00 |
$21,216.00 |
$23,614.20 |
$21,626.50
|
|
Stent axios caut enh 15x10mm electrocaut
|
$14,157.00 |
$14,157.00 |
$14,157.00 |
$32,403.15
|
|
Stent bili dbl pgtl 10fx5cm
|
$691.20 |
$691.20 |
$691.20 |
$2,649.79
|
|
Stent bili rx wallflx 10x80 uncvr
|
$5,614.20 |
$5,614.20 |
$11,238.60 |
$20,962.50
|
|
Stent iliac/open or perc/uni/init 37221
|
$14,005.20 |
$14,005.20 |
$15,588.60 |
$14,356.50
|
|
Stent iliac/open/perc/ea ad/ipsila 37223
|
$8,039.40 |
$8,039.40 |
$8,948.40 |
$8,985.00
|
|
Stent placemt retro carotid
|
$1,645.20 |
$1,645.20 |
$1,645.20 |
$5,328.00
|
|
Stent/tib/peroneal/unilat/initial 37230
|
$18,950.40 |
$18,950.40 |
$21,091.80 |
$17,271.50
|
|
Stereotactic bx aspir/exc burr intracranial les 61750
|
$2,464.80 |
$2,464.80 |
$2,587.80 |
$3,308.00
|
|
Sternal debridement
|
$998.40 |
$998.40 |
$1,048.20 |
$1,318.40
|
|
St evaluate speech sound production
|
$202.80 |
$202.80 |
$225.60 |
$293.00
|
|
St evaluation motion fluoroscopic swallow function cine/video
|
$211.80 |
$211.80 |
$244.80 |
$400.00
|
|
Stomach Emptying Scan (Nuclear Medicine)
|
$819.60 |
$819.60 |
$895.80 |
$1,345.40
|
|
Stot/tot hysterectomy after cesaren delivery 59525
|
$952.80 |
$952.80 |
$1,000.20 |
$2,723.50
|
|
Strapping of ankle and/or ft 29540
|
$67.20 |
$67.20 |
$70.80 |
$223.45
|
|
Strapping of elbow or wrist 29260
|
$94.20 |
$94.20 |
$99.00 |
$157.46
|
|
Strapping of toes 29550
|
$57.00 |
$57.00 |
$60.00 |
$164.70
|
|
Strep a ag ia
|
$42.00 |
$42.00 |
$46.80 |
$75.40
|
|
Strep b dna amp probe
|
$78.60 |
$78.60 |
$87.60 |
$124.15
|
|
Streptokinase 1.5 m-units inj
|
$917.47 |
$917.47 |
$917.47 |
$917.47
|
|
Streptomycin injection
|
$150.80 |
$150.80 |
$150.80 |
$138.30
|
|
Streptozocin injection
|
$270.37 |
$270.37 |
$270.37 |
$785.95
|
|
Stress test pulmonary
|
$73.20 |
$73.20 |
$109.80 |
$324.00
|
|
Subdural tap fontanelle/sutur infant init 61000
|
$204.00 |
$204.00 |
$214.20 |
$878.24
|
|
Subq i/p critical care pr day age 28 days/less than 99469
|
$802.20 |
$802.20 |
$842.40 |
$717.60
|
|
Subsequent intensive care infant 1500-2500 grams 99479
|
$245.40 |
$245.40 |
$257.40 |
$224.80
|
|
Subsequent intensive care infant 2501-5000 grams 99480
|
$231.00 |
$231.00 |
$242.40 |
$216.00
|
|
Succinylcholine chloride 20 mg/ml injection solution (wrapper)
|
$46.73 |
$46.73 |
$46.73 |
$54.80
|
|
Suction lipectomy head&neck
|
$1,147.20 |
$1,147.20 |
$1,147.20 |
$4,332.25
|
|
Suction lipectomy lwr extrem
|
$1,029.60 |
$1,029.60 |
$1,081.20 |
$5,661.00
|
|
Suction lipectomy trunk
|
$1,029.60 |
$1,029.60 |
$1,081.20 |
$4,385.50
|
|
Suction lipectomy upr extrem
|
$477.60 |
$477.60 |
$477.60 |
$4,544.00
|
|
Sugars single quant
|
$374.40 |
$374.40 |
$393.60 |
$64.28
|
|
Sulbactam 1 gram-durlobactam 1 gram (0.5 gram x2) intravenous solution
|
$3,129.21 |
$3,129.21 |
$4,374.50 |
$7,345.98
|
|
Sulfamethoxazole 400 mg-trimethoprim 80 mg/5 ml intravenous solution
|
$96.23 |
$96.23 |
$96.23 |
$82.46
|
|
Sulfonylurea screen qn-sendout
|
$192.00 |
$192.00 |
$213.60 |
$160.05
|
|
Sumatriptan 6 mg/0.5 ml subcutaneous solution
|
$359.84 |
$359.84 |
$359.84 |
$126.63
|
|
Sup of prep of antigen # of vials 95144
|
$22.80 |
$22.80 |
$24.00 |
$54.60
|
|
Support clav 29.6-40.5in med
|
$70.80 |
$70.80 |
$86.40 |
$94.08
|
|
Surg dx exam anorectal
|
$195.00 |
$195.00 |
$204.60 |
$3,480.50
|
|
Surg ect salp-oophorectomy 59120
|
$1,554.60 |
$1,554.60 |
$1,632.60 |
$1,632.60
|
|
Surg ect without salp-oophorectomy 59121
|
$1,556.40 |
$1,556.40 |
$1,634.40 |
$1,634.40
|
|
Surgical exposure prostate 55860
|
$1,561.80 |
$1,561.80 |
$1,639.80 |
$5,626.86
|
|
Surgical opening of stomach 43500
|
$1,407.60 |
$1,407.60 |
$1,477.80 |
$1,477.80
|
|
Surgical pathology level 1 gross examination only
|
$33.60 |
$33.60 |
$37.20 |
$80.60
|
|
Surgical pathology level 2 gross & microscopic examination
|
$66.60 |
$66.60 |
$74.40 |
$141.94
|
|
Surgical pathology level 3 gross & microscopic examination
|
$70.80 |
$70.80 |
$79.20 |
$181.31
|
|
Surgical pathology level 4 gross & microscopic examination
|
$79.20 |
$79.20 |
$88.20 |
$243.10
|
|
Surgical pathology level 5 gross & microscopic examination
|
$98.40 |
$98.40 |
$109.80 |
$480.60
|
|
Surgical pathology level 6 gross & microscopic examination
|
$138.00 |
$138.00 |
$154.20 |
$720.75
|
|
Surgical repair stomach bleedin ulcer 43501
|
$2,415.60 |
$2,415.60 |
$2,536.20 |
$2,415.60
|
|
Surgical repair stomach gastric lac 43502
|
$2,728.20 |
$2,728.20 |
$2,864.40 |
$2,864.40
|
|
Surg tx anal fistula 2nd stage 46285
|
$969.00 |
$969.00 |
$1,017.60 |
$3,245.23
|
|
Susceptibility agar dilution per agent
|
$35.40 |
$35.40 |
$40.20 |
$45.00
|
|
Susceptibility enzyme detection per enzyme
|
$57.60 |
$57.60 |
$64.80 |
$35.70
|
|
Susceptibility mic per plate
|
$184.80 |
$184.80 |
$194.40 |
$104.80
|
|
Suscept studies macrobroth dilution ea
|
$370.80 |
$370.80 |
$389.40 |
$59.28
|
|
Suspension of uterus 58400
|
$816.00 |
$816.00 |
$856.80 |
$856.80
|
|
Sutr lg intestine 1/mult perf without colostomy 44604
|
$1,900.20 |
$1,900.20 |
$1,995.00 |
$1,995.00
|
|
Suture bile duct injury 47900
|
$2,437.80 |
$2,437.80 |
$2,559.60 |
$2,559.60
|
|
Svc venogram s&i
|
$1,563.60 |
$1,563.60 |
$1,707.60 |
$1,994.00
|
|
Swallowing Evaluation (Bedside)
|
$216.00 |
$216.00 |
$249.60 |
$316.80
|
|
Swallowing Therapy Session
|
$186.00 |
$186.00 |
$207.60 |
$240.50
|